Key takeaways
- IRMAA is an extra amount added to your Part B and Part D premiums when your income is above set limits.
- Social Security generally uses your tax return from two years earlier, so 2026 premiums are based on 2024 income.
- For 2026, IRMAA starts above $109,000 in MAGI for single filers and $218,000 for joint filers.
- If your income dropped because of a life-changing event such as retirement, you can ask for a new decision with form SSA-44.
- Kris is a licensed agent, not a tax adviser. Talk with your tax professional before making income decisions.
What is IRMAA?
IRMAA stands for Income-Related Monthly Adjustment Amount. It’s an extra charge added to your Medicare Part B and Part D premiums when your income is above certain limits. Most people never pay it. But if you had a high-income year, you may see a surcharge on top of the standard premiums.
Social Security decides whether IRMAA applies to you, and it sends you a letter explaining the amount. If you already get Social Security benefits, the extra amount is usually taken out of your monthly check. If you don’t, Medicare bills you directly. Either way, the surcharge is separate from any premium your private plan charges.
The surcharge applies whether you have Original Medicare or a Medicare Advantage plan, because everyone with Part B pays a Part B premium. The Part D portion applies if you have drug coverage, either through a standalone Part D plan or a plan that includes drug coverage. You pay the Part D surcharge to Medicare, not to your plan.
How the two-year lookback works
Medicare uses a two-year lookback. Social Security generally checks the tax return the IRS has on file from two years before the premium year. That means your 2026 premiums are usually based on your 2024 income, and your 2027 premiums on your 2025 income.
This timing surprises a lot of new retirees. Your last full year of work, or a year with a big bonus, can show up on your Medicare bill two years later, even though your paycheck has stopped. It isn’t a mistake. It’s simply how the rules are written. Knowing about it ahead of time can help you plan for it.
The income Medicare looks at is your modified adjusted gross income (MAGI). For IRMAA, that’s generally your adjusted gross income plus any tax-exempt interest, such as interest from municipal bonds. Your tax professional can show you where those figures appear on your return. That way you can check them against your Social Security letter.
| Premium year | Tax year usually used | What to watch |
|---|---|---|
| 2026 | 2024 tax return | Income from your working years may still count |
| 2027 | 2025 tax return | Thresholds for 2027 not yet announced |
2026 IRMAA thresholds and who pays
For 2026, IRMAA applies when your MAGI from 2024 was above $109,000 if you filed as single, or above $218,000 if you filed jointly. If your income was at or below those amounts, you pay the standard premiums. Above them, the surcharge rises in tiers as income goes up.
The standard Part B premium for 2026 is $202.90 a month. IRMAA is added on top of that, and a separate amount is added to your Part D premium. Married people who file separately follow a different schedule, so check your Social Security letter or ask your tax professional. Joint filers are judged on their combined income.
Thresholds for 2027 have not been announced yet. Medicare typically publishes them in the fall. You can get a rough idea of where you stand with our IRMAA calculator. Keep in mind it gives an estimate, not a quote or tax advice. Your Social Security letter is the official word on what you owe.
- Single filers, 2026: IRMAA starts above $109,000 MAGI (from 2024).
- Joint filers, 2026: IRMAA starts above $218,000 MAGI (from 2024).
- What it affects: both your Part B and Part D premiums.
Reading your IRMAA letter
If IRMAA applies to you, Social Security sends a letter called an initial determination. It shows the income it used, the tax year that income came from, and the extra amounts you’ll pay for Part B and Part D. Read it carefully, because it also explains your options if you disagree.
Start by checking the basics. Is the tax year correct? Does the income match what you filed? Was your filing status, such as single or married filing jointly, recorded correctly? Mistakes are not common, but they do happen, especially after an amended return or a change in marital status. If something looks wrong, contact Social Security promptly.
Keep the letter with your Medicare papers. You may need it when you talk with your tax professional, compare plans, or file a request with Social Security. If you’re not sure what something means, call Social Security at 1-800-772-1213 or bring the letter to a consultation and go through it together.
Life-changing events and form SSA-44
If your income has dropped since the tax year Social Security used, you can ask for a new decision. The tool for this is form SSA-44, “Medicare Income-Related Monthly Adjustment Amount – Life-Changing Event.” You file it with Social Security, and you can find it on SSA.gov.
