IRMAA: why some people pay more for Medicare, and how to appeal
If your income is above a threshold, Medicare adds a surcharge to your Part B and Part D premiums. The catch is that it's based on your tax return from two years ago — so the year you retire, you can be charged as if you were still working. Here's how it works and how to fix it.
How IRMAA works
Everyone on Medicare pays the standard Part B premium. If your modified adjusted gross income from two years earlier is above a threshold, Social Security adds an Income-Related Monthly Adjustment Amount — IRMAA — on top, in brackets that rise with income. A separate IRMAA is added to your Part D premium, whether you have a standalone drug plan or drug coverage inside a Medicare Advantage plan.
The surcharge is deducted from your Social Security payment if you receive one. If you don't, the Part B amount is billed every three months and the Part D IRMAA monthly. At the top bracket it can more than triple the Part B premium.
2026 brackets (based on your 2024 tax return)
| Single filer MAGI | Married filing jointly MAGI | Part B premium per month | Added to Part D premium |
|---|---|---|---|
| Up to $109,000 | Up to $218,000 | $202.90 | $0 |
| $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 and above | $750,000 and above | $689.90 | + $91.00 |
Married filing separately uses its own two-bracket schedule. A couple in the first surcharge bracket pays about $2,300 a year more than the standard premiums between them; at the top, nearly $14,000.
The two-year lag
This is what catches people. 2026 premiums are based on 2024 income. If you retired in 2025, your 2024 return shows a full year of salary — and Medicare charges you as a high earner in a year when you may have very little income. The same happens to anyone who had a one-off spike: selling a business, a large capital gain, a big Roth conversion, cashing out stock options.
Form SSA-44: Life-Changing Event
If your income dropped because of retirement, reduced hours, marriage, divorce, a spouse's death, loss of a pension, or loss of income-producing property through events beyond your control (selling it doesn't count), you can ask Social Security for a new determination using your current or projected income. File form SSA-44 with proof — a retirement letter, a final pay stub.
What you can do about it in advance
- Watch the brackets. IRMAA is a cliff, not a slope: one dollar over a threshold puts you in the next bracket for the whole year. A modest IRA withdrawal or a small capital gain can be the dollar that does it.
- Know the two-year lag. Roth conversions, property sales and large withdrawals show up in your Medicare premium two years later. Discuss timing with your tax professional; I can explain the Medicare side.
- Qualified charitable distributions. After 70½, giving directly from an IRA to charity satisfies required distributions without raising MAGI.
- Coordinate with Social Security timing. Delaying Social Security while drawing from retirement accounts, or the reverse, changes MAGI in the years that matter. This is a conversation I have as part of claiming analysis.
I'm not a tax adviser and none of this is tax advice — your accountant should be part of any planning here. What I can do is flag when a decision you're making about Medicare or Social Security has an IRMAA consequence two years out.
Who this affects in the Capital Region
State and university pensioners, GE retirees with deferred compensation, people selling long-held homes, and dual-income couples where both keep working past 65 — in other words, a lot of Albany, Saratoga and Schenectady County residents who don't think of themselves as "high income." If you got a letter from Social Security saying your premium is higher because of your income, get in touch and we'll check whether an appeal applies.
I do not offer every plan available in your area. Any information I provide is limited to the plans I do offer in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your State Health Insurance Assistance Program for information on all of your options. Not connected with or endorsed by the U.S. government, the Social Security Administration or the federal Medicare program.
Common questions
Short answers to what people ask before they call.
What income counts for IRMAA?
Modified adjusted gross income — your AGI plus tax-exempt interest — from your federal tax return two years before the year in question. For 2026 premiums, that's your 2024 return. The taxable parts of wages, pensions, Social Security, IRA and 401(k) withdrawals, capital gains, rental income and Roth conversions all count; qualified Roth withdrawals and HSA distributions used for qualified medical expenses don't.
Where are the thresholds?
For 2026, IRMAA applies when your 2024 modified adjusted gross income was above $109,000 (single) or $218,000 (married filing jointly), with four further brackets above that up to $500,000 / $750,000. The figures are indexed each year and published by CMS. If your income is anywhere near those numbers, it's worth checking.
I just retired and my income dropped. Do I have to pay IRMAA based on my working years?
Not necessarily. Retirement, reduced work hours, marriage, divorce, death of a spouse and loss of income-producing property are all 'life-changing events' that let you ask Social Security to use your current-year income instead. You file form SSA-44 with documentation to request a new determination — usually called an IRMAA appeal, and one of the most under-used options in Medicare.
Does IRMAA apply to Medicare Advantage plans too?
Yes. IRMAA is charged on Part B (which you pay regardless of plan type) and on Part D drug coverage, including drug coverage built into an Advantage plan. Choosing an Advantage plan doesn't avoid it.
Is IRMAA permanent?
No — it's recalculated every year from the new two-year-old return. One high-income year (a house sale, a large Roth conversion) causes one year of surcharge, then it falls away.
Let's talk it through
A phone call or a message is all it takes. The first conversation is just a conversation.