Yes. IRMAA applies to both spouses on Medicare when a couple’s joint income crosses the threshold, and each enrolled spouse pays the full surcharge on their own Part B and Part D premiums. For 2026, the joint threshold is a combined modified adjusted gross income (MAGI) above $218,000 on the 2024 tax return.1Centers for Medicare & Medicaid Services. 2026 Medicare Parts A and B Premiums and Deductibles The surcharge is not split, halved, or prorated between spouses. If both of you are enrolled and the household lands in an IRMAA tier, both of you pay the tier’s full monthly amount.
Why Both Spouses Pay the Same Surcharge
The Social Security Administration sets each person’s IRMAA tier using the filing status and MAGI on the tax return it receives from the IRS. For 2026 coverage, that’s the 2024 return.2Medicare.gov. 2026 Medicare Costs When you file jointly, the combined MAGI on that single return governs both spouses. It doesn’t matter whether one spouse earned all of the income or the two of you split it evenly. If the joint figure exceeds the threshold, both enrolled spouses land in the same tier, and each pays the surcharge individually on top of the standard premium.
One consequence catches couples off guard: a spouse with no personal income of their own still pays the full surcharge if the household total triggers IRMAA. The charge attaches to the Medicare beneficiary, not to the earner.
What a Couple Actually Pays in 2026
The standard Medicare Part B premium for 2026 is $202.90 per month per person. The 2026 joint-filer MAGI brackets and per-spouse Part B totals are:1Centers for Medicare & Medicaid Services. 2026 Medicare Parts A and B Premiums and Deductibles
- $218,000 or less: no surcharge; $202.90 per spouse.
- $218,001 to $274,000: $81.20 surcharge; $284.10 per spouse.
- $274,001 to $342,000: $202.90 surcharge; $405.80 per spouse.
- $342,001 to $410,000: $324.60 surcharge; $527.50 per spouse.
- $410,001 to $749,999: $446.30 surcharge; $649.20 per spouse.
- $750,000 or more: $487.00 surcharge; $689.90 per spouse.
Every figure above is monthly and per spouse. Double it for the household bill when both are enrolled. A couple in the first IRMAA tier pays $568.20 combined for Part B, compared to $405.80 at the standard rate. At the top tier, the household Part B bill reaches $1,379.80 per month.
Part D Adds a Second Surcharge Each Spouse Pays
IRMAA also applies to Medicare prescription drug coverage. Each spouse enrolled in Part D pays the surcharge below on top of whatever the drug plan itself charges. For 2026 joint filers:1Centers for Medicare & Medicaid Services. 2026 Medicare Parts A and B Premiums and Deductibles
- $218,000 or less: $0.
- $218,001 to $274,000: $14.50.
- $274,001 to $342,000: $37.50.
- $342,001 to $410,000: $60.40.
- $410,001 to $749,999: $83.30.
- $750,000 or more: $91.00.
Stacked with Part B, a couple in the highest tier with both parts of coverage pays a combined $1,156.00 per month in IRMAA surcharges alone, before their actual drug plan premiums.
When Only One Spouse Is Enrolled Yet
The joint-income threshold still applies if you are 65 and enrolled while your spouse is younger and not yet eligible. SSA uses the filing status on the return, not whether both spouses happen to be Medicare beneficiaries.3Social Security Administration. POMS HI 01101.020 – IRMAA Sliding Scale Tables Your younger spouse’s salary, investment income, and other earnings all count toward the combined MAGI that places you in a tier. The difference is that only the enrolled spouse actually pays the surcharge. Once the younger spouse turns 65 and enrolls, they will pay the same tier’s surcharge based on whichever joint return SSA is using at that point.
Filing Separately Does Not Help
Married filing separately (MFS) is generally worse, not better, for IRMAA. SSA treats MFS filers as having lived together during the tax year by default, and the schedule collapses to two surcharge tiers that begin at a much lower income line. For 2026 Part B:1Centers for Medicare & Medicaid Services. 2026 Medicare Parts A and B Premiums and Deductibles
- $109,000 or less: no surcharge; $202.90.
- $109,001 to $390,999: $446.30 surcharge; $649.20.
- $391,000 or more: $487.00 surcharge; $689.90.
An MFS spouse with $110,000 of individual MAGI pays $649.20 for Part B. A joint-filing couple at $220,000 combined pays only $284.10 each. The structure exists specifically to prevent high-income couples from filing separately to game the thresholds.
There is one narrow exception. If you filed MFS but genuinely lived apart from your spouse for the entire tax year, you can call SSA at 1-800-772-1213 and ask that the single-filer table be used instead.4Social Security Administration. Form SSA-44 – Medicare Income-Related Monthly Adjustment Amount SSA requires an attestation under penalty of perjury that you lived apart all year, and the change applies only to the spouse who makes the attestation.5Social Security Administration. POMS HI 01120.060 – Married, Filing Separately – Lived Apart All Year
Life-Changing Events That Can Lower the Surcharge
Because IRMAA uses income from two years back, a couple whose situation has changed can ask SSA to recalculate using current-year projected income. That’s done on Form SSA-44, and it only works if the change resulted from one of seven qualifying life-changing events.4Social Security Administration. Form SSA-44 – Medicare Income-Related Monthly Adjustment Amount They are:
- Marriage.
- Divorce or annulment.
- Death of a spouse.
- Work stoppage or reduction of hours by you or your spouse.
- Loss of income-producing property from disaster, arson, fraud, or theft (not a voluntary sale).
- Loss of pension income from termination or reorganization of the employer’s plan.
- An employer settlement payment tied to bankruptcy or reorganization.
Two of these matter especially for couples because they change filing status. A newly widowed spouse who files as single the following year moves onto the single thresholds, and the loss of spousal income usually reduces MAGI as well. Filing the SSA-44 promptly after the death of a spouse can prevent months of overpaying at the joint-filer tier. Normal investment losses, a portfolio drop, or the end of a temporary high-paying job do not qualify. SSA is looking for discrete events, documented with an employer statement, retirement letter, corporate minutes, sale record, or signed attestation under penalty of perjury.6Social Security Administration. POMS HI 01120.030 – Life Changing Event (LCE) – Work Stoppage
If both spouses’ income events pushed you into a tier in the first place, plan the next couple of years together. A large required minimum distribution taken the same year one spouse sells appreciated property lands on a single joint return and can drive both of you into a higher tier two years later, whether or not you ever see that income again.