IRMAA — the Income-Related Monthly Adjustment Amount — is a surcharge added to your Medicare Part B and Part D premiums if your income is above a threshold. Your 2026 IRMAA is based on your 2024 Modified Adjusted Gross Income (MAGI). At or below $109,000 (single) or $218,000 (married filing jointly) you pay only the standard 2026 Part B premium of $202.90/month with no Part D surcharge; above those amounts, surcharges rise in five tiers. This is general information, not financial advice — confirm your determination with Social Security.
How IRMAA is calculated
Medicare looks at your MAGI — your adjusted gross income plus any tax-exempt interest — from your tax return two years earlier. So 2026 surcharges use your 2024 return. Crossing a threshold by even one dollar moves you into the next tier; IRMAA is a “cliff,” not a gradual phase-in.
The 2026 IRMAA brackets
The thresholds below are the same for Part B and Part D. The Part B figure is the total monthly premium; the Part D figure is the surcharge added to whatever your drug plan charges.
| 2024 MAGI (single) | 2024 MAGI (joint) | 2026 Part B premium/mo | 2026 Part D surcharge/mo |
|---|---|---|---|
| ≤ $109,000 | ≤ $218,000 | $202.90 | $0.00 |
| $109,001–$137,000 | $218,001–$274,000 | $284.10 | $14.50 |
| $137,001–$171,000 | $274,001–$342,000 | $405.80 | $37.50 |
| $171,001–$205,000 | $342,001–$410,000 | $527.50 | $60.40 |
| $205,001–$499,999 | $410,001–$749,999 | $649.20 | $83.30 |
| ≥ $500,000 | ≥ $750,000 | $689.90 | $91.00 |
Figures reflect CMS’s 2026 Medicare premium announcement. The standard 2026 Part B premium is $202.90. Married-filing-separately uses different thresholds. Find your tier instantly with our Medicare IRMAA calculator.
What IRMAA costs over a year
Because IRMAA is charged per person per month, it adds up. A single filer in the first tier pays an extra $81.20 (Part B) + $14.50 (Part D) = $95.70/month, or about $1,148 a year more than the standard premium. A couple both in the top tier pay roughly $13,900 in surcharges between them annually.
How to reduce or appeal IRMAA
- Manage MAGI. Roth conversions, capital gains, and large IRA withdrawals all raise MAGI two years before they hit your premium. Planning withdrawals can keep you under a threshold.
- Use an HSA. Spending from an HSA in retirement is tax-free and does not raise MAGI — one more reason to read Use your HSA as a retirement account.
- Appeal a life-changing event. If you retired, married, divorced, or lost a spouse, file Form SSA-44 so Social Security uses a more recent, lower-income year.
The two-year lookback in practice
Because IRMAA uses income from two years prior, a single high-income year can raise your Medicare premiums long after the money is gone. Common triggers include:
- A large Roth conversion done in your early 60s.
- Selling a home, business, or appreciated stock, creating a one-time capital gain.
- A big required minimum distribution (RMD) or lump-sum retirement-account withdrawal.
Planning these events with the IRMAA cliffs in mind — for example, spreading a Roth conversion across several years — can keep you under a threshold. Because the surcharge is a cliff, even being $1 over costs the full tier.
Life-changing events you can appeal
Form SSA-44 lets you ask Social Security to disregard the two-year-old return if one of these events reduced your income:
| Event | Examples |
|---|---|
| Work stoppage or reduction | Retirement, cutting back hours |
| Marriage / divorce / death | Marriage, divorce, or death of a spouse |
| Loss of income property | Loss of pension or income-producing property |
| Settlement | Employer settlement or pension restructuring |
Attach evidence (such as a retirement letter or amended tax return) and Social Security can recalculate your tier using the more recent, lower-income year.
IRMAA vs. the standard premium
Most beneficiaries pay only the standard premium. IRMAA affects a minority of higher-income enrollees, but for them it can more than triple the Part B premium. It is recalculated every year from a fresh two-year-old return, so your tier can rise or fall annually as your income changes — it is not a permanent label.
When and how you pay IRMAA
Social Security determines your IRMAA automatically from IRS data and sends a notice before the year begins. If you already receive Social Security, the Part B premium plus any IRMAA is deducted from your benefit. The Part D IRMAA, however, is billed separately — even though your drug plan premium is paid to a private insurer, the Part D surcharge is paid to Medicare. New enrollees and those not yet drawing Social Security are billed directly each quarter.
If you disagree with the determination, you have two routes: file Form SSA-44 for a qualifying life-changing event, or request a formal reconsideration if you believe the underlying tax data is wrong (for example, an amended return that lowered your MAGI). Acting promptly matters, because surcharges are charged month by month while an appeal is pending.
The bottom line
IRMAA is an income-based Medicare surcharge set by your MAGI from two years prior. For 2026, it kicks in above $109,000 (single) / $218,000 (joint) and climbs through five tiers to $689.90 Part B plus $91.00 Part D per month. These are estimates and general information, not financial advice — verify with CMS and the Social Security Administration.