What IRMAA Is (and Why It Surprises People)
IRMAA — the Income-Related Monthly Adjustment Amount — is a surcharge added to Medicare Part B and Part D premiums for higher-income beneficiaries. It surprises people for one big reason: it's based on your modified adjusted gross income from your tax return two years prior. Your 2026 premiums are set by your 2024 income.
That two-year lookback catches people in their first Medicare years constantly. Your final working years are often your highest-earning years — so many people retire, see their income drop, and still pay surcharges based on paychecks they no longer receive.
The 2026 Brackets
The standard 2026 Part B premium is $202.90 per month. IRMAA adds a surcharge in five tiers above it. For single filers (joint-filer thresholds are double, up to the top tier):
- $109,000 or less: standard $202.90/month — no surcharge
- Above $109,000 to $137,000: $284.10/month total
- Above $137,000 to $171,000: $405.90/month total
- Above $171,000 to $205,000: $527.70/month total
- Above $205,000 to $500,000: $649.50/month total
- Above $500,000 ($750,000 joint): $689.90/month total
The Cliff Problem
IRMAA brackets are cliffs, not ramps. One dollar of income over a threshold moves your entire premium to the next tier — for both spouses, for the whole year. A $1 Roth conversion mistake at the margin can cost a married couple well over $1,900 in added premiums for the year.
That's why income timing matters so much in the years around 65: large IRA withdrawals, Roth conversions, capital gains from selling a home or land, and even a final bonus all land in the two-year lookback window. None of this means avoiding income — it means knowing where the thresholds are before you trigger them, while there's still time to plan around them.
Life Changes: How to Appeal
If your income has dropped since that two-year-old tax return because of a life-changing event, you don't have to just accept the surcharge. Social Security's form SSA-44 lets you request a reduction based on your current, lower income.
Qualifying events include retirement or reduced work hours, marriage or divorce, death of a spouse, and loss of income-producing property. Retirement is by far the most common — and the most commonly missed. If you retired in 2025 or 2026 and you're paying IRMAA based on 2024 wages, an appeal is usually worth filing.
What This Means for Your Planning
IRMAA isn't a reason to fear Medicare — the surcharges affect a minority of beneficiaries, and even the top tier is often cheaper than comparable private coverage. But it is a reason to coordinate your retirement-income plan with your Medicare timeline. We flag the thresholds during every consultation, and when a client's situation calls for tax-specific strategy, we say plainly: bring your CPA into the conversation. Education is free; guessing is expensive.
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