Medicare Part D
2027 Medicare IRMAA Brackets: San Antonio, TX
SAN ANTONIO — As Medicare's Annual Enrollment Period runs through Dec. 7, higher earners in Bexar County are getting a clearer picture of what they'll owe next year for Part B and Part D. The Income-Related Monthly Adjustment Amount, known as IRMAA, kicks in for 2026 when a single filer's modified adjusted gross income tops $109,000, or $218,000 for a married couple filing jointly. Above those lines, Medicare adds a surcharge on top of the standard Part B and Part D premiums.
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Key takeaways
- IRMAA surcharges for 2026 start when a single filer's income is above $109,000, or above $218,000 for married couples filing jointly, with the top tier applying at $500,000 for single filers and $750,000 for joint filers.
- IRMAA adds an extra charge on top of the standard Part B and Part D premiums, and it's usually taken out of your Social Security check rather than billed separately.
- If a life-changing event like retirement or the death of a spouse lowered your income, you can file form SSA-44 to ask Social Security to use more recent income instead of an older tax return.
- IRMAA is based on modified adjusted gross income, which includes tax-exempt interest, and it applies to Part D drug coverage even if you have a Medicare Advantage plan that includes drug benefits.
San Antonio retirees, take note: the 2027 IRMAA income brackets have not yet been released
If income-related surcharges could apply to you, the details below can help you prepare before your first 2027 Social Security statement arrives.
What IRMAA actually is
IRMAA is not a separate bill. It's an add-on to your Part B premium (which covers doctor visits and outpatient care) and your Part D premium (prescription drug coverage). Most people pay just the standard Part B amount. But if your income is above the threshold, Social Security tacks on an extra monthly charge that's usually deducted from your benefit check.
Two important things to understand:
- IRMAA uses old tax data. Your 2027 surcharge will be based on the tax return you filed in 2026 for tax year 2025.
- It's a cliff, not a slope. Go one dollar over a bracket and you jump to the next surcharge tier for the whole year.
The 2026 income brackets: what we know so far
The Social Security Administration sorts higher earners into five surcharge tiers. For 2026, the brackets begin at:
- Single filers: above $109,000
- Married filing jointly: above $218,000
- Married filing separately: a much lower threshold — surcharges begin just above $109,000
From there, the tiers step up at higher income levels, with the top bracket applying to single filers with income at or above $500,000 and joint filers at or above $750,000. The exact dollar surcharges for each tier are posted at Medicare.gov once finalized by CMS.
The Part B surcharge is a flat dollar amount added to the standard premium. The Part D surcharge is also a flat dollar amount, paid to Medicare — separate from whatever premium your drug plan charges.
Common mistakes to avoid
This is where many otherwise careful retirees get tripped up:
1. Assuming a one-time income spike is permanent. Sold a house in 2025? Took a large IRA withdrawal? That income will show up on your 2027 IRMAA determination — but only for that one year, unless it repeats. 2. Ignoring the appeal window. If you've had a "life-changing event" — retirement, the death of a spouse, divorce, loss of pension income — you can ask Social Security to use more recent income. The form is SSA-44. 3. Confusing MAGI with taxable income. IRMAA uses modified adjusted gross income, which adds back tax-exempt interest (like municipal bond income). Some households cross the threshold without realizing it. 4. Forgetting the Part D piece. Even if you're on a standalone drug plan or a Medicare Advantage plan that includes drug coverage, the Part D IRMAA still applies.
By the numbers
Medicare Part B premium, 2006–2026
The standard monthly Part B premium has climbed from $88.50 in 2006 to $202.90 in 2026. Hover any point for that year’s premium.
Source: CMS. Standard premium shown; in some hold-harmless years many existing enrollees paid less. Confirm at Medicare.gov.
By the numbers
How people get Medicare in Bexar County
(MA penetration in Bexar County)
MA penetration from CMS enrollment data; Medigap share is an estimate. U.S. average is about 54% Medicare Advantage. These are area-level figures, not plan-specific.
Other 2027 changes worth knowing
While you're reviewing your coverage during Annual Enrollment (Oct. 15 – Dec. 7, 2026), keep these program-wide figures in mind:
- Part D out-of-pocket cap: $2,100 in 2026 and $2,400 in 2027. Once your out-of-pocket drug spending hits that number, you pay nothing more for covered drugs the rest of the year.
- Part D maximum deductible: $615 in 2026 and $700 in 2027.
- The coverage gap (the old "donut hole") is gone as of 2025. Part D now has three phases: deductible, initial coverage, and catastrophic.
- Medicare Prescription Payment Plan. You can ask your drug plan to spread your out-of-pocket drug costs into level monthly payments across the year — helpful if a big pharmacy bill would otherwise land in January.
What San Antonio residents can do right now
San Antonio is in Bexar County, where Medicare beneficiaries have a wide range of Advantage and standalone Part D options to review this fall. IRMAA applies the same way regardless of which plan you choose — it's tied to your income, not your plan — but Annual Enrollment is still the right moment to make sure your coverage fits your prescriptions and providers for 2026.
If you think IRMAA may apply to you in 2027:
- Pull your 2024 tax return and check your MAGI.
- If a life-changing event has since reduced your income, download SSA-44 from ssa.gov.
- Call your local State Health Insurance Assistance Program (SHIP) — in Texas, that's the Health Information, Counseling and Advocacy Program (HICAP) — for free, unbiased help.
Higher-income surcharges
IRMAA income brackets (2026, most recent published)
If your income is above a threshold, you pay an income-related surcharge (IRMAA) on top of your Part B and Part D premiums. The table below shows the 2026 brackets; CMS publishes the 2027 brackets later in the fall, usually November. Your 2027 surcharge will be based on your 2025 tax return.
| Income — single filer | Income — married, joint | Part B monthly premium | Part D surcharge |
|---|---|---|---|
| $109,000 or less | $218,000 or less | $202.90 | Plan premium only |
| $109,001 – $137,000 | $218,001 – $274,000 | $284.10 | + $14.50 |
| $137,001 – $171,000 | $274,001 – $342,000 | $405.80 | + $37.40 |
| $171,001 – $205,000 | $342,001 – $410,000 | $527.50 | + $60.40 |
| $205,001 – $500,000 | $410,001 – $750,000 | $649.30 | + $83.30 |
| Above $500,000 | Above $750,000 | $689.90 | + $91.00 |
Standard Part B premium is $202.90/month. Part D surcharges are added to your drug plan’s premium. Married-filing-separately uses a different, compressed schedule. Confirm current amounts at Medicare.gov.
Try it
Find your 2026 Medicare premium
Most people pay the standard Part B premium. If your 2024 income was higher, an income-related surcharge (IRMAA) applies. Enter your details to see your bracket.
Surcharges are added to your premiums and based on your 2024 tax return. Married-filing-separately uses a different schedule. Confirm at Medicare.gov.
Try it
How the 2026 Part D drug cap works
Slide to your estimated yearly prescription costs and see how the new $2,100 out-of-pocket cap protects you. This illustrates the standard Part D benefit; your plan may structure costs differently.
Once your out-of-pocket spending on covered drugs reaches $2,100, you pay nothing more for the rest of 2026. Confirm details at Medicare.gov.
Good to know
Frequently asked questions
Q: I just retired. Will Medicare still charge me based on my old salary?
Q: Does IRMAA go away if my income drops?
Q: My spouse and I file jointly. Do we each pay IRMAA?
- CMS — Medicare costs & IRMAA (medicare.gov)
For personalized answers, contact Medicare.gov, 1-800-MEDICARE, or your local SHIP.