LGBTQ+ Medicare IRMAA Premium Calculator 2026

Medicare charges higher premiums to high earners through a system called IRMAA (Income-Related Monthly Adjustment Amount). For LGBTQ+ households, the critical detail is this: domestic partners each file as single, so each person's IRMAA threshold is $109,000. Married same-sex couples filing jointly face a combined $218,000 threshold — effectively double. This can make a multi-thousand-dollar annual difference, but it cuts both ways depending on how income is split.

Why IRMAA hits LGBTQ+ households differently

IRMAA was designed as a surcharge on high earners enrolled in Medicare Parts B and D. The formula is straightforward: your Modified Adjusted Gross Income from two years prior determines which tier you're in, and that tier sets a surcharge added to the standard Part B premium ($202.90/month in 2026).

The critical detail for LGBTQ+ households is how the income thresholds work by filing status:

• Single filers (including domestic partners): IRMAA begins at $109,000 MAGI
• Married filing jointly: IRMAA begins at $218,000 combined MAGI

A married couple with $220,000 combined income (say, $130K + $90K) barely clears the MFJ tier 1 threshold and pays a modest surcharge. The same two people as domestic partners file two separate single returns: the $130K earner is in tier 1 and pays the surcharge; the $90K earner is in tier 0 and pays nothing. In this case DP status actually costs more in total IRMAA than married status — but the $90K earner's clean tier-0 single return offsets the comparison for households where one partner earns well above and one earns well below the thresholds.

2026 IRMAA brackets — single and MFJ

Source: CMS 2026 Medicare premium announcement. Values verified via Kiplinger and The Finance Buff.¹² IRMAA tiers are per-person; each enrolled Medicare beneficiary pays based on their own tier.

Worked examples

The two-year lookback: why 2024 income matters now

Your 2026 IRMAA is based on your 2024 MAGI as reported on your 2024 federal tax return (filed in early 2025). If you retired, lost income, or had a one-time event in 2025 that significantly changed your income, you can request a redetermination using your more recent income. Form SSA-44 ("Medicare Income-Related Monthly Adjustment Amount — Life-Changing Event") covers qualifying events: retirement or work reduction, loss of employer benefits, divorce, death of a spouse, or other life-changing events.

This creates a specific planning window: if you're approaching Medicare eligibility and your income in two years prior will be a different story than today, model both years. Large Roth conversions or asset sales in 2024 can create IRMAA exposure in 2026 even if your income is lower by then.

Roth conversion strategy and IRMAA for LGBTQ+ households

For domestic partner households, the interaction between Roth conversions and IRMAA is particularly important. Every dollar you convert from traditional to Roth IRA in a given year adds to your MAGI — which could push you into a higher IRMAA tier two years later. For single filers, the thresholds are narrower:

• A DP converting $50,000 in 2024 with $95,000 in other income has total MAGI of $145,000 — in single tier 2, paying $202.90/mo surcharge in 2026.
• The same conversion for a married couple with $190,000 combined base income: MFJ total $240,000 — stays in MFJ tier 1, paying only $81.20/mo each.

The practical implication: domestic partner households doing Roth conversions need to be more careful about conversion sizing. Filling up to the tier 1 boundary ($109,000 single) without crossing into tier 1 may mean smaller annual conversions than a married couple can do. The flip side: two domestic partners can each independently manage their conversion amount to stay under their individual single threshold, which can be advantageous for couples where one partner has much lower income.

See the full Roth Conversion Strategy for LGBTQ+ Households guide for a decade-by-decade framework, and the LGBTQ+ Medicare & Long-Term Care Planning Guide for the broader Medicare picture including Medigap timing and the Medicaid gap for domestic partners.

Married filing separately — a trap, not a strategy

Some married same-sex couples consider filing separately (MFS) for other tax reasons — for example, if one spouse is on an income-driven student loan repayment plan. But MFS has a uniquely punitive IRMAA schedule: any married person filing separately with MAGI above $103,000 jumps to MFJ tier 3 rates immediately. There's no tier 1 or tier 2 graduated phase-in for MFS filers. Unless there's a compelling IDR or other reason to file MFS, the IRMAA impact alone is usually a strong argument against it. A fee-only advisor can model the full MFS tradeoff for your specific student loan repayment and IRMAA exposure.

What domestic partners can do

• Model the marriage IRMAA impact now. Use this calculator every year as income changes. The answer isn't always "marriage saves money on Medicare" — it depends on the income split.
• Size Roth conversions to single-filer thresholds. As a domestic partner, fill to $109,000 MAGI before crossing into tier 1. Each partner manages their own threshold independently.
• Coordinate asset sales and distributions. Capital gains from selling investments, rental income, and traditional IRA distributions all count toward MAGI. Coordinate the timing of large realizations with a two-year IRMAA horizon in mind.
• Consider the marriage IRMAA benefit as one input among many. For some income combinations, marriage saves thousands per year on IRMAA. For others, DP status is cheaper. Factor this alongside the inherited IRA 10-year rule, Social Security spousal benefits, and other legal-status differences when evaluating the marriage decision.