How IRMAA works
Social Security gets your modified adjusted gross income (MAGI) from the IRS: your adjusted gross income plus tax-exempt interest, generally from two years before the premium year. If it is above the first bracket line, you pay a higher Part B premium and a Part D surcharge on top of your drug plan's premium. There are five income brackets above the standard premium, and they work as cliffs: one dollar over a line moves you to the next amount for the whole year.
| 2024 MAGI, single | 2024 MAGI, joint | 2026 Part B (monthly) | Part D surcharge |
|---|---|---|---|
| $109,000 or less | $218,000 or less | $202.90 | None |
| $109,001 to $137,000 | $218,001 to $274,000 | $284.10 | $14.50 |
| $500,000 or more | $750,000 or more | $689.90 | $91 |
The full table, including the middle brackets and married filing separately, is on Medicare costs in 2026. The 2027 brackets, which will use 2025 income, hadn't been published as of November 13, 2026.
What pushes North Carolinians over the line
- Two pensions plus Social Security. Because most North Carolina public jobs are covered by Social Security, a retired couple can have two TSERS or LGERS pensions and two Social Security benefits, and the taxable part of all four counts toward the joint line.
- Retirement account withdrawals. Money taken from the NC 401(k), NC 457 or an IRA, including required minimum distributions and Roth conversions, is income in the year you take it, so a large withdrawal can trigger IRMAA two years later.
- One-time sales of a business, farmland, timber or a second home in the mountains or at the coast.
Your North Carolina return doesn't matter. Only your federal MAGI does.
What to do if you get an IRMAA notice
Social Security mails a notice explaining the amount and the income it used. If you retired, cut back work, lost a pension or your spouse died, file Form SSA-44 to ask Social Security to use a newer, lower year; see how to lower IRMAA after you retire. If you don't get Social Security yet, Medicare bills the Part B IRMAA every 3 months and the Part D IRMAA monthly; pay them on time, because unpaid premiums can end your coverage. Estimate your amount with the IRMAA calculator. For questions about plan choices at your income, you can request a call from a licensed insurance agent.
Related questions
How do I lower IRMAA after I retire?
Form SSA-44, step by step.
How much is Part B in 2027?
Where the 2027 amounts stand.
What does Medicare cost per month in North Carolina?
All the monthly pieces.
Sources
- Social Security — Premiums: rules for higher-income beneficiaries
- CMS — 2026 Medicare Parts A & B premiums and deductibles (IRMAA tables)
- Social Security POMS HI 01101.010 — MAGI and the tax year used
- Medicare.gov — Pay Medicare premiums (IRMAA bills)
- State Health Plan — 2027 plan comparison, Medicare-primary subscribers (group Medicare Advantage with Part D)
- NC Department of State Treasurer — NC 401(k) and NC 457 plans
- Congressional Research Service — Social Security Coverage of State and Local Government Employees (R46961)
More questions in this guide
- Do I have to pay a premium for Medicare Part A?
- How do I lower my IRMAA after I retire?
- How much does Medicare cost per month in North Carolina?
- How much is Medicare Part B in 2027?
Part of the guide: Medicare costs in 2026 for North Carolinians · All questions
Frequently asked questions
Does my North Carolina state tax return affect IRMAA?
No. Social Security uses only the income the IRS reports from your federal return. Deductions or exclusions on your North Carolina return don't change it.
Do I pay the Part D IRMAA if my drug coverage comes from the State Health Plan?
Yes, if your income is over the line. The State Health Plan's group Medicare Advantage Base Plan and Enhanced Plan include group Part D coverage, and the Part D IRMAA applies to any Part D plan, including employer and retiree group plans. It's billed by Medicare or taken from your Social Security, not paid to the Plan.
Is IRMAA permanent?
No. Social Security looks at your income again every year. If your income falls, your IRMAA falls or ends, usually two years later, or sooner if you report a life-changing event on Form SSA-44.
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