IRMAA, the Income-Related Monthly Adjustment Amount, is a surcharge that raises your Medicare Part B and Part D premiums when your income is above set thresholds. So how does IRMAA work in practice? The Social Security Administration looks at your tax return from two years earlier, checks your modified adjusted gross income against a bracket table, and, if you’re over the line, adds a fixed dollar amount to your monthly premiums. For 2026 premiums, that surcharge starts once your 2024 MAGI tops $109,000 as a single filer or $218,000 on a joint return.1Centers for Medicare & Medicaid Services. 2026 Medicare Parts A and B Premiums and Deductibles You don’t apply for it, and you don’t opt in. It’s automatic, but it can be challenged.
How SSA Decides Whether You Owe It
SSA uses a two-year lookback. For 2026 premiums, the agency reviews your 2024 federal tax return. If that return isn’t available yet, it falls back to 2023.2Social Security Administration. Form SSA-44 Medicare Income-Related Monthly Adjustment Amount – Life-Changing Event The lag exists because SSA works from verified IRS records rather than estimates.
The number that matters is your modified adjusted gross income. For IRMAA, MAGI is your adjusted gross income from line 11 of your 1040 plus any tax-exempt interest from line 2a.3Social Security Administration. POMS HI 01101.010 – Modified Adjusted Gross Income (MAGI) Nontaxable Social Security benefits and foreign earned income are not added back for this calculation, even though the general IRS definition of MAGI includes them.4Internal Revenue Service. Modified Adjusted Gross Income
SSA runs this check every year, so your status can change. Fall below the threshold on a newer return and the surcharge comes off. Cross it and you’ll owe one for the first time. Either way, you receive an initial determination notice explaining your premium.5Medicare. Initial IRMAA Determination
The brackets have a hard edge. Exceeding a tier by one dollar puts you at the full surcharge for that level.
What You’ll Pay in 2026
Most people on Part B pay 25% of the program’s cost, and the government covers the rest. IRMAA raises your share to 35%, 50%, 65%, 80%, or 85% depending on which tier your income lands in.6Social Security Administration. Medicare Premiums: Rules for Higher-Income Beneficiaries
Part B Monthly Premiums for 2026
The standard Part B premium is $202.90. Higher-income beneficiaries pay these total monthly amounts based on their 2024 return:1Centers for Medicare & Medicaid Services. 2026 Medicare Parts A and B Premiums and Deductibles
- $109,000 or less single / $218,000 or less joint: $202.90
- $109,001–$137,000 / $218,001–$274,000: $284.10
- $137,001–$171,000 / $274,001–$342,000: $405.80
- $171,001–$205,000 / $342,001–$410,000: $527.50
- $205,001–$499,999 / $410,001–$749,999: $649.20
- $500,000 or more / $750,000 or more: $689.90
Part D Surcharges for 2026
Part D IRMAA is a flat monthly add-on to whatever you already pay your drug plan. The income tiers match Part B:1Centers for Medicare & Medicaid Services. 2026 Medicare Parts A and B Premiums and Deductibles
- Under the threshold: $0
- First tier over: $14.50
- Second tier: $37.50
- Third tier: $60.40
- Fourth tier: $83.30
- Top tier: $91.00
At the top bracket, the combined Part B and Part D IRMAA reaches $578 a month, or close to $6,940 a year, on top of your regular drug plan premium.
A Trap for Married Filing Separately
If you’re married, lived with your spouse at any point during the year, and filed a separate return, the bracket structure collapses to three tiers instead of six. Cross $109,000 in MAGI and you jump straight to $649.20 for Part B and $83.30 for Part D. The top tier starts at $391,000.1Centers for Medicare & Medicaid Services. 2026 Medicare Parts A and B Premiums and Deductibles A separately filing spouse making $110,000 pays the same IRMAA as a joint filer making $600,000. If you and your spouse lived apart the entire year, the standard single-filer brackets apply instead.
Income Events That Push People Over the Line
Because IRMAA rides on a single year’s tax return, a one-time income spike can raise your premiums long after the money is gone.
Selling a home is one of the most common triggers. Profit above the exclusion amount ($250,000 single, $500,000 joint for owners who lived in the home at least two of the last five years) is capital gain, and it flows into MAGI.7Internal Revenue Service. Topic No. 701 Sale of Your Home A large gain in 2024 will show up in your 2026 IRMAA determination.
Roth conversions do the same thing. The full amount converted from a traditional IRA or 401(k) counts as taxable income that year. A big conversion can raise premiums for a full year, two years later. Splitting the conversion across tax years can keep each year’s MAGI under a threshold.
