Three things determine what you'll actually pay: your 2024 modified adjusted gross income (which sets IRMAA in 2026 because of the two-year lookback), your coverage choice (Original Medicare with Medigap and Part D, or Medicare Advantage), and how much care you use. This guide shows the federal amounts for each income level. Plan premiums and copays vary by company, plan and ZIP code, so we don't estimate them here; see plans in your ZIP code for current amounts.
The income brackets that matter for IRMAA
| Single (2024 MAGI) | Joint (2024 MAGI) | 2026 monthly Part B | 2026 monthly Part D amount |
|---|---|---|---|
| Up to $109,000 | Up to $218,000 | $202.90 | None |
| $109,001–$137,000 | $218,001–$274,000 | $284.10 | +$14.50 |
| $137,001–$171,000 | $274,001–$342,000 | $405.80 | +$37.50 |
| $171,001–$205,000 | $342,001–$410,000 | $527.50 | +$60.40 |
| $205,001–$499,999 | $410,001–$749,999 | $649.20 | +$83.30 |
| $500,000 or more | $750,000 or more | $689.90 | +$91 |
The Part D amount is added to your drug plan's premium (or the drug part of a Medicare Advantage plan) and paid to Medicare. Full IRMAA explainer.
Income level 1: limited income
If your income is near the limits for Washington's help programs, they can cut your Medicare costs sharply:
- Medicare Savings Programs (MSPs) pay your Part B premium ($202.90 a month, $2,434.80 a year in 2026) for income up to 138% of the federal poverty level. QMB, up to 110%, also pays Medicare deductibles and coinsurance. Washington has no asset test for these programs.
- Extra Help (LIS) lowers Part D premiums, deductibles and copays for income up to $23,940 a year for one person or $32,460 for a couple in 2026, and comes automatically with an MSP.
- Apple Health (Medicaid), if you qualify, pays Medicare premiums and cost sharing and covers some services Medicare doesn't.
With QMB and Extra Help, what you pay for Medicare-covered care can drop to little more than small prescription copays. Apply through Washington Connection.
Income level 2: middle income (up to $109,000 single, $218,000 joint)
No IRMAA applies. You pay standard federal amounts plus whatever your plans charge.
| Cost component | 2026 amount |
|---|---|
| Part B premium ($202.90 a month) | $2,434.80 a year |
| Part B deductible | $283 |
| Part B coinsurance after the deductible (Original Medicare) | 20% of the Medicare-approved amount, with no yearly limit |
| Part A hospital deductible (Original Medicare) | $1,736 per benefit period |
| Medigap, Part D or Medicare Advantage plan premium | Set by each plan |
| Part D drug costs | Capped at $2,100 out of pocket |
| Medicare Advantage out-of-pocket limit for in-network Part A and B services | No more than $9,250 |
A Medigap policy can cover most of the Part A and Part B cost sharing in the table, in exchange for its premium. A Medicare Advantage plan replaces it with the plan's own copays, up to its out-of-pocket limit. See Original Medicare vs. Medicare Advantage in Washington.
Income level 3: IRMAA tier 1 ($109,001–$137,000 single, $218,001–$274,000 joint)
You pay an extra $81.20 a month for Part B and $14.50 a month for Part D. That's {{(irmaa.tiers.1.part_b - irmaa.tiers.0.part_b + irmaa.tiers.1.part_d_surcharge) * 12:.2f}} a year added per person in 2026.
This is where IRMAA "cliff" planning matters most. A single filer whose 2024 MAGI was $109,000 pays no IRMAA; at $109,001, the whole first-tier amount applies.
Income level 4: upper brackets ($137,001–$205,000 single, $274,001–$410,000 joint)
IRMAA tiers 2 and 3 add $202.90 to $324.60 a month to Part B, plus $37.50 to $60.40 a month for Part D: {{(irmaa.tiers.2.part_b - irmaa.tiers.0.part_b + irmaa.tiers.2.part_d_surcharge) * 12:.2f}} to {{(irmaa.tiers.3.part_b - irmaa.tiers.0.part_b + irmaa.tiers.3.part_d_surcharge) * 12:.2f}} a year per person.
At this income, the question is whether your 2024 income reflected a one-time event (a Roth conversion, capital gain or business sale) or your usual income. A one-time event alone doesn't qualify for Form SSA-44, but a life-changing event since then, such as retirement, may. If it's your usual income, IRMAA is part of your Medicare budget.
