What Is IRMAA?

Most people pay the standard Part B premium, $202.90 per month in 2026. If Social Security decides your income is above a set line, it adds a surcharge to that premium, and a second, smaller surcharge to your Part D drug coverage. The surcharge is not a penalty and has nothing to do with your health. It is a means test, set by income alone. Part B premiums have been tied to income since 2007, and drug coverage premiums since 2011.

Three things surprise almost everyone who sits down in our offices.

• It uses old income. Social Security reads the return the IRS has on file, which is the return from two years earlier. Your 2026 premium comes from your 2024 return.*
• It is per person. A married couple on Medicare pays it twice, once on each premium, based on the joint return.
• It follows you into any plan. The Part B surcharge applies whether you keep Original Medicare or choose a Medicare Advantage plan. The Part D surcharge applies to any Medicare drug coverage, including drug coverage built into an Advantage plan, and you pay it to Medicare, not to the insurance company.*

The income Social Security looks at is modified adjusted gross income, or MAGI: your adjusted gross income plus any tax-exempt interest. If you have only Part B, or only drug coverage, the adjustment applies to the one you have.

Key point: IRMAA is recalculated every year. A high-income year costs you for one premium year, two years later, and then it is gone, unless the next return is also above the line.

This guide is educational, not personalized advice.

The 2026 IRMAA Brackets

Here are the 2026 tiers, from the CMS fact sheet released in November 2025.* Find your filing status and the line your 2024 MAGI falls on, then read across. The Part B column is your total monthly premium; the surcharge columns show the add-ons to Part B and to your drug plan.

Source: CMS, 2026

What the table does not say:

• The brackets are cliffs, not slopes. One dollar over a line puts you in the next tier for the entire year. For a single filer, income of $109,001 carries the same surcharge as income of $137,000.
• The Part B tiers are multiples of the standard premium. Each tier is $202.90 times 1.4, 2.0, 2.6, 3.2, or 3.4.*
• The Part D surcharge is separate from your drug plan’s premium. It is added on top of whatever the plan charges, even when the plan premium is zero, and it is paid to Medicare.*
• Married filing separately is compressed. If you are married, lived with your spouse at any time during the year, and file a separate return, the standard premium applies up to $109,000. Above $109,000 and below $391,000 the surcharges are $446.30 for Part B and $83.30 for Part D, and at $391,000 or more they are $487.00 and $91.00, the same as the two highest tiers above.*
• The top bracket is frozen. The $500,000 and $750,000 lines are not indexed for inflation until at least 2028.*

In annual terms, per person: the first tier adds $81.20 plus $14.50, or $95.70 a month, which is $1,148.40 a year. The top tier adds $487.00 plus $91.00, or $578.00 a month, which is $6,936.00 a year. A couple pays each of those twice.

The Two-Year Lookback

Social Security does not know what you earned this year. It asks the IRS for the most recent return it has fully processed, and that is normally the return from two years ago.*

So the money you earn in 2026 sets your premium in 2028. A big year at 63 shows up at 65, right when you enroll.

The notice arrives late in the year, in a letter from Social Security, not from your insurance company. If Social Security is already paying you, the surcharge comes out of your benefit. If not, you get a bill. Occasionally the IRS has only given Social Security your 2023 return. If that is the year on your letter and you have filed for 2024, call or visit a local Social Security office and it will update its records.

A man in his late 60s called our offices holding one of those letters. His premium had roughly doubled, and he assumed the insurance company had raised his Supplement rate. The letter was Social Security’s, and the increase was IRMAA from a strong income year two years earlier. The teaching point: two different bills, two different senders. The plan premium had not moved at all.

What Pushes People Over the Line

Ordinary retirement income rarely does it. The one-time events do. Roth conversions, realized capital gains, and required minimum distributions all raise MAGI, and the bill for them arrives two years later.* Four we see most:

Selling a business or a property

A couple in the Valley sold the small business they had run for decades, the year one of them was 63. Their normal income was modest. The sale year was not. Two years later both surcharges appeared, and they called us certain something was wrong. Nothing was. A one-time sale is not a life-changing event, so there was no appeal to file. The surcharge lasted one premium year and dropped off when the next return became the lookback year. The teaching point: if a sale is coming, the year it closes is a Medicare decision as much as a tax decision.

