IRMAA for married couples

One income test, two premiums

For a joint return, Social Security looks at the couple's combined MAGI from the return two years earlier and compares it with the joint limits. The result applies to each spouse who is enrolled in Medicare. If both are enrolled, both pay the same tier. If only one is enrolled, only that spouse pays, but the test still uses the joint income, including the income of the spouse who is not yet on Medicare.

The joint limits are exactly twice the individual limits for the first four cliffs: $218,000, $274,000, $342,000 and $410,000 for 2026. The top tier starts at $750,000 instead of the $1,000,000 that doubling would give, so very high-income couples reach the top tier sooner than two single people would.

What each tier costs a couple

The table shows the yearly Part B premium plus the Part D surcharge for both spouses together, assuming both are on Medicare, using the 2026 amounts.

The first joint cliff costs a couple $2,296.80 a year: one dollar of MAGI over $218,000 doubles the cost of the first individual cliff because two premiums go up at once.

The married-filing-separately trap

It can look tempting for the higher-earning spouse to file separately so the other spouse's premium is based on a lower income. IRMAA is designed to stop that. If you are married, file separately and lived with your spouse at any time during the year, there are only three levels:

One dollar over $109,000 on a separate return jumps straight to what is tier four for everyone else. A spouse with $120,000 of their own income would pay $8,790 a year on a separate return, while the same couple filing jointly with, say, $200,000 combined would each pay the standard $2,434.80. Separate filing also costs many tax benefits. It can make sense for unrelated reasons, such as income-driven student loan payments or keeping liability separate, but rarely for IRMAA.

Couples who lived apart for the entire year and file separately are treated as individuals and use the regular individual table.

A worked example

Ana and Luis file jointly. Luis, 66, is on Medicare; Ana, 62, still works and earns $150,000. Luis's pension and Social Security bring their 2024 joint MAGI to $230,000. For 2026, only Luis pays IRMAA, in joint tier one: $3,583.20 for the year instead of $2,434.80, or $1,148.40 more. When Ana enrolls in Medicare at 65, she will pay the same tier as Luis if their joint MAGI is still above $218,000. Her final working years are therefore the years to watch; her salary at 63 and 64 sets her first two Medicare premiums.

If Ana retires at 64 and their joint MAGI falls to $140,000, the couple can file Form SSA-44 for the work stoppage instead of waiting two years for the lower income to show up.

Planning moves for couples

• Use the wider joint tiers while you have them. Roth conversions and planned gains are cheaper in IRMAA terms on a joint return than they will be for a surviving spouse on the individual limits.
• Coordinate both spouses' QCDs. Each spouse 70½ or older can make qualified charitable distributions from their own IRA; both lower the joint MAGI.
• Time retirements. Two retirements in different years can mean two separate drops in income; each one is a work stoppage for Form SSA-44.
• Plan for the survivor. Read IRMAA after the death of a spouse before deciding how much to keep in tax-deferred accounts.

Frequently asked questions

Sources

• CMS: 2026 Medicare Parts B premiums and deductibles
• Social Security: Premiums, rules for higher-income beneficiaries
• IRS Publication 501: Filing status

Related guides

• IRMAA after the death of a spouse
• What is IRMAA?
• Roth conversions and IRMAA