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IRMAA: The Income Brackets That Raise Your Medicare Premiums

Most people budget for a Medicare premium and assume that's the number. Then a letter arrives from Social Security adding $80, $300, or more to it every month — for both Part B and any drug coverage — and nobody warned them it was coming. That letter is IRMAA: the Income-Related Monthly Adjustment Amount. It isn't a penalty and it isn't tied to any plan you picked. It's a federal surcharge based purely on your income, and it catches retirees off guard every year, often right after a big income event like a home sale or an IRA withdrawal two years earlier.

What is IRMAA, and who actually has to pay it?

IRMAA is an extra amount added to your standard Medicare Part B premium and, separately, to your Part D drug coverage, once your income crosses a threshold. In 2026 that threshold is $109,000 for a single filer or $218,000 for a married couple filing jointly. Below those amounts, everyone pays the same standard premium regardless of income.

It applies whether you have Original Medicare with a Medigap policy or a Medicare Advantage plan — IRMAA rides on top of Part B itself, not on whichever plan you use it with. It applies to a Medicare Advantage plan's built-in drug coverage exactly the same way it applies to a standalone Part D plan. There is no way to avoid it by choosing a particular type of coverage; the only lever is income.

Why is my 2026 premium based on my income from 2024?

Because Social Security uses the most recent tax return the IRS has finished processing when it sets next year's premiums — and that is normally your return from two years earlier. Your 2026 IRMAA determination is based on your 2024 tax return; your 2027 determination will be based on your 2025 return. Medicare finalizes each year's IRMAA figures in the fourth quarter of the prior year, which is why the data point is always two years old rather than one.

This lag is the single most misunderstood part of IRMAA. It means a one-time high-income year — selling a house, a large Roth conversion, an unusually big required minimum distribution — can trigger a surcharge two full years later, long after the income is gone and spent. It also means a surcharge you're paying today may already be based on income you no longer earn, which is exactly the situation the appeal process further down exists to fix.

What are the 2026 IRMAA brackets and surcharges?

There are five income tiers above the standard threshold, and each one adds a fixed dollar amount to both Part B and Part D. The table below shows the 2026 figures, using modified adjusted gross income (MAGI) from your 2024 tax return.

• Up to $109,000 single / $218,000 joint: no surcharge — standard $202.90 Part B premium only.
• $109,001–$137,000 single / $218,001–$274,000 joint: +$81.20 Part B (total $284.10), +$14.50 Part D.
• $137,001–$171,000 single / $274,001–$342,000 joint: +$202.90 Part B (total $405.80), +$37.50 Part D.
• $171,001–$205,000 single / $342,001–$410,000 joint: +$324.60 Part B (total $527.50), +$60.40 Part D.
• $205,001–$499,999 single / $410,001–$749,999 joint: +$446.30 Part B (total $649.20), +$83.30 Part D.
• $500,000+ single / $750,000+ joint: +$487.00 Part B (total $689.90), +$91.00 Part D.

Two things trip people up here. First, this is a cliff, not a gradual slope — one dollar over a threshold moves your entire premium to the next tier, not just the income above the line. Second, if you're married but file a separate tax return from your spouse, the brackets are far narrower and far harsher: no surcharge up to $109,000, but a single dollar over that jumps you straight to the second-highest tier ($649.20 total Part B, $83.30 Part D) all the way up to $391,000, with only the top tier above that. Filing separately for reasons unrelated to Medicare can be an expensive surprise for a couple who didn't know this rule existed.

What counts as income for IRMAA — and what doesn't?

IRMAA uses Modified Adjusted Gross Income: your Adjusted Gross Income from your tax return (Form 1040, line 11) plus any tax-exempt interest (line 2a), such as interest from municipal bonds. That means it captures more than most people expect — wages, the taxable portion of Social Security, interest and dividends, capital gains, pension and annuity income, rental and business income, and withdrawals from traditional IRAs and 401(k)s, including Roth conversions and required minimum distributions.

What it generally does not include: qualified withdrawals from a Roth IRA or Roth 401(k), since those aren't taxable income in the first place, and gifts or inheritances you received rather than earned. This is the reason financial planners talk about Roth conversions and tax-bracket management well before Medicare age — money moved into a Roth account before you enroll stops counting against you in retirement, while the same withdrawal from a traditional account counts every year you take it.

Can I appeal an IRMAA surcharge?

Yes, and it's worth doing if your circumstances have genuinely changed. Social Security allows an appeal, using Form SSA-44 (Medicare Income-Related Monthly Adjustment Amount – Life-Changing Event), when one of eight specific events has reduced your income since the tax year used to calculate your surcharge:

• Marriage
• Divorce or annulment
• Death of a spouse
• Work stoppage or reduction in work hours
• Loss of income-producing property (beyond your control — a disaster, for example)
• Loss of pension income (such as a plan terminating or reducing benefits)
• An employer settlement payment due to closure or bankruptcy
• Any other event Social Security recognizes as a significant income reduction

Retiring is the event that catches the most people — if your 2024 income was your last full working year but you retired in 2025 or 2026, you don't have to wait for the two-year lookback to catch up. You can file SSA-44 with documentation (a retirement letter, a signed statement of expected income, a divorce decree, and similar records) by mail, fax, or in person at a local Social Security office. Appeals typically take 30 to 90 days, and if you've already overpaid, the difference is refunded, usually to the same account your Social Security benefit is deposited into.

A separate situation — not a life-changing event, but a correction — applies if Social Security simply used the wrong tax year or outdated IRS data, for example because you filed an amended return. That's handled as a request to use more accurate information rather than an SSA-44 appeal, but it goes through the same local office.

How and when do you actually pay IRMAA?

Part B IRMAA is folded directly into your monthly Part B premium bill or deducted from your Social Security check along with the rest of your premium — you never receive a separate bill for it. Part D IRMAA works differently: it is always billed separately by Medicare, never by your plan, even if an employer or a retirement system pays your regular Part D premium on your behalf. You're responsible for that bill regardless of who pays the underlying plan premium, and it's paid the same ways you'd pay any other Medicare premium — through your Social Security deduction, a MyMedicare online account, your bank's bill-pay service, Medicare Easy Pay, or by mail.

One more point worth knowing before Annual Enrollment: switching plans during the October 15–December 7 window changes what you pay a carrier. It does nothing to your IRMAA, because IRMAA isn't attached to a plan at all — it's attached to you. Our guide to the Annual Enrollment Period covers what switching can and can't change, and our guide to choosing a Part D plan in Tucson covers the parts of your drug costs you actually can control by shopping — formulary tier, pharmacy network, and total annual cost.

Frequently Asked Questions

Does choosing a $0-premium Medicare Advantage plan get you out of paying IRMAA?

No. IRMAA is a separate federal surcharge tied to your income, not to any plan's premium. Even on a $0-premium Medicare Advantage plan, a high enough income still means a Part B IRMAA charge, and a Part D IRMAA charge if the plan includes drug coverage.

If I retire and my income drops, do I still pay IRMAA based on my old, higher income?

You might, for a while, since IRMAA normally runs two years behind your tax return. But retirement is one of the eight life-changing events Social Security accepts on Form SSA-44, so you can ask them to use your current, lower expected income instead of waiting two years.

Does a Roth conversion I do this year affect my premium right away?

Not right away. IRMAA is based on your tax return from two years earlier, so a conversion done in 2026 affects your IRMAA in 2028, not your premium today. That two-year gap is exactly why conversions should be planned well before you expect to need Medicare.