IRMAA: Medicare's Income Surcharge
What IRMAA actually is
IRMAA stands for Income-Related Monthly Adjustment Amount. It's not a separate fee — it's an add-on to your regular Medicare Part B and Part D premiums. If your income is above a certain threshold, you pay more.
Think of it as Medicare's way of means-testing: people who earn more contribute more to the program. The standard Part B premium for 2026 is $202.90/month. With IRMAA, that can climb to over $689/month at the highest income levels.
Added to your monthly Part B premium. Ranges from $81.20 to $487.00 extra per month depending on income.
Added to your prescription drug plan premium. Ranges from $14.50 to $91.00 extra per month.
Who pays IRMAA
IRMAA kicks in when your Modified Adjusted Gross Income (MAGI) exceeds certain thresholds. For 2026, this is based on your 2024 tax return.
$109k
IRMAA applies if your 2024 MAGI exceeded this amount
$218k
IRMAA applies if your combined 2024 MAGI exceeded this amount
MAGI = your Adjusted Gross Income (Form 1040, line 11) + tax-exempt interest income (line 2a). This includes wages, retirement distributions, Social Security benefits, capital gains, rental income, and any tax-free municipal bond interest.
2026 IRMAA income brackets
There are five IRMAA tiers above the standard premium. The higher your income, the more you pay. These brackets are based on your 2024 MAGI.
| Single | Joint | Part B Total | Part D Extra |
|---|---|---|---|
| ≤ $109k | ≤ $218k | $202.90/mo | — |
| $109k – $137k | $218k – $274k | $284.10/mo | +$14.50/mo |
| $137k – $171k | $274k – $342k | $405.80/mo | +$37.50/mo |
| $171k – $205k | $342k – $410k | $527.50/mo | +$60.40/mo |
| $205k – $500k | $410k – $750k | $649.20/mo | +$83.30/mo |
| > $500k | > $750k | $689.90/mo | +$91.00/mo |
Even $1 over a bracket threshold puts you in the higher tier. If your 2024 MAGI was $109,001 as a single filer, you'd pay the same IRMAA as someone earning $$137k. This cliff effect makes income planning especially important.
How IRMAA is determined
Social Security handles IRMAA automatically — you don't apply for it. Here's the process:
The IRS automatically sends your MAGI to Social Security each year. For 2026premiums, they use your 2024 return (the 2-year lookback).
Social Security compares your MAGI to the IRMAA thresholds and assigns you to a tier. They notify you by mail, typically in late fall before the new year.
Part B IRMAA is deducted from your Social Security check (or billed directly if you don't receive SS). Part D IRMAA is billed by Medicare or your drug plan.
Both spouses pay: If you file jointly, both you and your spouse pay the IRMAA surcharge individually based on your combined income.
Strategies to reduce or avoid IRMAA
Since IRMAA uses a 2-year lookback, smart planning today can lower your premiums in the future. Here are strategies to consider:
If you're converting traditional IRA funds to Roth, do it before age 63 when possible. Conversions add to MAGI and can push you into higher IRMAA brackets.
Large capital gains from selling investments or property can spike your MAGI. Consider spreading sales across tax years or using tax-loss harvesting.
Qualified Charitable Distributions (QCDs) from your IRA satisfy RMDs without adding to MAGI. Bunching deductions or using donor-advised funds can also help.
Delaying Social Security can reduce your MAGI in the years before you claim. But weigh this against the benefits of claiming earlier.
Selling a business, receiving an inheritance, or cashing out stock options can cause a one-time MAGI spike that triggers IRMAA for 2 years (the year it happens + the lookback year). If possible, plan these events before turning 63.
When you can appeal IRMAA
If your income has dropped significantly since your 2024 tax return, you may qualify for a reduction. Social Security allows appeals based on "life-changing events."
- Marriage, divorce, or annulment
- Death of a spouse
- Work stoppage (retirement, layoff, reduction in hours)
- Loss of income-producing property (disaster, foreclosure)
- Loss of pension income
- Employer settlement payment (severance)
Complete Form SSA-44 (Medicare Income-Related Monthly Adjustment Amount — Life-Changing Event) and submit it to your local Social Security office. Include documentation of the event and proof of your reduced income. You can file online, by mail, or in person.
What to do next
Now that you understand how IRMAA works, here's how to take action:
Use our IRMAA calculator to see your 2026 bracket based on your 2024 income.
Your 2026 income will affect your 2028 IRMAA. If you're near a bracket boundary, small adjustments now can save money later.
IRMAA planning intersects with retirement planning, tax strategy, and Social Security decisions. A financial advisor or tax professional can help optimize your approach.