Do both spouses pay IRMAA?
Yes, whenever both are enrolled in Medicare. There is no household premium; Medicare prices each beneficiary on their own, so a married couple gets two premium bills and, above the thresholds, two surcharges. The tier itself comes from one shared number. A couple whose 2024 joint MAGI is above $218,000 both sit in 2026's first tier, and the pair of surcharges works out to 2 x ($81.20 + $14.50) x 12, or $2,296.80 for the year. A spouse who is not yet on Medicare owes no premium at all, but that spouse's income still counts, because the joint return cannot be split.
What if only one spouse is on Medicare?
Then only one surcharge exists, and the couple's whole income drives it. Premiums attach to enrollment, so a 62-year-old spouse still working owes Medicare nothing. Their salary, though, is folded into the couple's adjusted gross income, and AGI plus tax-exempt interest is the MAGI that Medicare reads (the MAGI page details which income items count). Single-earner couples learn this the hard way: a retired 66-year-old with modest personal income can land in a surcharge tier entirely on the strength of the younger spouse's paycheck. The 2026 test is the combined 2024 return against the joint thresholds, beginning above $218,000, regardless of whose name earned the dollars.
The bill also changes shape as the younger spouse ages in. Because a premium exists only where there is enrollment, that spouse feeds income into the tier calculation while owing nothing personally, and the household runs on one surcharge set by the whole return. That arrangement ends the month the second spouse's own Medicare begins. From then the same joint MAGI produces two surcharges instead of one, and the household outlay can roughly double with the income figure unchanged. A couple paying a single first-tier surcharge of $95.70 a month watches it become $191.40 a month once both cards are active, purely because a second enrollment now exists to be charged.
How much does IRMAA cost a couple in 2026?
| Joint MAGI (2024 return) | Monthly IRMAA per spouse (Part B + Part D) | Couple total per year |
|---|---|---|
| > $218,000 – ≤ $274,000 | $95.70 | $2,296.80 |
| > $274,000 – ≤ $342,000 | $240.40 | $5,769.60 |
| > $342,000 – ≤ $410,000 | $385.00 | $9,240.00 |
| > $410,000 – < $750,000 | $529.60 | $12,710.40 |
| ≥ $750,000 | $578.00 | $13,872.00 |
Computed from the CMS 2026 tables (announced November 14, 2025): each yearly figure is 2 x (Part B IRMAA + Part D IRMAA) x 12.
The middle of the table is where most surcharged couples actually land, so it is worth reading in dollars rather than leaving to the row. A joint 2024 MAGI in the second tier costs the pair $5,769.60 for the year; the third tier lifts that to $9,240.00, and the fourth to $12,710.40. Each of those totals is one person's monthly Part B and Part D surcharge, counted for two enrollees across twelve months, and every dollar of it lands on top of the two standard Part B premiums the couple already owes. A couple settled just inside the second tier pays $240.40 in surcharge per spouse each month, the identical amount a single filer at that tier would owe on their own return.
Two enrolled spouses, both parts, twelve months: the formula never gets more complicated than that. At the top, a couple with 2024 joint MAGI at or above $750,000 pays $13,872.00 a year in surcharges beyond the two standard premiums they already pay. The complete tables on the 2026 IRMAA brackets page carry per-person monthly detail for every tier, single filers included. Hand the IRMAA calculator a joint MAGI and it returns each spouse's tier along with the doubled couple figure.
Does each spouse get their own bill and their own appeal?
Both, and the paperwork does not merge. SSA issues a determination letter to each spouse individually, each with a separate 60-day window to seek reconsideration. When a life-changing event cuts the couple's income, retirement for instance, the joint MAGI estimate is identical on both requests, yet SSA still wants one filing per beneficiary; a single SSA-44 fixes a single spouse's surcharge. Collection is individual too: the surcharge comes out of each spouse's own Social Security payment, and a spouse not yet drawing benefits gets their own Medicare invoice instead. The IRMAA appeal page maps the correction grounds and the escalation steps.
Does filing separately split the bill?
No. Splitting the return does not split the surcharge, and for spouses who lived with each other at any time in the year it backfires badly: the separate-filer table has no in-between rows, so any 2024 MAGI above $109,000 is charged the fourth-tier rate of $446.30 a month on Part B from the first dollar over. Put in yearly terms the damage is steep: add the $83.30 Part D surcharge at that tier and each separate filer pays about $6,355.20 a year in IRMAA before either standard premium, and a couple who both enrolled pays that twice. One narrow condition escapes it: spouses who lived apart for the entire tax year are scored on the single-filer thresholds instead, evidenced by a "D" written beside line 5a of the return or a signed statement carrying the other spouse's last known address. The three-row table and the lived-apart exception live in the guide to IRMAA when filing separately.
Does a Medicare Advantage plan avoid IRMAA?
No. A Medicare Advantage plan, also called Part C, changes how Original Medicare's benefits are delivered, but it does not replace the Part B premium underneath, and IRMAA rides on that premium. An Advantage member keeps paying Part B every month, and the surcharge attached to Part B is charged on top exactly as it would be without the plan. A couple already above the thresholds owes the same two Part B surcharges whether their coverage runs through Original Medicare or an Advantage plan. Advantage enrollment in fact requires active Part B, so dropping the Part B premium to shed its surcharge is not a move a Part C member can make. The common assumption that Part C folds every Medicare cost into one plan premium does not hold for the surcharge.
Drug coverage works the same way. When an Advantage plan bundles in Part D benefits, the Part D IRMAA still applies, and Medicare collects it rather than the insurer. The plan bills its own premium; the government bills the Part D surcharge separately, so an Advantage couple pays the plan for coverage and pays Medicare for the surcharge. The plan choice changes who provides the coverage, not who owes the surcharge or its size. The tier still comes from the one joint 2024 return, and each spouse is billed on their own enrollment, the same two-bill pattern that governs Original Medicare.
Couple questions people ask
Do husband and wife both pay IRMAA?
Yes, once each, provided each has Medicare. Two enrollments mean two surcharges from one joint MAGI; one enrollment means one surcharge.
How is IRMAA calculated for married filing jointly?
From the joint return: line 11 plus line 2a gives the couple's MAGI, which is measured against the joint thresholds (starting above $218,000 of 2024 income for 2026). Every enrolled spouse is then charged that tier's amounts.
Per-beneficiary billing is built into CMS's own 2026 premium tables; the separate-determination and life-changing-event rules come from SSA POMS HI 01120.001 and HI 01120.005; the separate-filer tiers come from the same CMS fact sheet.