The income you report at 64 sets the premium you pay at 66
Medicare charges high earners more for identical coverage, and it decides how much using a tax return you filed two years ago. Social Security, meanwhile, pays spouses and survivors on rules built around a legal marriage date — which for a lot of LGBTQ+ couples arrived decades after the relationship did. Both are manageable. Both have to be handled years early.
Schedule a free intro callThe short version
- IRMAA is a cliff, not a ramp. One dollar over a threshold triggers the full surcharge for all twelve months — and it's billed per person, so a married couple pays it twice.
- Your 2026 premium was set by your 2024 tax return. Planning has to start around age 63, not at enrollment.
- At the top tier a couple pays $13,872 a year in surcharges alone, on top of the standard $202.90 Part B premium each.
- Roth conversions, QCDs, and the timing of a home or equity sale are the levers that actually move the number.
- Social Security spousal and survivor benefits run off your legal marriage date — which, for a lot of LGBTQ+ couples, is much later than the anniversary you celebrate.
2026 IRMAA brackets for Medicare Part B & Part D
Based on your filing status and modified adjusted gross income in tax year 2024. Premiums are per person, per month. The standard Part B premium is $202.90; the average Part D plan is about $38.99 before any surcharge.
| Individual return (2024 MAGI) | Joint return (2024 MAGI) | Married filing separately (2024 MAGI) | Part B total / mo | Part D surcharge / mo | Annual surcharge, couple |
|---|---|---|---|---|---|
| $109,000 or less | $218,000 or less | $109,000 or less | $202.90 | Plan premium only | — |
| Above $109,000 to $137,000 | Above $218,000 to $274,000 | N/A | $284.10incl. +$81.20 | Plan + $14.50 | $2,297 |
| Above $137,000 to $171,000 | Above $274,000 to $342,000 | N/A | $405.80incl. +$202.90 | Plan + $37.50 | $5,770 |
| Above $171,000 to $205,000 | Above $342,000 to $410,000 | N/A | $527.50incl. +$324.60 | Plan + $60.40 | $9,240 |
| Above $205,000 and less than $500,000 | Above $410,000 and less than $750,000 | Above $109,000 and less than $391,000 | $649.20incl. +$446.30 | Plan + $83.30 | $12,710 |
| $500,000 or more | $750,000 or more | $391,000 or more | $689.90incl. +$487.00 | Plan + $91.00 | $13,872 |
Source: Centers for Medicare & Medicaid Services, 2026 Medicare Parts A & B Premiums and Deductibles. Part D surcharges are added to whatever your plan charges. The couple column assumes both spouses are enrolled in Part B and Part D. Thresholds are indexed and change every year.
One dollar, twelve months, two people
IRMAA has no phase-in. You are either under the line or you owe the whole tier — and because it's billed per enrolled person, a married couple owes it twice.
$1,148
First tier, one person
MAGI just above $109,000 single or $218,000 joint
$2,297
First tier, a couple
Same coverage, two bills, one year
$13,872
Top tier, a couple
MAGI at or above $750,000 joint
Where this hits our clients hardest: two high earners, filing jointly, both enrolling in Medicare within a few years of each other. The joint thresholds are exactly double the single ones, so a dual-income household gets no relief from filing jointly — it just doubles the bill on the other side. Married filing separately is worse still: the surcharge starts at $109,000 and jumps straight to the second-highest tier.
Six perfectly reasonable decisions that cost a tier
None of these are mistakes. They're the ordinary moves of a household that did well. The mistake is making them in the wrong calendar year.
Selling the house you bought before the neighborhood turned
Gain above the $250,000 single / $500,000 married exclusion is MAGI. Couples who bought in West Hollywood, Capitol Hill, or the Castro in the nineties routinely clear the exclusion by several hundred thousand dollars — and unmarried co-owners only get one exclusion each on their own share.
One big Roth conversion instead of five small ones
Converting the whole traditional IRA in a single year is often the right instinct and the wrong schedule. A multi-year plan sized to bracket edges gets the same tax-free result without buying two years of surcharges.
Exercising options or unwinding concentrated stock
A decade of RSUs and ISOs at one employer becomes a single-year income event when you finally diversify. Splitting the unwind across tax years, and pairing gains with harvested losses, usually keeps you a tier lower.
Selling a practice, a book of business, or an LLC
One-time proceeds don't qualify for an SSA-44 appeal. Installment-sale treatment or shifting a closing date across December 31 can be worth thousands in premiums on top of the tax difference.
Starting a pension or annuity in the wrong year
New guaranteed income permanently raises the floor of your MAGI and eats the room you were using for conversions. Coordinate the start date with the rest of the withdrawal plan rather than defaulting to the earliest option.
