Grand Junction · Higher-income Medicare

Do You Pay IRMAA on a Medicare Advantage Plan in 2027?

Yes. The income surcharge is attached to Part B and to Part D, and a Medicare Advantage plan is built on both. Choosing a plan with a $0 premium does not remove it, and neither does a Part B giveback. What your choice of plan can change is smaller than most people hope and worth knowing before October 15 to December 7. Here are the amounts, who collects them, and what happens if the bill goes unpaid.

Medicare On Main Data Desk

Published September 29, 2026 · 9 min read · Reviewed by Brian Penner, 22+ years in Medicare

This question comes up every October, usually after a $0 premium plan arrives in the mail at a house that is paying several hundred dollars a month for Part B. The hope is that moving from Original Medicare into a Medicare Advantage plan leaves the surcharge behind. It does not, because the surcharge was never attached to Original Medicare in the first place. It is attached to two premiums: the one for Part B and the one for Part D.

A Medicare Advantage plan needs the first and usually includes the second. Medicare.gov's costs page says of Advantage plans, "You must have Part B and keep paying your Part B premium to stay in your plan." And the 2027 Medicare & You handbook, after describing the Part D surcharge, adds one sentence for exactly this reader: "You'll also have to pay this extra amount if you're in a Medicare Advantage Plan that includes drug coverage."

In Mesa County that describes a large group. Of the county's 41,709 Medicare beneficiaries in June 2026, 17,134 were in a Medicare Advantage plan with drug coverage and 15,944 were in a stand-alone Part D plan, according to the CMS monthly enrollment file. CMS says the surcharge reaches "roughly 8% of people with Medicare Part B" nationally. For anyone in that 8%, the rule is the same in either group.

What IRMAA costs on a Medicare Advantage plan with drug coverage

These are the 2026 amounts CMS published, based on 2024 income. Each figure is per person, so a married couple on a joint return who are both on Medicare pay it twice.

Source: CMS — 2026 Medicare Parts A & B Premiums and Deductibles / Part D Income-Related Monthly Adjustment Amounts. Surcharges are in addition to the standard $202.90 Part B premium and to any premium the plan itself charges. Married people who file separately fall under a different, steeper table.

The plan you choose appears nowhere in that table. Income sets the row, and the only column a plan can remove is the Part D one, by not including drug coverage at all.

Why a $0 premium plan still comes with a surcharge

A plan's premium is what the plan charges you. IRMAA is what the government charges you, and the two never meet. CMS's 2027 enrollment guidance defines Part D IRMAA as "a premium amount separate from the Part D plan's monthly premium" and says that people who owe it "must pay this additional premium directly to the government, not to the plan." The CMS fact sheet describes the collection the same way: "regardless of how a beneficiary pays their Part D premium, the Part D income-related monthly adjustment amounts are deducted from Social Security benefit checks or paid directly to Medicare."

That is why no plan brochure mentions it. The plan does not set it, collect it or know about it until Medicare tells the plan that someone has stopped paying. A $0 plan premium is in addition to the Part B premium, and for a higher-income household the Part B premium is the larger number by a wide margin. A single filer in the first tier pays $284.10 a month for Part B in 2026, plus $14.50 for Part D, whichever plan card is in the wallet.

Arithmetic on the amounts in the CMS 2026 fact sheet; 2027 threshold from Medicare & You 2027, page 86.

Which surcharge goes with which kind of coverage

Sources: 20 CFR § 418.2001, which lists "Medicare prescription drug plans, Medicare Advantage plans with prescription drug coverage, Programs of All-Inclusive Care for the Elderly plans, and cost plans offering prescription drug coverage"; Medicare & You 2027, page 86.

The last row catches people by surprise. If your Medicare Advantage plan comes through a former employer or a public retirement system, the group may pay some or all of the plan premium. The surcharge still comes to you. The handbook: "You'll pay Part D IRMAA payments separately, even if your employer or another third party (like a retirement system) pays your plan premiums." That applies to the PERA retirees we talk with in Grand Junction as much as to anyone. We are not affiliated with PERA and do not sell PERACare; questions about that coverage go to PERA.

Can I skip the Part D surcharge by skipping drug coverage?

It works on paper. An Advantage plan without drug coverage, or Original Medicare without a Part D plan, carries no Part D premium for the surcharge to attach to. Whether it is wise depends on one thing: whether you have other drug coverage that Medicare counts as creditable.

Veterans who fill prescriptions through the VA are the clearest case, and we cover that in the VA and Medicare post. For them an Advantage plan without drug coverage is an ordinary choice, and the Part B surcharge is the only one they owe.

For everyone else the numbers argue against it. The first-tier Part D surcharge is $14.50 a month. Against that, Medicare.gov describes the penalty for going without: "You'll pay an extra 1% for each month you could have signed up for Part D, but didn't, and didn't have creditable drug coverage." The penalty is added to the premium for as long as you have drug coverage, and in the meantime a new prescription is paid for out of pocket with no $2,100 cap behind it. Saving $174.00 a year that way is a small gain set against an open-ended risk.

Does a Part B giveback lower IRMAA?

