Frequently Asked Questions
What is Medicare IRMAA?
IRMAA stands for Income-Related Monthly Adjustment Amount. It is an additional premium surcharge added to your standard Medicare Part B and Part D premiums when your income exceeds certain thresholds. IRMAA is based on your income from 2 years ago — so your 2026 Medicare premiums are based on your 2024 tax return.
What income triggers Medicare IRMAA in 2026?
For 2026, IRMAA surcharges begin when your Modified Adjusted Gross Income (MAGI) exceeds $106,000 for single filers or $212,000 for married couples filing jointly. At the highest income tier (above $500,000 single / $750,000 married), the combined Part B and Part D surcharge can exceed $500 per month per person.
How much is Medicare IRMAA in 2026?
The standard Part B premium in 2026 is $174.70/month. With IRMAA, you pay an additional $69.90 to $419.30/month depending on income tier. For Part D, IRMAA adds $12.90 to $81.00/month to your plan premium. At the highest tier, total Part B + Part D IRMAA surcharges can exceed $500/month per person.
Can I appeal my Medicare IRMAA?
Yes — you can appeal IRMAA if you experienced a qualifying life-changing event that reduced your income: retirement, divorce, death of spouse, loss of income-producing property, reduction in work hours, or receipt of employer settlement. File Form SSA-44 with the Social Security Administration. If your income genuinely decreased, IRMAA can be reduced or eliminated.
Does Roth conversion affect Medicare IRMAA?
Yes — Roth conversions increase your Modified Adjusted Gross Income in the year of conversion, which can trigger or increase IRMAA two years later. This is a critical retirement planning consideration. Carefully model the 2-year IRMAA impact before doing large Roth conversions, especially in the years immediately before Medicare enrollment.
Millions of retirees are blindsided by Medicare IRMAA every year — receiving a notice that their Medicare premiums are significantly higher than expected because of income from two years prior. If you are a higher-income retiree or recently sold property, liquidated investments, or took large retirement account distributions, IRMAA may affect you. Here is everything you need to know.
How IRMAA Works
Medicare uses a 2-year lookback. Your 2026 Medicare premiums are determined by your 2024 Modified Adjusted Gross Income (MAGI) as reported on your federal tax return. The Social Security Administration reviews your tax data and automatically applies IRMAA surcharges if your income exceeded the thresholds.
You will receive an IRMAA determination letter from SSA if surcharges apply. The additional amounts are deducted directly from your Social Security benefit payment.
2026 IRMAA Income Brackets
| 2024 Income (Single) | 2024 Income (Married) | Part B Monthly | Part D Add-On |
|---|---|---|---|
| ≤ $106,000 | ≤ $212,000 | $174.70 | Plan premium only |
| $106,001–$133,000 | $212,001–$266,000 | $244.60 | +$12.90 |
| $133,001–$167,000 | $266,001–$334,000 | $349.40 | +$33.30 |
| $167,001–$200,000 | $334,001–$400,000 | $454.20 | +$53.80 |
| $200,001–$500,000 | $400,001–$750,000 | $559.00 | +$74.20 |
| > $500,000 | > $750,000 | $594.00 | +$81.00 |
How to Appeal IRMAA
If your income has decreased since the year SSA used to calculate your IRMAA, you can request a reduction. Qualifying life-changing events include retirement or reduction in work hours, divorce or legal separation, death of spouse, loss of income-producing property (due to disaster or other circumstances), loss of pension income, or employer settlement payment.
How to appeal: File Form SSA-44 (Medicare Income-Related Monthly Adjustment Amount — Life-Changing Event) at your local Social Security office or by mail. Provide documentation of the qualifying event and your reduced income. SSA will use your more recent income to recalculate your IRMAA.
IRMAA Planning Strategies
The 2-Year Lookback Problem
The most important planning insight: anything that increases your income two years before Medicare enrollment — selling a rental property, large IRA withdrawal, Roth conversion — will trigger IRMAA. If you are 63 or 64, be very careful about large income events that will appear on the tax return used for your first year of Medicare.
Roth Conversion Timing
Roth conversions can be an excellent long-term strategy, but doing a large conversion in years that will create IRMAA 2 years later adds a significant hidden cost. Work with a financial advisor to model the IRMAA impact alongside the tax benefit before executing large conversions.
Income Smoothing
Spreading large income events across multiple years — rather than concentrating them in one year — can keep income below IRMAA thresholds and save thousands in premiums. This applies to capital gains realization, IRA withdrawals, and business income.
- Know your 2024 MAGI — if it exceeds $106,000 (single) or $212,000 (married), expect an IRMAA notice
- Budget for IRMAA if you are approaching Medicare age with significant income
- If you recently retired or had a major income reduction, file Form SSA-44 immediately to appeal
- Plan Roth conversions and large withdrawals with the 2-year IRMAA lookback in mind
- Review your IRMAA status every year — brackets adjust annually for inflation