What Is IRMAA (Income-Related Monthly Adjustment Amount)?
IRMAA stands for Income-Related Monthly Adjustment Amount. It is a surcharge that Medicare adds to your Part B and Part D premiums if your income exceeds certain thresholds. Most Medicare beneficiaries pay the standard Part B premium of $202.90 per month in 2026, but higher earners pay more based on a tiered system tied to their tax returns from two years earlier.
Think of IRMAA as a sliding scale. The more income you report, the higher your monthly Medicare premium goes. According to the Social Security Administration, roughly 7% of Medicare beneficiaries pay IRMAA surcharges. If your modified adjusted gross income (MAGI) is above $109,000 as an individual or $218,000 as a married couple filing jointly, you will pay extra on top of the standard premium.
Here is what makes IRMAA confusing for many people: Medicare does not use your current income. It uses your MAGI from two years ago. So your 2026 premiums are based on your 2024 tax return. This two-year lookback catches many retirees off guard, especially those who had a spike in income from selling a home, cashing out investments, or taking a large retirement account distribution.
IRMAA applies to two parts of Medicare:
- Part B (medical insurance): The surcharge is added directly to your monthly premium, increasing it from the standard $202.90 up to $689.90 at the highest tier.
- Part D (prescription drug coverage): An additional surcharge is added on top of whatever your drug plan charges, ranging from $14.50 to $91.00 per month.
IRMAA does not apply to Part A (hospital insurance). Most people pay $0 for Part A if they or their spouse paid Medicare taxes for at least 40 quarters.
2026 IRMAA Income Brackets and Premium Amounts
The table below shows how much you will pay for Part B in 2026 based on your 2024 MAGI. For the full year-specific breakdown including Part D surcharges, see our 2026 IRMAA income brackets and Part B premiums guide.
| Individual MAGI | Married Filing Jointly MAGI | Monthly Part B Premium | Monthly IRMAA Surcharge |
|---|---|---|---|
| $109,000 or less | $218,000 or less | $202.90 | $0 |
| $109,001 to $137,000 | $218,001 to $274,000 | $284.10 | $81.20 |
| $137,001 to $171,000 | $274,001 to $342,000 | $405.80 | $202.90 |
| $171,001 to $205,000 | $342,001 to $410,000 | $527.50 | $324.60 |
| $205,001 to $499,999 | $410,001 to $749,999 | $649.20 | $446.30 |
| $500,000 or more | $750,000 or more | $689.90 | $487.00 |
The Part D surcharge follows the same income tiers, adding $14.50 to $91.00 per month on top of your drug plan premium.
When you add Part B and Part D IRMAA together, the annual cost per person can be significant:
| IRMAA Tier | Individual MAGI Range | Annual IRMAA Cost (Per Person) |
|---|---|---|
| No IRMAA | $109,000 or less | $0 |
| Tier 1 | $109,001 to $137,000 | $1,148 ($95.70/month) |
| Tier 2 | $137,001 to $171,000 | $2,885 ($240.40/month) |
| Tier 3 | $171,001 to $205,000 | $4,620 ($385.00/month) |
| Tier 4 | $205,001 to $499,999 | $6,355 ($529.60/month) |
| Tier 5 | $500,000+ | $6,936 ($578.00/month) |
For married couples, double the per-person amounts. A couple in Tier 4 could pay over $12,700 per year in IRMAA surcharges alone, on top of their regular Medicare premiums and out-of-pocket costs.
What Income Counts Toward IRMAA?
Medicare uses your modified adjusted gross income, or MAGI, to determine whether you owe IRMAA. Your MAGI is your adjusted gross income (AGI) plus any tax-exempt interest income. The Social Security Administration pulls this number directly from the IRS.
Common income sources that count toward MAGI include:
- Wages and self-employment income
- Pension and annuity payments
- Taxable Social Security benefits
- Capital gains from selling stocks, bonds, or property
- Rental income
- Required minimum distributions (RMDs) from traditional IRAs and 401(k)s
- Tax-exempt interest from municipal bonds
What does not count: Roth IRA withdrawals (since they are tax-free), loan proceeds, gifts, and inheritances. This distinction matters for retirement income planning.