Municipal bond interest you assumed was invisible
Tax-exempt interest is excluded from taxable income but added straight back for IRMAA. A muni-heavy portfolio can put you in a higher tier than your 1040 suggests.
Six levers, all of them pulled early
Because of the two-year lookback, the planning window for your first Medicare premium opens the year you turn 63. The goal isn't to dodge every tier — sometimes a surcharge is the correct price for a better lifetime outcome. The goal is to choose it on purpose.
Size Roth conversions to the bracket edge
Converting in your sixties lowers lifetime required minimum distributions — but the conversion is MAGI, and MAGI from 2024 set your 2026 premium. Convert up to the top of a tier, not through it.
Use the gap years between retiring and claiming
The window between your last paycheck and your first Social Security check is usually the lowest-MAGI stretch of your life. That's the room where conversions and gain harvesting are cheapest — and delaying Social Security widens it while also growing the survivor benefit.
Qualified charitable distributions, not donor-advised funds
From age 70½, giving directly from an IRA satisfies RMDs and never touches MAGI. A donor-advised fund contribution lowers taxable income but does nothing for IRMAA — a distinction that costs charitably minded retirees real money every year.
Draw from three buckets, not one
Blending withdrawals across traditional, Roth, and taxable accounts lets you hit the same spending number at a lower MAGI. Roth withdrawals and HSA reimbursements for qualified expenses don't count at all.
Sequence the one-time events
A house sale above the exclusion, an equity unwind, a business sale. Split across tax years, pair gains with harvested losses, or move a closing date across December 31 — each can be worth a full tier.
Remember it's two Medicare bills
IRMAA is assessed per enrolled person. A couple crossing a joint threshold pays the surcharge twice, which is why joint brackets bite harder than the numbers look.
Form SSA-44
If your income dropped because of a qualifying life-changing event, you don't have to wait two years for the premium to catch up. File Form SSA-44, document the event, and SSA will use your estimated current-year income instead. Retiring counts. A one-time capital gain does not.
- Marriage
- Divorce or annulment
- Death of a spouse
- You or your spouse stopped working
- You or your spouse reduced work hours
- Loss of income-producing property (not from a sale)
- Loss or reduction of a pension
- Employer settlement payment after closure or bankruptcy
The most common miss: retiring mid-year, paying a surcharge built on peak earning income, and never filing the one form that would have removed it. Note that marriage and divorce are both on the list — for couples who married later in life, the SSA-44 is sometimes available in the same year the marriage itself changes the thresholds.
Social Security and IRMAA, answered
Level Ground
The playing field isn't level — but level ground starts here.
- Why the financial playing field isn't level for LGBTQ+ families — and how to change that
- The legal and financial protections that put you on equal footing
- How to plan and budget for surrogacy, adoption, and the milestones that matter most
Join 350+ LGBTQ+ professionals taking control of their financial future.
This page is part of our wider guide to LGBTQ+ financial planning — how fee-only, fiduciary planning works for queer households, and which topic to start with.
Know which bracket you're headed for
The years between 60 and 70 are where claiming strategy and IRMAA management either compound in your favor or quietly cost you five figures. A free intro call is a good place to map it out.
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The rules that hinge on a marriage date
Same-sex spouses have had full Social Security rights since 2015. The problem is that the benefit formulas count from the legal marriage date, and for couples who were together twenty years before the law allowed a license, that date can be the difference between a benefit and nothing.
Spousal benefit: one year of marriage
A married spouse can claim up to 50% of the higher earner's full retirement age benefit, but generally only after the marriage has lasted at least one continuous year. Domestic partnerships and civil unions count only in the handful of states whose statutes carry inheritance rights — the rest of the time they buy you nothing at the Social Security window.
Survivor benefit: nine months
A surviving spouse steps up to 100% of the deceased spouse's benefit after nine months of marriage (waived for accidental death). Couples who married late because the law made them wait are the households most likely to trip this line, and it's the strongest argument for the higher earner delaying to 70.
Divorced-spouse benefit: ten years
Ten years or longer means you can claim on an ex-spouse's record without affecting their benefit and without their involvement. Couples who were together for decades but legally married only after 2015 often fall short of ten legal years — worth checking before a divorce is finalized.
Pre-Obergefell marriages can be backdated
SSA has honored earlier marriage dates and, following Ely v. Saul, paid survivor benefits to some partners who were legally barred from marrying before their partner died. If a claim was denied years ago, it's worth revisiting rather than assuming the answer is still no.
If you're not married, none of these apply. An unmarried partner receives no spousal or survivor benefit no matter how long you've been together — which makes the survivor gap a number you should measure rather than assume.