Quick Answer: IRMAA, or 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 certain threshold. In 2026, that threshold starts at $109,000 for individuals and $218,000 for married couples filing jointly. The Social Security Administration bases your IRMAA on your tax return from two years earlier, so your 2026 premium is determined by your 2024 income. If your income has dropped since then due to a life-changing event like retirement, you may be able to appeal.
Nothing derails a retirement budget quite like opening a Medicare premium notice and seeing a number that’s hundreds of dollars higher than you expected. For a meaningful number of higher-income retirees, that surprise has a name: IRMAA.
If you’ve never run into it, IRMAA can feel like it came out of nowhere, especially since it’s based on income from two years before you even see the bill. Here’s what IRMAA actually is, how the Social Security Administration calculates it, what the 2026 brackets look like, and what to do if a recent life change means you shouldn’t be paying it anymore.
What Is IRMAA?
IRMAA stands for Income-Related Monthly Adjustment Amount. It’s a surcharge added on top of the standard Medicare Part B and Part D premiums for beneficiaries whose income exceeds certain thresholds set by the Social Security Administration.
IRMAA isn’t a penalty and it isn’t optional once you cross the threshold. It’s simply a built-in part of how Medicare is funded: higher earners pay a larger share of the program’s cost through higher premiums. It applies whether you have Original Medicare or a Medicare Advantage plan, as long as you’re enrolled in Part B and/or Part D.
Why Does IRMAA Use Income From Two Years Ago?
The Social Security Administration relies on the most recent tax return the IRS has on file, which is typically from two years prior. For your 2026 IRMAA determination, the SSA looks at your 2024 tax return. This lag is exactly why IRMAA catches so many people off guard: your income and your premium notice are never talking about the same year.
What Are the 2026 IRMAA Brackets?
For 2026, the standard Part B premium is $202.90 a month. IRMAA applies once your modified adjusted gross income (MAGI) from 2024 exceeds $109,000 for individual filers or $218,000 for those married filing jointly. Once you cross that threshold, your Part B premium can range from roughly $284.10 to $689.90 a month, depending on which of the five income tiers you fall into. Part D IRMAA surcharges are added on top of your plan’s premium and range from about $14.50 to $91.00 a month.
IRMAA Works Differently Than a Tax Bracket
This trips up a lot of people. Income tax brackets are marginal, meaning only the income above each threshold is taxed at the higher rate. IRMAA doesn’t work that way. Once your MAGI crosses into a tier, the surcharge for that entire tier applies to your full premium, not just the portion of income above the line. A single dollar over a threshold can trigger a meaningfully higher monthly premium for the whole year.
How Is IRMAA Calculated?
The SSA uses your Modified Adjusted Gross Income, which is your adjusted gross income plus tax-exempt interest income, from your federal tax return two years prior. This calculation happens automatically each year; you don’t apply for IRMAA or request it, and there’s no way to opt out if your income qualifies you for it.
If the SSA determines you owe an IRMAA, they’ll send you an Initial Determination Notice showing your new premium and the reasoning behind it. If you have both Part B and Part D coverage, you’ll see a surcharge applied to each separately.
A Trade-Off Worth Understanding
Because IRMAA is based on income from two years ago, certain one-time financial events, like a large Roth IRA conversion, the sale of an investment property, or a lump-sum retirement account withdrawal, can push you into an IRMAA tier the following year even though your regular ongoing income hasn’t actually changed. This is a common and expensive surprise for people doing tax planning without factoring Medicare into the equation.
Can You Appeal an IRMAA Determination?
Yes, but only under specific circumstances. If your income has dropped since the tax year the SSA used because of a qualifying life-changing event, you can file Form SSA-44, Medicare Income-Related Monthly Adjustment Amount – Life-Changing Event, to ask the SSA to use more current income instead.
Qualifying life-changing events include retirement or work reduction, marriage, divorce, the death of a spouse, loss of pension income, loss of income-producing property, and an employer settlement payment. A one-time capital gain from selling an asset generally doesn’t qualify, since it’s not considered an ongoing change in your income.
A Real Scenario Worth Considering
Say you retired in Tulsa last year, but your most recent tax return still reflects a full year of salary from your old job, putting you into an IRMAA tier you’re no longer anywhere close to based on your current retirement income. Filing Form SSA-44 with proof of your retirement date and your reduced income could bring your premium back down to where it should be, and any overpayment already made can typically be refunded.
How Do You Avoid or Reduce IRMAA Going Forward?
If you’re still a few years out from Medicare, there’s real value in thinking about how retirement account withdrawals, Roth conversions, and capital gains might affect your MAGI two years down the road, since Medicare premiums are one of the most commonly overlooked pieces of retirement income planning.
If you’re already on Medicare and facing an IRMAA surcharge that doesn’t reflect your current income, filing Form SSA-44 promptly after a qualifying event is the most direct path to lowering it. This is exactly the kind of planning conversation I have regularly with clients in the Tulsa area, since a $1,000 to $6,000 a year surcharge is worth understanding well before it shows up on a bill. If you’d like help thinking through how IRMAA might affect your Medicare costs, you can schedule a free consultation and we’ll walk through your specific situation.
Frequently Asked Questions
What is IRMAA?
IRMAA, or the Income-Related Monthly Adjustment Amount, is a surcharge added to Medicare Part B and Part D premiums for beneficiaries whose income exceeds certain thresholds set by the Social Security Administration.
What income triggers IRMAA in 2026?
IRMAA applies in 2026 if your 2024 modified adjusted gross income exceeded $109,000 for individual filers or $218,000 for married couples filing jointly.
Why is my IRMAA based on income from two years ago?
The Social Security Administration uses the most recent complete tax return available from the IRS, which is typically from two years prior, to determine your current-year IRMAA.
Can I appeal my IRMAA if my income has dropped?
Yes. If a qualifying life-changing event, such as retirement, marriage, divorce, or the death of a spouse, has reduced your income since the tax year used, you can file Form SSA-44 to request a redetermination based on more current income.
Does IRMAA apply to Medicare Advantage plans?
Yes. IRMAA applies to anyone enrolled in Medicare Part B and/or Part D, regardless of whether you have Original Medicare or a Medicare Advantage plan that includes prescription drug coverage.
The Bottom Line
IRMAA comes down to one key idea: Medicare premiums aren’t one-size-fits-all once your income crosses certain thresholds, and because those thresholds are based on income from two years earlier, it’s easy to get caught paying a surcharge that no longer reflects your actual financial picture. Knowing the brackets, understanding how the two-year lookback works, and knowing when Form SSA-44 applies can save you real money.
If you’re facing an IRMAA surcharge or want to plan ahead of one before you enroll in Medicare, call 918-815-6382 or schedule a free consultation and we’ll walk through your specific situation. You can also browse our Medicare plan options or read our Medicare frequently asked questions for more detail.