Income Events That Catch Retirees Off Guard
Several common financial moves can push your MAGI above the IRMAA threshold without you realizing it until two years later:
- Selling your home: If your profit exceeds the $250,000 exclusion (single) or $500,000 exclusion (married), the excess counts as income. A retiree who sold a long-held property for a $400,000 gain could jump two IRMAA tiers.
- Large Roth conversions: Converting a traditional IRA to a Roth is a taxable event. The converted amount adds to your MAGI, potentially triggering IRMAA for two years.
- One-time windfalls: Severance pay, stock option exercises, business sale proceeds, or a large inheritance from a traditional IRA can all spike your income temporarily.
- Required minimum distributions (RMDs): Starting at age 73, the IRS requires withdrawals from tax-deferred accounts. A large retirement balance means large RMDs that may push you into IRMAA territory.
Does IRMAA Apply to Medicare Advantage Plans?
Yes. If you have a Medicare Advantage plan (Part C), you still pay the Part B IRMAA surcharge. Medicare Advantage does not replace Part B. You must stay enrolled in Parts A and B to have a Medicare Advantage plan, so the IRMAA surcharge on Part B applies to you just like anyone else on Original Medicare.
If your Medicare Advantage plan includes drug coverage (most do), you will also pay the Part D IRMAA surcharge. One important detail: the Part D IRMAA is billed separately from your plan premium. Social Security deducts it from your monthly benefit check, or you receive a separate bill from Medicare.
When comparing how much Medicare costs, make sure to factor in IRMAA on top of plan premiums, copays, and deductibles. A $0-premium Medicare Advantage plan still costs $202.90+ per month if you are paying the standard Part B premium, and much more if IRMAA applies.
How to Appeal Your IRMAA Determination
If your income has dropped since the tax year Medicare is using, you can ask Social Security to use a more recent year instead. This is done by filing Form SSA-44, officially called “Medicare Income-Related Monthly Adjustment Amount – Life-Changing Event.”
Social Security recognizes eight qualifying life-changing events:
- Marriage
- Divorce or annulment
- Death of a spouse
- Work stoppage (you or your spouse stopped working or reduced hours)
- Work reduction (involuntary loss of income-producing property)
- Loss of income-producing property (due to disaster, fraud, or other event beyond your control)
- Loss of pension income
- Receipt of an employer settlement payment
To file an appeal:
- Download Form SSA-44 from ssa.gov
- Gather documentation of the life-changing event (death certificate, retirement letter, termination notice, settlement agreement, etc.)
- Provide an estimate of your reduced income for the current or more recent year
- Submit to your local Social Security office or call 1-800-772-1213 to request an appointment
If Social Security accepts your appeal, they will recalculate your IRMAA using the reduced income. Any overpayments are typically refunded or credited within a few months.
A common example: You retired in January 2025 after earning $180,000 in 2024. Your 2026 premiums are based on that $180,000 income. But your 2025 and 2026 income is now $40,000 from Social Security and a small pension. Filing SSA-44 with proof of your retirement can reduce or eliminate your IRMAA surcharge.
5 Strategies to Reduce or Avoid IRMAA
While you cannot change last year’s tax return, you can plan ahead. These strategies require coordination with a financial advisor or tax professional, but understanding them can save thousands of dollars over your Medicare years.
1. Time your Roth conversions before age 63. Since IRMAA uses a two-year lookback, any income spike at age 63 or later will affect your Medicare premiums. If you plan to convert a traditional IRA to a Roth, consider doing it in your late 50s or early 60s before the lookback window opens.
2. Use Qualified Charitable Distributions (QCDs). After age 70 1/2, you can donate up to $105,000 per year directly from your IRA to a qualifying charity. QCDs satisfy your RMD requirement without adding to your MAGI. This can keep your income below the IRMAA threshold.
