The open hours at the Charles Street CVS run until 9 p.m. on weekdays, but it was barely past four when I noticed Lester Novak near the pharmacy counter on a Tuesday afternoon in late March 2026. He was speaking quietly to the pharmacy tech, asking whether any assistance programs could help offset the cost of his blood pressure medication. When he turned to leave, I introduced myself.
We talked for almost two hours at a coffee shop two blocks away. Lester Novak is 42, a legal secretary in Baltimore who has lived alone in a Charles Village apartment since his divorce three years ago. His income varies month to month. His car has been sitting in a repair lot since October 2025, when a transmission failure came with a $1,400 estimate he could not cover. He takes the bus to temp assignments now.
“I don’t talk about any of this with people I know,” he told me, wrapping both hands around a paper cup. “It’s embarrassing. I feel like I’m constantly putting out fires.”
The fire he had been trying to put out for the past four months started with a Medicare premium notice — and a fear that the part-time work he had recently picked up was about to make his healthcare costs unmanageable.
A Premium Notice and a Creeping Fear
Lester’s hard stretch began in late 2022, when a herniated disc and nerve damage forced him to stop working full-time. After a 14-month approval process, he began receiving Social Security Disability Insurance benefits — approximately $1,180 a month — in early 2024. Federal rules make SSDI recipients eligible for Medicare 24 months after their disability onset date, which meant Lester’s coverage began in January 2025.
By mid-2025, feeling well enough for light assignments, he signed with a temp agency doing part-time legal secretary work — earning roughly $720 a month in good months, sometimes less. Then in November 2025, a Medicare statement arrived showing a monthly Part B charge of $185. He had no idea whether that number was standard or a warning of something worse to come.
“I had heard that if you make too much money, your Medicare goes up,” he told me. “I didn’t know what ‘too much’ meant. I just assumed I had messed something up by going back to work.”
What Lester did not know — and what had sent him quietly asking pharmacy staff about prescription assistance months later — was whether his 2025 part-time earnings would eventually catch up with him as a premium increase in 2027.
What IRMAA Is — and Who It Actually Hits
The Income-Related Monthly Adjustment Amount, or IRMAA, is a surcharge the Social Security Administration adds to Medicare Part B and Part D premiums when a beneficiary’s Modified Adjusted Gross Income exceeds set thresholds. According to the Medicare and You 2026 Handbook, the SSA uses income data from two years prior — meaning 2026 premiums are determined by 2024 tax returns.
For single filers, the standard Part B premium applies to anyone earning approximately $106,000 or less in annual MAGI. Above that level, surcharges begin. As Charles Schwab’s Medicare income guide explains, IRMAA primarily affects people with large investment income, significant retirement distributions, or high wages — not part-time workers earning a few hundred dollars a month.
Lester’s total gross income for 2025 was approximately $22,440 — his SSDI of $1,180 per month combined with roughly eight months of part-time temp earnings. That figure sits less than one-quarter of the way to the IRMAA floor. His $720-a-month temp work, on its own, would contribute only about $8,640 to annual income.
Running the Real Numbers — and Finding a Different Problem
When I walked Lester through the IRMAA tiers at the coffee shop, his response was immediate: “I had no idea the cutoff was that high.” He had been operating under the assumption — from something overheard at a temp agency — that any income over a few hundred dollars a month would trigger a Medicare penalty. As AARP’s explainer on part-time work and Medicare makes clear, part-time earnings do not automatically affect premiums; the impact depends entirely on whether total income crosses the IRMAA thresholds.
There was, however, a legitimate concern hidden in Lester’s situation — just not the one he had been fixated on. Because his total income was close to the limit for Extra Help, the federal program that subsidizes Medicare Part D drug costs for low-income enrollees, any meaningful income increase could affect his eligibility for that benefit. In 2025, the full Extra Help income limit for a single person was approximately $22,590. Lester’s total annual income sat just inside that boundary.
“That part actually worried me more once I understood it,” he said. “It’s like — you’re trying to work a little, get back on your feet, and the line where things get harder is right there next to you.”
Where Lester Stands Now
The week I met Lester, he had just accepted a new three-month temp contract — the steadiest stretch of work since his disability began. The income would cover the bus pass, the medication, and possibly, eventually, the transmission repair. He had stopped dreading the mail, at least for now.
His credit score remained damaged from 2023, when he missed several card payments while waiting on SSDI approval. The embarrassment around money — the sense that his situation reflected something broken in himself — had not fully lifted. But the Medicare fear had resolved into something he could actually see clearly.
For anyone in a similar position, AARP’s guide on lowering Medicare premiums notes that certain life events — including a significant drop in income — can trigger a formal IRMAA review through the Social Security Administration, potentially adjusting premiums before the standard two-year lookback would catch up. That option existed for Lester in theory, though at his income level, it was never the concern he thought it was.
“I spent four months worried about the wrong thing,” he told me as he gathered his jacket to leave. “I wish someone had just explained it to me. Like, just sat down and said: here’s the number. You’re not there.”
He walked out into the April afternoon, still catching the No. 11 bus home. Some financial fears, it turns out, are built on thresholds that were never close to being crossed. The harder work — the credit score, the car, the fragile income line — those were still waiting.
Related: She Switched to a $0-Premium Medicare Advantage Plan to Save Money — Then a $1,140 Bill Arrived Anyway
Related: A Milwaukee Bus Driver Was Paying $1,847 a Month for Health Insurance — Until He Discovered What He’d Been Missing
Leave a Reply