Medicare Open Enrollment Opened. The Number That Matters Is Not the Premium.

Medicare open enrollment runs October 15 through December 7. Most of the attention goes to plan comparison: drug coverage, provider networks, out-of-pocket maximums.

Those choices matter. But for higher-income households, the larger number was decided two years ago and is not on the enrollment form.

Medicare premiums for higher earners include a surcharge called the income-related monthly adjustment amount. It is calculated on modified adjusted gross income from the tax year two years before the premium year, because that is usually the most recent return available. (Source: Social Security Administration, Program Operations Manual System HI 01101.030.)

So 2026 premiums were set by the 2024 return. And the return being written right now sets the 2028 premium.

The brackets are cliffs, not slopes. In 2026, an individual at $109,000 of modified adjusted gross income pays the standard Part B premium of $202.90 per month. An individual one dollar above pays $284.10. (Source: Centers for Medicare & Medicaid Services, 2026 Medicare Parts A & B Premiums and Deductibles, November 14, 2025.) Add the Part D surcharge and the difference runs roughly $1,148 over a year, and a married couple where both are enrolled pays it twice.

That is why the decision worth making during open enrollment season is not only which plan to choose. It is whether this year's conversion, distribution, or realized gain is about to cross a line that will not send its bill for two years.

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Bellwether Wealth does not provide tax or legal advice. This material is provided for general informational and educational purposes only and should not be construed as individualized tax, legal, or investment advice. Tax laws and regulations are complex and subject to change, and their application depends on an individual's specific facts and circumstances. Before implementing any tax, retirement, charitable giving, estate planning, or other strategy discussed, consult with your CPA, tax professional, attorney, and/or other qualified professional regarding your individual circumstances. Advisory services offered through Bellwether Wealth, an SEC-registered investment adviser.