Medicare Part D

2026 Medicare surcharge thresholds for Knoxville retirees

KNOXVILLE — As Medicare's fall Annual Enrollment Period runs through Dec. 7, one detail catches many East Tennessee retirees by surprise each year: your income from two years ago can quietly raise what you pay for Part B and Part D in 2027.

Higher earners in Knoxville face bigger Medicare bills in 2027

That extra charge is called IRMAA — the Income-Related Monthly Adjustment Amount. It is not a penalty, and it is not tied to any particular plan. It is an add-on the Social Security Administration applies when your income crosses certain lines. If you are new to Medicare, or if your income changed recently, this is the part of the program worth understanding before you sign anything.

What IRMAA is, in plain English

Most people on Medicare pay the standard Part B premium and whatever premium their Part D drug plan charges. But if your income is above a set threshold, Medicare adds a surcharge on top of both.

For 2026, IRMAA begins above $109,000 in income for a single filer (and above roughly double that for a married couple filing jointly). The higher your income, the higher the surcharge tier. There are five brackets, and the top one applies to the highest earners.

Two important points:

• The surcharge is billed by Social Security, not by your insurance company.
• It applies whether you have Original Medicare, a Medicare Advantage plan, or a stand-alone Part D drug plan.

Which year's income counts

This is where a lot of Knoxville readers get tripped up. Medicare uses your modified adjusted gross income (MAGI) from two years ago to set the current year's surcharge. So your 2027 IRMAA is based on your 2025 tax return.

That two-year lookback is why a one-time event — selling a house, cashing out an old investment, taking a large IRA withdrawal — can push you into IRMAA territory long after the money has been spent.

What to do if your income has dropped

If you had a "life-changing event" that lowered your income, you can ask Social Security to use more recent numbers instead of the two-year-old return. Qualifying events include:

• Retirement or reduced work hours
• Marriage, divorce, or the death of a spouse
• Loss of pension income
• Loss of income-producing property (through disaster or other reasons)

You file Form SSA-44 with documentation. If approved, Social Security recalculates your surcharge. This is one of the most under-used tools in Medicare, and it is worth knowing about if your paycheck days are behind you.

How this fits with other 2027 Medicare changes

IRMAA is not the only number worth watching this fall. A few program-level facts for 2027:

• Part D has a hard $2,400 out-of-pocket cap on covered drugs in 2027 (up from $2,100 in 2026).
• The Part D maximum deductible is $700 in 2027 (up from $615 in 2026).
• The old "donut hole" coverage gap is gone — Part D now has three phases.
• The Medicare Prescription Payment Plan lets you spread drug costs across the calendar year in monthly installments instead of paying a large amount at the pharmacy counter.

None of these change based on your income. But if IRMAA applies to you, your Part D total cost still includes both your plan's premium and the surcharge Social Security adds.

Where Knoxville residents can get help

Knoxville is in Knox County, where a range of Medicare Advantage and stand-alone Part D options are available during Annual Enrollment. Comparing plans on your own is fine — but if IRMAA, tax planning, or a recent life change is part of your picture, get personalized help before you enroll.

• Medicare.gov — the official plan finder and program rules
• 1-800-MEDICARE (1-800-633-4227) — 24/7 phone help
• Tennessee SHIP (State Health Insurance Assistance Program) — free, unbiased local counseling for Medicare beneficiaries
• Social Security (ssa.gov or 1-800-772-1213) — for IRMAA questions and Form SSA-44