Social Security only accepts certain events. You’ll need to show the event happened and that it reduced your income. Proof might include a letter from your employer about your retirement date or a copy of a death certificate. You’ll also estimate your income for the current year. Have a recent pay stub or retirement income statement handy when you do.
You can file the form by mail, bring it to your local Social Security office, or call to ask about other ways to submit it. If Social Security approves your request, it will use your more recent, lower income to recalculate your premiums. If the estimate you gave turns out to be wrong, your IRMAA may be adjusted later, so give your most realistic number.
- Marriage, divorce or annulment
- Death of your spouse
- Work stoppage (such as retiring) or a reduction in work hours
- Loss of income-producing property you didn’t cause, such as from a disaster
- Loss or reduction of certain pension income
- An employer settlement payment because of a closure, bankruptcy or reorganization
Retirement counts as a work stoppage. If your IRMAA is based on a working year and your income has since dropped, form SSA-44 may lower or remove the surcharge. If Social Security used the wrong tax information, you can also ask them to take another look.
Roth conversions, home sales and one-time spikes
Many IRMAA surprises come from a single big year, not a high salary. A Roth conversion, a large IRA withdrawal, a home sale with a taxable gain, or selling stocks can push your MAGI over a threshold. Two years later, that one-time spike can raise your premiums.
Unfortunately, these voluntary choices usually don’t qualify as life-changing events. Selling your house or converting to a Roth is your decision, so Social Security generally won’t accept it as a reason to lower IRMAA. The higher premium usually lasts one year, then drops if your income falls again. Knowing that can make a one-time surcharge easier to budget for.
Other income can sneak up on you too. Required minimum distributions from retirement accounts, capital gains paid out by mutual funds, and taxable Social Security benefits all count toward your adjusted gross income. None of these are unusual, but together they can move you closer to a threshold than you expected.
That’s why timing matters. Some people spread Roth conversions across several years, while others accept a year of IRMAA because the long-term tax benefit is worth it. There’s no single right answer. It depends on your full tax picture, which is a question for your tax professional, not your insurance agent.
Planning ahead with your tax professional
The simplest way to manage IRMAA is to plan before the income happens. Because of the two-year lookback, the decisions you make at 63 can affect your premiums at 65. If you’re thinking about retirement, a home sale or a Roth conversion, bring IRMAA into the conversation early.
Kris is a licensed insurance agent, not a tax or legal adviser. She can explain how IRMAA affects your Medicare premiums and coverage choices. For decisions about conversions, withdrawals or capital gains, work with a CPA or tax preparer. The IRS website also explains how adjusted gross income is figured.
Your Medicare plan choice can still matter. IRMAA raises premiums no matter which coverage you pick, but your total costs also depend on deductibles, copays and drug coverage. Comparing Medicare Supplement and Medicare Advantage options with IRMAA in mind can help you budget. The right plan is the one that fits your health needs and your total costs.
How Kris can help
Kris can review your IRMAA letter with you, explain what it means for your Part B and Part D premiums, and help you see how different plans fit your budget. If a life-changing event applies, she can point you to the right Social Security form and steps.
She can also help you think ahead. If you’re a few years from Medicare and expect a big income year, Kris can explain how IRMAA works so you can bring the right questions to your tax professional. Since 2017, she has helped people across northwest Ohio make sense of Medicare costs, one conversation at a time.
Consultations are no-cost and no-obligation. You can meet Kris in person at her Perrysburg office, or by phone or video if that’s easier. Call (419) 277-8097 or send a message to set up a time. You can also learn more on our Medicare page. There’s never any pressure to enroll in anything.
We do not offer every plan available in your area. Currently, we represent 14 organizations which offer 119 products in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options. This is a proprietary website and is not associated, endorsed or authorized by the Social Security Administration, the Department of Health and Human Services or the Center for Medicare and Medicaid Services. This site contains decision-support content and information about Medicare, services related to Medicare and services for people with Medicare. If you would like to find more information about the Medicare program please visit the Official U.S. Government Site for People with Medicare located at www.medicare.gov.
This article is general education, not a recommendation for any specific plan. Figures were current as of September 8, 2026; plan details change every year.