Income level 5: high income (above $205,000 single, $410,000 joint)
The top IRMAA tiers add $446.30 to $487 a month to Part B and $83.30 to $91 a month for Part D. That's {{(irmaa.tiers.4.part_b - irmaa.tiers.0.part_b + irmaa.tiers.4.part_d_surcharge) * 12:.2f}} to {{(irmaa.tiers.5.part_b - irmaa.tiers.0.part_b + irmaa.tiers.5.part_d_surcharge) * 12:.2f}} a year per person on top of standard Medicare costs.
For this group, tax planning (the timing of Roth conversions, capital gains and retirement-account withdrawals) affects Medicare premiums more than plan choice does.
How the amount of care you use changes the math
- A light year (an annual wellness visit, a few appointments, common medicines): you may not reach the Part B deductible, and you mostly pay premiums.
- A heavy year (surgery, a hospital stay, specialty drugs): with Original Medicare and Medigap Plan G, your costs for Medicare-covered services are generally limited to the Plan G premium plus the Part B deductible. With Medicare Advantage, your in-network costs for Part A and Part B services stop at the plan's out-of-pocket limit (no more than $9,250 in 2026). Either way, Part D drug costs stop at $2,100.
Washington-specific cost factors
- Medigap pricing. Washington law requires a Medigap company to charge everyone with the same standardized plan the same premium, rather than pricing by age, with limited exceptions such as spousal discounts and a separate rating pool for people with Medicare because of a disability or end-stage renal disease (RCW 48.66.045).
- Changing Medigap plans. Washington lets people who already have a Medigap policy replace it without health questions with a plan that has the same or fewer benefits, under the rules in RCW 48.66.045; Plan A can be replaced only with Plan A. See Medigap in Washington for the details and exceptions.
- Help with limited income. Washington's Medicare Savings Program limits (110%, 120% and 138% of the poverty level) are higher than the national ones, and there's no asset test.
- WA Cares Fund. If you're still working, 0.58% of your wages goes to WA Cares, Washington's long-term care benefit, which is separate from Medicare. See WA Cares Fund.
A licensed insurance agent with Benefits Life can explain how plans from the companies they work with fit your budget, at no cost to you. Call (206) SENIORS (206-736-4677), TTY 711.
Sources
- CMS — 2026 Medicare Parts A & B premiums and deductibles (IRMAA tables)
- Social Security — Premiums: rules for higher-income beneficiaries
- Social Security POMS HI 01101.010 — Modified adjusted gross income and the tax year used
- Medicare.gov — Medicare costs
- Washington Health Care Authority — Medicare Savings Program
- WAC 182-517-0100 — Medicare savings programs
- Medicare.gov — Help with drug costs (Extra Help)
- RCW 48.66.045 — Medicare supplement policies: replacement and premiums
- WA Cares Fund — How the fund works
Frequently asked questions
How much does Medicare cost in Washington if my income is below the IRMAA threshold?
Below $109,000 of 2024 income for a single filer, you pay the standard Part B premium of $202.90 a month ($2,434.80 a year) in 2026, plus the premium for any Medigap, Part D or Medicare Advantage plan you choose and your share of costs when you get care. Plan premiums vary by company, plan and ZIP code, so check the plans available to you.
What's the most expensive Medicare situation in Washington?
The highest costs come with the top IRMAA bracket ($500,000 or more single, $750,000 or more joint), where the 2026 Part B premium is $689.90 a month and Part D adds $91 a month, combined with a plan premium and heavy use of care or drugs. Part D out-of-pocket drug costs are capped at $2,100 in 2026.
Does my income affect what plan I should choose?
It can. With limited income, Apple Health, the Medicare Savings Programs and Extra Help can pay most Medicare costs, and some people with both Medicare and Apple Health consider a D-SNP. In the middle, the choice between Original Medicare with Medigap and Medicare Advantage often shapes your costs most. At high income, IRMAA adds the same amount whichever plan you choose, so doctors, drugs and coverage rules may matter more than premiums.
Can I lower my IRMAA bracket?
Sometimes. If you've had a life-changing event since your 2024 tax year (marriage, divorce, death of a spouse, work stoppage, work reduction, loss of income-producing property or certain pension income), you can ask Social Security to use a more recent year with Form SSA-44. One-time income such as a Roth conversion or stock sale doesn't qualify on its own.
Why is my 2026 IRMAA based on my 2024 income?
Social Security generally uses the most recent tax return the IRS gives it, which is from two years before. 2024 returns were used to set 2026 IRMAA, so income you have in 2026 will affect your Medicare premiums in 2028.
Medicare in your Washington county
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