3. Spread income across tax years. If you are selling a business, property, or large investment position, consider installment sales or spreading the gains across multiple years to avoid a single-year income spike that pushes you into a higher IRMAA tier.
4. Harvest capital losses. If you have investments that have lost value, selling them to offset gains reduces your taxable income and MAGI. This is called tax-loss harvesting, and it is a common year-end planning tool.
5. Plan RMD strategies early. If you have large balances in traditional retirement accounts, consider a drawdown strategy before RMDs begin at age 73. Partial Roth conversions in lower-income years can shrink future RMDs and lower your IRMAA exposure.
Each of these strategies involves tradeoffs. A licensed Medicare broker can help you understand how plan choices interact with your income situation, while a financial advisor can handle the tax planning side.
How IRMAA Compares to Other Medicare Costs
IRMAA is just one piece of the Medicare cost puzzle. It helps to see where it fits alongside other expenses you may face:
- Part B premium: Everyone pays this. The standard amount is $202.90/month in 2026, but IRMAA can increase it to $689.90/month.
- Part D premium: Varies by plan, typically $20 to $80/month, plus an IRMAA surcharge of $14.50 to $91.00 if applicable.
- Late enrollment penalties: Permanent surcharges for delaying Part B or Part D enrollment beyond your initial window. Unlike IRMAA, these never go away.
- Medigap premiums: If you choose Original Medicare with a Supplement plan, you pay a separate monthly premium for the Supplement, on top of Part B.
- Medicare Advantage copays and deductibles: If you choose an MA plan, your out-of-pocket costs depend on the specific plan, with annual maximums typically between $3,000 and $8,000.
Understanding how all these costs fit together is why working with an independent Medicare broker can be so valuable. A broker who represents multiple carriers can compare total out-of-pocket costs across plans, including IRMAA, premiums, copays, and deductibles. If you are in Ohio, our guide to finding a Medicare agent in Ohio walks you through the process step by step.
Frequently Asked Questions About IRMAA
What income level triggers IRMAA in 2026?
For 2026, IRMAA kicks in when your 2024 modified adjusted gross income exceeds $109,000 for individuals or $218,000 for married couples filing jointly. Above those thresholds, you pay a surcharge on both Part B and Part D premiums.
Is IRMAA a one-time charge or ongoing?
IRMAA is recalculated every year based on your tax return from two years prior. If your income drops below the threshold, the surcharge goes away the following year. It is not a permanent penalty like late enrollment penalties.
Can I get a refund if I overpaid IRMAA?
If you successfully appeal through Form SSA-44 and Social Security determines you were overcharged, you will receive a refund or credit. The process typically takes a few months after your appeal is approved.
Does IRMAA affect my spouse?
Each spouse is assessed individually, but both spouses’ incomes are combined on a joint tax return to determine the MAGI. If you file jointly and your combined income exceeds the threshold, both of you will pay the surcharge on your respective Medicare premiums.
When does Social Security notify me about IRMAA?
Social Security mails an IRMAA determination letter (called an “Initial Determination”) late in the year before it takes effect. For 2026 IRMAA, most people received their letters in November or December 2025. If you disagree with the determination, you have 60 days to request a reconsideration.
Get Help With Your Medicare Premiums and IRMAA
IRMAA adds real costs to Medicare, but it does not have to be a surprise. Planning ahead, understanding how your income affects premiums, and knowing when to file an appeal can save you hundreds or thousands of dollars each year.
At The Big 65, Karl Bruns-Kyler and team have helped Medicare beneficiaries across 33 states for over 20 years. As an independent broker, The Big 65 works with 10 insurance organizations offering 50 different Medicare products, with no extra cost to you. Whether you need help choosing between Medicare Advantage and Original Medicare, understanding how IRMAA affects your total costs, or enrolling for the first time, a licensed agent can walk you through your options.
Call 877-850-0211 or schedule a free consultation today. There is never a charge for our services.