Roth conversions

A retired couple in their early 60s, living on a pension and Social Security with a large traditional IRA, wanted to convert part of it to Roth before required distributions began. A conversion is taxable income in the year it happens, and it counts for IRMAA. What we do is map each year’s proposed conversion against the tiers that will apply two years later, when both will be on Medicare, so each year fills a tier without spilling into the next. Then the plan goes to their tax preparer, who owns the tax side. The teaching point: a conversion is a good tool with a known IRMAA cost. Known is the operative word.

Required minimum distributions

They begin at 73 for people born from 1951 through 1959, and at 75 for those born in 1960 or later.* They are taxable, not optional, and they grow with the account. A household that stayed under the line for years can cross it the year the distributions start.

Other one-time income

Severance, a pension lump sum, exercised stock options, a large IRA withdrawal, tax-exempt interest, and the taxable part of Social Security all count.

Watch out: a one-time gain by itself does not qualify for an appeal. The appeal is for life events, not income events.

The SSA-44 Appeal

Social Security built a path around the lookback for people whose lives have changed. If a life-changing event lowered your income, you can ask it to use a more recent year instead. The form is Form SSA-44, Medicare Income-Related Monthly Adjustment Amount, Life-Changing Event, and the plain-language overview is on ssa.gov: request to lower an IRMAA.

The life-changing events

The form recognizes these events, and only these:*

• Marriage
• Divorce or annulment
• Death of a spouse
• Work stoppage, such as retirement
• Work reduction, such as moving to part time
• Loss of income-producing property, when the loss was outside your control, such as a disaster, theft, or investment fraud, not a sale you chose
• Loss of pension income, because an employer’s pension plan was ended or reorganized
• An employer settlement payment because of the employer’s bankruptcy or reorganization

How the appeal works

1. Confirm the event and its date.
2. Estimate this year’s MAGI. The form asks for your expected income for the year the surcharge applies, and for next year if the drop continues.
3. Attach proof. Documentation of the event, such as a letter from your employer about your retirement or a death certificate, and a signed copy of your return for the year in question if you filed one.*
4. File it. Online through your my Social Security account, by fax or mail to a Social Security office, or in person by appointment. If Social Security asks for more information, answer by the deadline in its letter.
5. File again if you need to. The same event can support a request for the following year as well.

A woman in her 70s came into our offices for a routine annual review. Her husband had closed his business, they were living on Social Security and what they had put away, and the surcharge was still coming out of her check because the lookback year carried the business income. She had mailed the form months earlier and heard nothing. We walked through it again, and she took the form and her documents to the local Social Security office in person. Work stoppage is on the list, and when the event qualifies, Social Security recalculates the premium on the current year’s estimate. The teaching point: the form is not filed until Social Security has it. If the mail goes quiet, go in.

Watch out: if none of the eight events apply, there is no appeal, and the surcharge stands until the next return becomes the lookback year. The reverse is also true: a divorce or a layoff qualifies even when the old return also carried a property sale, because the appeal is about what happened to you, not the number on the old return. An amended return is a different request: call Social Security with the amended return and your IRS acknowledgment. And if you disagree with the decision itself, that is a reconsideration, not an SSA-44; the letter explains how to file it.

Planning Before You Enroll

By the time the letter arrives, the number is locked, on a return you already filed. That is why our advisors bring IRMAA into the conversation two years before Medicare starts, not two months.

Here is what we do with everyone still earning well in their early 60s:

• Pull the return Medicare will use. Your 2026 premium comes from 2024. We find the MAGI line and the tier it lands on.
• Check for an appeal. If you are retiring the year you enroll, the SSA-44 belongs in the enrollment packet, not in a drawer.
• Map the next two years. Every planned conversion, sale, distribution, and retirement date goes on one page next to the tiers, so you can see which year each dollar lands in.
• Hand it to your tax professional. IRMAA sits on top of the tax return, so we coordinate with the person who prepares yours.

This is a tax-adjacent topic, and the professional who prepares your return belongs in the conversation. This is educational, not tax or legal advice; consult your tax professional about your situation.

That is the Certified Medicare Planner® standard: the return in hand before the recommendation, each spouse’s premium worked out separately, and a written summary after the meeting. It is our own registered mark, not a government credential, and you can read what it promises you.

IRMAA is not a punishment. It is a math problem, and math problems have answers when you do the math before the bill arrives. Approaching 65? Start with the turning 65 guide. Still on an employer plan? Read leaving employer coverage, because the year you retire and the year you enroll are often the same year. Letter just came? Already on Medicare covers the annual review. For the foundation these surcharges sit on, see how Medicare works and Parts A and B. And the workshop on Friday, October 2, 2026 walks through all of it in an hour: reserve a seat at the Medicare workshop.