Medicare open enrollment starts October 15, 2025
If you’re planning to enrol in Medicare for 2026, mark your calendar: open enrolment starts October 15, 2025. This is the time when millions of Americans can review their health coverage, compare plans, and make changes for the coming year.
But wait, something you might not know — what you earned a year ago in 2024 can determine how much you’ll be paying for Medicare next year. The government looks two years in the rearview mirror to see if you’ll be paying more for a fee called the Income-Related Monthly Adjustment Amount, or IRMAA.
If you made more than some dollar amount in 2024, you might have IRMAA surcharges added to your base Medicare premiums — and they add up fast.
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How your income affects medicare fees
Most people are required to pay a base premium for Part B (medical) and Part D (prescription medication). But if you make over certain amounts, you’ll pay more in IRMAA.
Under the Medicare Trustees Report, premiums would jump to an astronomical 2026. The typical Part B premium would be a forecasted $206.50 a month, but higher-income beneficiaries could be charged hundreds more per month based on income.
2026 IRMAA values are:
- $109,001–$137,000 (single) or $218,001–$274,000 (joint) → Pay an extra $82.60 a month for medical and $14.50 extra for drugs.
- $137,001–$171,000 (single) or $274,001–$342,000 (joint) → Add $206.50 for medical and $37.50 for drugs.
- $171,001–$205,000 (single) or $342,001–$410,000 (joint) → Add $334.40 for medical and $60.40 for drugs.
- $205,001–$500,000 (single) or $410,001–$750,000 (joint) → Add $454.30 for medical and $78.60 for drugs.
- $500,001+ (single) or $750,001+ (joint) → Add $495.60 for health and $85.80 for drugs.
Though almost 8% of Medicare beneficiaries are now charged the surcharge, that number is growing. More than 8.6 million Americans will be paying IRMAA in 2034, the report projects.
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Why planning ahead is important
“Moral: Medicare premiums are deducted straight from Social Security, so it hurts when you see them increase,” said John Jones, a Heritage Financial financial planner. “Sometimes your entire Social Security raise is used immediately to cover Medicare.”
The tip is to anticipate ahead so you won’t be caught off guard when premiums are too expensive. Since IRMAA is a two-year lookback on income, what you earn today will be what you’ll be paying tomorrow.
Michael Chuah, Paxterra Law attorney, put it this way: “People need to plan. Because IRMAA has a two-year look back, what you do today affects what your premiums are tomorrow.”
Shining concepts to cut your future expenses
Financial advisors suggest some tricks to cut your income before signing up for Medicare:
Roth conversions consider converting funds from a pre-tax 401(k) or IRA into a Roth account, which taxes today but has no future taxable distributions. Roth distributions are not included when calculating IRMAA.
Have your required minimum distributions (RMDs) in view: At age 73, you’ll be forced to withdraw money from traditional retirement accounts — and it’s tax-deductible. Higher balance positions in Roths can help protect you from this.
Fill up your tax bracket: If you’re in the 22% tax bracket, you can “fill up” by contributing just enough to a Roth every year so that you stay in that bracket and don’t get into a higher bracket.
Nick Bour, CEO of Inspire Wealth, recommends put your money in accounts earlier: “Put as much of your savings as you can in Roth accounts before retirement. That leaves you free when you do have to worry about Medicare.”
Pay attention to this if You’re already near retirement
If you’re already in your 60s and haven’t saved, it’s not too late — but don’t delay. Experts recommend:
Working fewer hours or postponing major income events in the past two years until age 65 to maintain taxable income at a lower level.
Partial Roth conversions since your income has been comparatively lower.
Challenging your IRMAA if you have experienced a life-altering event such as marriage, divorce, loss of spouse, or a drastic income reduction.
Jones also said that an appeal is worth taking even after accumulating the blanket Roth conversions. “You can justify your high income level as a one-time thing, and at times Medicare will pay for the extra fees.”
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The bottom line
Medicare premiums rise steeply, especially for people with higher incomes. Knowing how your current income influences premiums in two years can save you hundreds — and even thousands — of dollars a year.
Because open enrolments for 2026 begin this October, this is the moment to review your income, tax strategy, and retirement needs. A little bit of planning now can mean more money in your pocket — and less worry — when it’s time to pay for your medical care.