No. Some Advantage plans use part of their federal rebate to reduce the member's Part B premium, and the regulation that permits it, 42 CFR § 422.266(b)(3), measures that reduction against the Part B premium "determined without regard to the application of subsections (b), (h), and (i) of section 1839 of the Act." Subsection (i) is the income-related premium. So a giveback can reduce what you pay toward the standard $202.90, and the surcharge stays where it was. We walk through the mechanics, and the fact that givebacks are not offered in every county, in the Part B giveback post.

What happens if the surcharge is not paid

For most people this never comes up, because the money is withheld from a Social Security deposit before they see it. It comes up for people who are 65 or older, on Medicare, and not yet drawing Social Security, which is common among higher earners who are delaying benefits to 70. They get a bill.

The Part B surcharge is part of the Part B premium, and Part B is a condition of being in an Advantage plan at all. The Part D surcharge has its own rule. 42 CFR § 423.293(d)(3): "CMS will terminate Part D coverage for any individual who fails to pay the Part D—IRMAA as determined by the Social Security Administration." Section 423.44(e) sets the clock: "the grace period ends with the last day of the third month after the billing month."

For an Advantage member the consequence is larger than the drug coverage. The enrollment guidance: "After the three-month grace period, individuals who fail to pay their Part D IRMAA will be disenrolled from their MA-PD or Part D plan by CMS." Its example is a member whose bill is due March 1, who ignores the notices through March, April and May, and is disenrolled June 1. Reinstatement is possible for good cause, "such as an extended period of hospitalization," if everything owed is paid within three months. The practical advice is simpler: if Medicare bills you, set up Medicare Easy Pay or pay through your Medicare account, and do not send the payment to the plan.

What we know about 2027 so far

Three things are published, and one is not.

• The first threshold. The 2027 handbook says "in 2027 it's $111,000 if you file individually or $222,000 if you're married and file jointly," compared with $109,000 and $218,000 for 2026.
• The tax year. Medicare uses the return "from 2 years ago," so 2027 premiums are judged on 2025 income, which is already filed.
• The Part D base premium. CMS set it at $41.33 for 2027, up from $38.99. We covered that announcement in the 2027 Part D premiums post.
• Not yet published: the full 2027 tier table and the official dollar surcharges. CMS released the 2026 amounts on November 14, 2025, so expect the 2027 ones in the same season.

The Part D piece can be estimated ahead of time, because its formula is in the regulation. 42 CFR § 423.286(d)(4)(ii) sets the adjustment as the base premium multiplied by the tier's premium percentage "reduced by 25.5 percent; divided by 25.5 percent." Run on the 2026 base of $38.99, that formula returns $14.50, $37.50, $60.40, $83.30, $91.00, which matches CMS's published 2026 table in every tier. Run on the 2027 base, it returns about $15.40 at the first tier and $96.40 at the top. That is our arithmetic and not a CMS announcement, so treat it as an estimate until the official table is out. For the Part B side, the Medicare Trustees' projections are in the 2027 Part B cost post.

What actually lowers it

Income does, and nothing about the plan. There are two routes, and they work on different years.

If your income has already dropped because of a life-changing event, such as retirement, the handbook points to SSA.gov/medicare/lower-irmaa, and Social Security can use a more recent year. The events and the form are in the SSA-44 appeal post; the federal rule is the same in Colorado. If your income has not dropped, the planning is about the return you are building now. What you report for 2026 sets the 2028 surcharge, and the posts on required minimum distributions, capital gains and Roth conversions each take one line of that return. Those are tax decisions, and they belong with your tax advisor.

What I would do

Take the surcharge out of the plan comparison. It is the same dollar amount beside every Advantage plan with drug coverage and beside Original Medicare with a Part D plan, so it cannot help you choose between them. Write it down once, as a fixed cost, and then compare the plans on what differs: the network, the out-of-pocket limit, the drug formulary and the plan's own premium.

Then check how you are paying it. If it is withheld from Social Security, there is nothing to do. If you are billed, put it on automatic payment before January, because a missed Part D surcharge can end an Advantage enrollment that you spent the fall choosing. In Mesa County, 26.6% of adults live with high blood pressure and 8.1% with diabetes, per CDC PLACES, and most of them fill a prescription every month. Losing that coverage over a bill of $14.50 is an avoidable mistake.

How we know all this: the Medicare On Main Data Desk frames every article with public data — here, the CMS fact sheet of November 14, 2025 for every 2026 Part B and Part D income-related amount and threshold; Medicare & You 2027 (pages 23, 24 and 86) for the 2027 first threshold, the Medicare Advantage sentence, how the surcharge is collected and the employer and retirement-system rule, quoted as published; Medicare.gov's costs pages; 20 CFR § 418.2001, 42 CFR §§ 423.286, 423.293, 423.44 and 422.266, quoted as published on Cornell LII; the CMS CY 2027 Enrollment and Disenrollment Guidance § 60.2.5; the CMS Medicare Monthly Enrollment file for Mesa County (June 2026); and CDC PLACES county data (2023). The 2027 Part D estimate is our own arithmetic on the published formula and is labeled as such. No 2027 plan, premium or carrier is named, because CMS has not released the 2027 landscape. This is education, not advice; take tax questions to your tax advisor, and confirm plans, costs and eligibility with a licensed agent or Medicare.gov. We take no payment from any carrier to feature a plan.