You’ve planned for housing, food, travel and healthcare. But one retirement cost blindsides more people than almost any other: IRMAA. Most retirees have never heard of it until it appears on their Medicare statement, and by then it is already costing them money.
This guide explains what IRMAA is, the 2026 brackets, what triggers it, and the practical ways to avoid or reduce it.
Key takeaways
- IRMAA is an extra charge on Medicare Part B and Part D premiums for people with higher incomes.
- It is based on your tax return from two years earlier: your 2026 premiums use your 2024 income.
- In 2026 it starts when modified adjusted gross income (MAGI) is above $109,000 (single) or $218,000 (married filing jointly).
- It works like a cliff: go $1 over a threshold and you pay the whole surcharge for that tier.
- If your income has dropped because of a life-changing event, you can ask SSA to use your current income instead (Form SSA-44).
What IRMAA is
IRMAA stands for Income-Related Monthly Adjustment Amount. Most people pay the standard Medicare Part B premium, which is $202.90 a month in 2026. Higher-income beneficiaries pay more, in five steps, up to $689.90 a month. Part D drug coverage carries its own IRMAA, added on top of your plan’s premium. The Social Security Administration decides your tier and usually deducts the amount from your Social Security check.
2026 IRMAA brackets
| MAGI (single) | MAGI (married filing jointly) | Part B per month | Part D surcharge per month |
|---|---|---|---|
| $109,000 or less | $218,000 or less | $202.90 | $0 |
| $109,001 to $137,000 | $218,001 to $274,000 | $284.10 | $14.50 |
| $137,001 to $171,000 | $274,001 to $342,000 | $405.80 | $37.50 |
| $171,001 to $205,000 | $342,001 to $410,000 | $527.50 | $60.40 |
| $205,001 to $499,999 | $410,001 to $749,999 | $649.20 | $83.30 |
| $500,000 or more | $750,000 or more | $689.90 | $91.00 |
The amounts are per person. A married couple both on Medicare who land in the first IRMAA tier pay roughly $2,300 a year more in Part B and Part D combined than a couple $1 below the line.
Why it’s a cliff, not a slope
Income tax brackets only tax the dollars above each line at the higher rate. IRMAA doesn’t work that way. Cross a threshold by a single dollar and the full surcharge for that tier applies for the whole year. That makes it worth knowing exactly where your income sits before you finalise a Roth conversion, sell investments or take a large withdrawal.
The two-year lookback
Because SSA uses your tax return from two years earlier, a one-off income spike shows up later as a surprise premium increase. A Roth conversion or property sale at 63 can raise your Medicare premiums at 65. And a big income year in your first year of retirement can be followed by two years of higher premiums even though your income has since fallen.
What counts toward IRMAA
IRMAA uses MAGI: your adjusted gross income plus tax-exempt interest. That includes:
- wages, pensions and IRA or 401(k) withdrawals, including required minimum distributions
- Roth conversion amounts
- capital gains and dividends, even those taxed at 0%
- the taxable part of your Social Security
- rental and business income
- municipal bond interest, even though it isn’t federally taxed
Qualified Roth IRA withdrawals and HSA withdrawals for medical expenses do not count.
How to avoid or reduce IRMAA
- Do Roth conversions before 63, or size them to stay under the next threshold. See our Roth conversions guide.
- Spread large transactions over several years rather than taking one big withdrawal or sale.
- Use Roth money to top up spending in years when you are close to a threshold.
- Give through a QCD. From 70½, qualified charitable distributions (up to $111,000 in 2026) satisfy your RMD without adding to MAGI. See RMDs and taxes.
- Time capital gains. Realise gains in lower-income years, and remember gains taxed at 0% still count. See capital gains in retirement.
- Plan two years ahead. Each year, project the income that will set your premiums two years from now.
Appealing IRMAA with Form SSA-44
If your income has dropped because of a life-changing event, you can ask SSA to recalculate using a more recent year. Qualifying events include stopping or reducing work, marriage, divorce, death of a spouse, and loss of pension or income-producing property. Retirement itself is the most common reason. File Form SSA-44 with proof of the event and your new income estimate. It is the one IRMAA tool that works after the fact.
Frequently asked questions
Is IRMAA permanent?
No. It is recalculated every year. If your income falls below the threshold, the surcharge drops off two years later, or sooner with a successful SSA-44 appeal.
Does a Roth conversion trigger IRMAA?
It can. The converted amount counts toward MAGI in the year you convert, which sets your premiums two years later.
Do both spouses pay IRMAA?
Yes. On a joint return, each spouse on Medicare pays the surcharge for the household’s tier.
The bottom line
IRMAA is avoidable for many retirees, but only with planning done two years in advance. Know the 2026 thresholds, check where your income will land, and use Roth money, QCDs and well-timed conversions to stay on the right side of the line. Our guide to tax-efficient withdrawal strategies shows how to fit it into your yearly plan.
Want the full playbook? The Essential Retirement Tax Strategy Guide walks through Medicare thresholds, Roth conversions and withdrawal order in plain English, with worked examples.
2026 figures are from the Centers for Medicare & Medicaid Services. This article is for education only and is not financial advice. Review major decisions with a qualified professional.
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