Medicare and IRMAA: Enrollment, Costs, and Income Surcharges

What changes when Medicare and IRMAA are planned with income — not guessed?

Before

• Part B timing and late penalties are unclear.
• IRMAA shows up as a surprise from income two years ago.
• Life changes (divorce, widowhood, retirement) are not mapped to premiums.

After

• You know when to enroll if you have work coverage.
• 2026 Part B and IRMAA context on this page guide the income talk.
• Life-change windows are used when the rules allow a fresh look.

What are the first steps?

Three months before you turn 65:

1. Decide whether you need Part B now or qualify to wait.
2. Check your 2024 tax return against the IRMAA lines.
3. Compare Medigap and Medicare Advantage plans.
4. Stop HSA contributions on time.
5. Book a free SHIP counseling session if you want a second opinion.

When should I sign up for Medicare?

Your initial enrollment period is seven months: the three months before the month you turn 65, that month, and the three months after.

If you or your spouse are still working and covered by that employer's plan, you may be able to wait without a penalty. Get it in writing from HR.

What does Medicare cost in 2026?

For Part B, the standard premium is $202.90 a month and the yearly deductible is $283 in 2026. Most people pay no Part A premium if they or a spouse worked about 10 years.

Part D drug plans, Medigap plans, and Medicare Advantage plans have their own costs.

What is IRMAA?

IRMAA is an extra charge on Part B and Part D for higher incomes. For 2026, it starts when 2024 modified adjusted gross income is above $109,000 single or $218,000 joint.

The first tier makes Part B $284.10 a month. The top tier is $689.90. It's based on your tax return from two years earlier.

Can I lower IRMAA after my husband dies or I retire?

Often, yes. Form SSA-44 lets you ask Social Security to use a newer, lower income after a life-changing event, such as a spouse's death, divorce, marriage, stopping or cutting back work, or losing pension income.

Send proof, like a death certificate or a letter from your employer.

How can planning keep me under an IRMAA line?

Watch what counts in your modified adjusted gross income: IRA withdrawals, Roth conversions, capital gains, and even tax-free interest. One big sale can push you up a tier for a year.

Spreading income over several years, or giving to charity straight from your IRA after 70½, can help.

Is there a penalty for signing up late?

Yes. The Part B late enrollment penalty adds 10% to your premium for each full 12-month period you could have had Part B but didn't (as of 2026). You pay it for as long as you have Part B. Part D has its own late penalty.

Should I choose Original Medicare or Medicare Advantage?

It's a trade-off. Original Medicare lets you see any doctor who takes Medicare. Add a Medigap plan and a Part D plan for fuller coverage. Medicare Advantage bundles coverage, often with lower premiums, but uses networks.

Your best time to buy Medigap is the six months starting when you're 65 and enrolled in Part B.

Can I keep putting money in my HSA?

No, not once Medicare starts. Stop HSA contributions before your Medicare coverage begins. If you sign up after 65, Part A can be backdated up to six months, so stop contributions six months before you apply.

You can still spend HSA money on qualified costs, including Medicare premiums.

Where can I get free Medicare help in Illinois?

The Illinois Senior Health Insurance Program, run by the Illinois Department on Aging, gives free, unbiased Medicare counseling. It's a good second opinion before you choose a plan.

Does Medicare cover dental, vision, and hearing?

Mostly no. Original Medicare doesn't cover most routine dental care, eye exams for glasses, or hearing aids.

Some Medicare Advantage plans add these benefits. If they matter to you, compare plans on that point and budget for them.

Do I need a Part D drug plan?

If you don't have other drug coverage that's at least as good as Medicare's, called creditable coverage, sign up for Part D when you're first eligible. Waiting can bring a late penalty that lasts as long as you have Part D.

Part D also has its own IRMAA charge for higher incomes. Compare plans every fall, because drug lists and prices change each year.

Education, not advice. Every family is different. Talk with your own tax, legal, and financial professionals before you act. Figures are 2026 amounts from the official sources below and can change.