IRMAA: Higher Medicare Premiums for Higher Incomes

IRMAA, the income-related monthly adjustment amount, is an extra charge on your Part B and Part D premiums when your income is above a set level. In 2026 it starts when modified adjusted gross income is above $109,000 for a single filer or $218,000 for a married couple filing jointly, based on your 2024 tax return. The surcharge ranges from $81.20 to $487.00 a month on Part B and from $14.50 to $91.00 a month on Part D, per person (CMS). It is not a penalty and it is not permanent: Social Security looks at your income again every year, and you can ask for a new decision if your income has dropped because of a life-changing event such as retirement.

How IRMAA works

• Social Security decides whether you owe IRMAA, using the federal tax return the IRS has for you, usually from two years before the premium year. 2026 premiums use 2024 returns.
• The income measure is modified adjusted gross income (MAGI): the adjusted gross income on your return plus any tax-exempt interest.
• IRMAA is charged per person. A married couple who are both on Medicare can each pay it.
• It applies to Part B and to Part D. The Part D amount is added on top of your plan premium and paid to Medicare, not the plan. It applies whether you have a standalone Part D plan or a Medicare Advantage plan that includes drug coverage.
• You get a letter from Social Security explaining the decision, usually before the new year starts. If you pay premiums out of your Social Security check, the higher amount comes out of the check.

The 2026 IRMAA brackets

These are the 2026 amounts CMS published. The Part B column is the total monthly premium; the Part D column is the surcharge added to whatever your plan charges. At the top, the bracket starts at $500,000 single or $750,000 joint, and income at or above that amount is in the top bracket.

Married filing separately has its own scale

If you are married, lived with your spouse at any time in the tax year and file separately, Social Security's sliding scale is much steeper. In 2026, MAGI of $109,000 or less carries no IRMAA. Above $109,000 and under $391,000, the Part B premium is $649.20 and the Part D surcharge $83.30. At $391,000 or more, it is $689.90 and $91.00. Before choosing a filing status, ask your tax preparer to look at the Medicare effect as well as the tax effect.

What it costs: two examples

A single filer whose 2024 MAGI was $110,000 is $1,000 over the first threshold. In 2026 that person pays $284.10 for Part B instead of $202.90, plus a $14.50 Part D surcharge: $95.70 a month extra, or $1,148.40 for the year.

A married couple filing jointly with $300,000 of 2024 MAGI falls in the third bracket. Each spouse pays $405.80 for Part B and a $37.50 Part D surcharge, so together they pay $480.80 a month more than the standard amounts, or $5,769.60 for the year.

Our IRMAA calculator at headwatershw.com/tools/irmaa-calculator/ shows the 2026 bracket for your own income and filing status.

When your income has dropped: life-changing events

Because IRMAA looks back two years, it often lands just after people retire, when their income is already lower. Social Security will use a more recent year's income if your income went down because of one of these life-changing events. You can ask with form SSA-44, Medicare Income-Related Monthly Adjustment Amount, Life-Changing Event, and Lisa helps you fill it in and file it.

• Marriage
• Divorce or annulment
• Death of a spouse
• Work stoppage, such as retiring
• Work reduction, such as cutting to part-time
• Loss of income-producing property, such as from a disaster
• Loss or reduction of certain pension income
• An employer settlement payment because of the employer’s closure, bankruptcy or reorganization

If the decision is wrong

If the IRS data Social Security used is wrong or out of date, for example an amended return or a one-time item that was counted twice, you can ask for a reconsideration. Social Security policy gives you 60 days from when you receive the notice, and it presumes you received it five days after the date on the letter. Lisa helps you put the request together with the right proof.

One-time income, such as a large capital gain or a Roth conversion, is not a life-changing event. It raises IRMAA for one premium year and then drops out. Planning those moves with the two-year look-back in mind can keep you in a lower bracket.

What income counts, and what usually does not

Because IRMAA starts from adjusted gross income, anything that raises AGI on your federal return can push you into a higher bracket two years later. Common examples are wages, traditional IRA and 401(k) withdrawals (including required minimum distributions), pension payments, the taxable part of Social Security, interest, dividends and capital gains, including the gain on selling a rental property or a business. Tax-exempt interest, such as from municipal bonds, is added back in, which surprises many people.

Qualified withdrawals from a Roth IRA are generally not part of adjusted gross income, so they do not raise MAGI. Converting a traditional IRA to a Roth does count, in the year you convert. A tax professional can tell you how a specific move shows up on your return.

The bracket edges are cliffs

IRMAA brackets are not phased in. One dollar over a threshold puts you in the whole bracket. In 2026 a single filer with MAGI of $109,000 pays the standard $202.90 for Part B, while a single filer at $109,001 pays $284.10 plus $14.50 for Part D. That is why people near a threshold often look at the timing of large withdrawals, sales and Roth conversions with IRMAA in mind, and why the brackets for the year two years ahead matter when you plan.

How IRMAA is paid, and whether your plan choice changes it

• If you receive Social Security benefits, the Part B premium, including any IRMAA, and the Part D IRMAA are usually taken out of your monthly benefit.
• If you do not receive benefits yet, Medicare bills you directly for the amounts.
• Your plan choice does not change IRMAA. Original Medicare with a Medicare Supplement, or a Medicare Advantage plan: the Part B IRMAA is the same. Any Part D IRMAA applies whether your drug coverage is a standalone plan or part of a Medicare Advantage plan.
• What your plan choice does change is everything else you pay: plan premiums, copays, deductibles and the out-of-pocket limit. Our guide at headwatershw.com/learn/medicare-costs-2026/ puts the pieces together.

What changes for 2027

CMS had not published the 2027 Part B premium or the 2027 IRMAA brackets as of October 19, 2026; they are usually announced in the fall. The 2027 amounts will be based on 2025 tax returns. Until then, every IRMAA figure on this page is the 2026 figure and is labelled that way.

Figures used in this guide

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The bottom line

IRMAA is based on income from two years back, it is charged per person, and it can be reduced when your income falls for a reason Social Security recognizes. If you are retiring, file the SSA-44 as soon as you have proof of the change. If you are planning a big sale or conversion, look at the Medicare brackets first. Lisa can walk through your Part B and Part D costs with you, including how IRMAA fits with your plan choice.