Other one-time events with the same effect include exercising stock options, taking a lump-sum pension payout, and selling investments with large capital gains. The surcharge lifts once your income returns to normal, but the two-year delay means you feel it well after the fact.
Getting the Surcharge Removed or Reduced
There are two routes, and they answer different problems: your income has genuinely dropped, or the tax data SSA used is wrong.
If Your Income Has Dropped: Form SSA-44
SSA will recalculate your premium based on your current or projected income only if a specific life-changing event caused the drop.2Social Security Administration. Form SSA-44 Medicare Income-Related Monthly Adjustment Amount – Life-Changing Event Qualifying events are:
- Marriage
- Divorce or annulment
- Death of a spouse
- You or your spouse stopped working or cut hours
- Loss of income-producing property through disaster, arson, fraud, or theft (a voluntary sale doesn’t count)
- Loss of pension income because the plan was terminated or reorganized
- An employer settlement payment tied to bankruptcy or reorganization
File Form SSA-44 with the date of the event, your estimated MAGI for the current year, and supporting documentation. What you need to attach depends on the event: a signed employer statement or pay stubs for work stoppage, a certified divorce decree, a death certificate, a letter from the pension administrator, or a settlement document or attorney letter for an employer settlement.8Social Security Administration. POMS HI 01120.043 – Life Changing Event – Employer Settlement Payment Submit it to your local Social Security office by mail or in person; in-person delivery gets you a receipt.
If the Tax Data Is Wrong
You can also ask SSA to redo the determination if the IRS data it used was inaccurate or has since been corrected. That includes an amended return (Form 1040-X) that lowered your MAGI, a mismatch between what SSA received and what you actually reported, and cases where SSA used a three-year-old return because your two-year-old one wasn’t yet available.9HHS.gov. Medicare Part B Premium Appeals For these, you don’t need Form SSA-44. Call SSA at 1-800-772-1213 and say you want to lower your IRMAA, with your corrected tax documents in hand.10Social Security Administration. Request to Lower an Income-Related Monthly Adjustment Amount
The 60-Day Deadline
If you want to formally appeal your IRMAA determination, you have 60 days from the date you received the notice to request reconsideration.11Social Security Administration. POMS HI 01140.001 – Overview of the Appeals Process for IRMAA SSA assumes you received it five days after the date on the letter. If reconsideration is denied, further appeal levels are available through an administrative law judge, the Medicare Appeals Council, and ultimately federal district court.9HHS.gov. Medicare Part B Premium Appeals You keep paying the higher premium while the appeal is pending. If you win, SSA refunds the difference.
How You Actually Pay It
If you already collect Social Security, SSA pulls both the standard Part B premium and the IRMAA surcharge from your monthly benefit.12Medicare. How to Pay Part A and Part B Premiums The Part D IRMAA is also withheld from your Social Security check, no matter how you normally pay your drug plan.6Social Security Administration. Medicare Premiums: Rules for Higher-Income Beneficiaries
If you’re not yet collecting Social Security, or your check is too small to cover the premium, you get a Medicare Premium Bill (Form CMS-500) in the mail each month.13Medicare. Medicare Premium Bill (CMS-500)
Skipping the Part D surcharge carries real consequences. Medicare gives a three-month grace period. After that, your plan disenrolls you and must send written notice within 10 calendar days.14Centers for Medicare & Medicaid Services. What Happens When a Plan Member Does Not Pay Their Medicare Plan Premiums Go 63 or more consecutive days without creditable drug coverage and you’ll face a permanent late enrollment penalty when you sign back up.
Planning Around the Thresholds
Because the surcharge turns on a single year’s income, timing decisions matter a lot in the years just before and during Medicare eligibility.
Qualified Charitable Distributions are one of the cleaner tools. If you’re 70½ or older, you can send up to $111,000 a year directly from your IRA to a qualifying charity. It satisfies your required minimum distribution without adding to taxable income, so it stays out of MAGI. Each spouse can do this from their own IRA.
Roth conversions cut both ways. The conversion itself raises MAGI in the year you do it, but future Roth withdrawals don’t count toward MAGI at all. Spreading conversions across several years before 65 can move money into a Roth without triggering years of elevated Medicare premiums.
Beyond that: time the sale of appreciated assets so a large gain doesn’t share a tax year with another income event, harvest losses to offset gains, and think carefully about when to take a pension lump sum if you have a choice. Each of these choices matters more once you’re within two years of Medicare, because the income you report then is the income SSA will use to set your premiums.