Updated for 2026 | 8 min read | Based on official CMS 2026 data
In This Article
What Is IRMAA?
IRMAA stands for Income-Related Monthly Adjustment Amount. It is a surcharge that the Centers for Medicare & Medicaid Services (CMS) adds to the standard Medicare Part B and Part D premiums for beneficiaries with higher incomes. Think of it as a means-tested premium adjustment — the more you earned two years ago, the more you pay today.
IRMAA was introduced by the Medicare Modernization Act of 2003 and first applied to Part B premiums in 2007. Part D IRMAA followed in 2011. Today it affects roughly 8% of Medicare beneficiaries — a significant but often overlooked cost in retirement planning.
In 2026, the standard Medicare Part B premium is $202.90 per month. If your income exceeds certain thresholds, that number increases — sometimes substantially. The highest IRMAA bracket carries a total Part B premium of $689.90 per month.
Who Pays IRMAA in 2026?
You will owe an IRMAA surcharge in 2026 if your 2024 MAGI exceeded:
- $109,000 for individual filers
- $218,000 for married filing jointly
- $109,000 for married filing separately (if you lived with your spouse at any point during the year)
If your income fell at or below those thresholds, you pay only the standard $202.90 per month. No surcharge applies.
How CMS Calculates Your Surcharge
The key detail most people miss: CMS does not look at your current income. It uses your Modified Adjusted Gross Income (MAGI) from your federal tax return two years prior. For 2026 Medicare premiums, that means your 2024 tax return is what determines your tier.
MAGI is your Adjusted Gross Income — Line 11 of IRS Form 1040 — plus any tax-exempt interest income from Line 2a. It does not include non-taxable Social Security benefits, Roth IRA withdrawals, or qualified charitable distributions.
The process works in three steps. First, CMS requests your tax data from the IRS. Second, the Social Security Administration uses that data to determine your tier and sends you an Initial Determination Notice by mail. Third, the surcharge is deducted directly from your Social Security benefit check — or billed separately if you are not yet receiving benefits.
This two-year lag creates a situation many retirees encounter: you retire in 2025, your income drops substantially, but your 2026 Medicare premium still reflects your higher 2024 earnings. The good news is you can appeal — more on that below.
2026 Part B IRMAA Brackets
The following thresholds are based on official 2026 data published by CMS on November 14, 2025. The full announcement is available on the CMS 2026 Medicare Parts A & B Premiums and Deductibles fact sheet.
| Individual MAGI | Joint MAGI | IRMAA Surcharge | Total Part B Premium |
|---|---|---|---|
| ≤ $109,000 | ≤ $218,000 | $0.00 | $202.90 |
| $109,001 – $137,000 | $218,001 – $274,000 | $81.20 | $284.10 |
| $137,001 – $171,000 | $274,001 – $342,000 | $202.90 | $405.80 |
| $171,001 – $205,000 | $342,001 – $410,000 | $324.60 | $527.50 |
| $205,001 – $499,999 | $410,001 – $749,999 | $446.30 | $649.20 |
| ≥ $500,000 | ≥ $750,000 | $487.00 | $689.90 |
Note: Married filing separately with income above $109,000 jumps directly to the Tier 5 premium ($649.20) unless income exceeds $391,000, at which point Tier 6 ($689.90) applies.
2026 Part D IRMAA Surcharges
IRMAA does not stop at Part B. If you have a Medicare Part D prescription drug plan — whether standalone or bundled into a Medicare Advantage plan (MAPD) — the same income tiers trigger a monthly surcharge on top of your plan's regular premium.
| Individual MAGI | Joint MAGI | Part D Monthly Surcharge |
|---|---|---|
| ≤ $109,000 | ≤ $218,000 | $0.00 |
| $109,001 – $137,000 | $218,001 – $274,000 | $14.50 |
| $137,001 – $171,000 | $274,001 – $342,000 | $37.50 |
| $171,001 – $205,000 | $342,001 – $410,000 | $60.40 |
| $205,001 – $499,999 | $410,001 – $749,999 | $83.30 |
| ≥ $500,000 | ≥ $750,000 | $91.00 |
The surcharge is added on top of your individual plan's premium. If your plan charges $35 per month and you are in the second income tier, your total Part D cost is $35 + $14.50 = $49.50 per month.
Can You Appeal IRMAA?
Yes — and this is one of the most important things to know. The SSA allows you to appeal your surcharge if your income has decreased due to a life-changing event (LCE). Qualifying events include:
- Marriage, divorce, or death of a spouse
- Retirement or a significant reduction in work hours
- Loss of income-producing property (for example, due to a disaster)
- Loss of pension income
- Receipt of an employer settlement payment
To appeal, complete SSA Form SSA-44 (Medicare Income-Related Monthly Adjustment Amount — Life-Changing Event) and submit it to your local Social Security office with documentation of the income change. If approved, SSA will recalculate your IRMAA using your more recent income.
You can also request a reconsideration if you believe SSA used incorrect income data — for instance, if your tax return was amended after SSA pulled the original figures from the IRS.
Margaret filed an appeal after learning about the process. Her income had dropped significantly at retirement. Her surcharge was reduced the following year.
Income Planning Strategies to Reduce IRMAA
Because IRMAA is based on income from two years prior, there is a genuine planning window before you reach Medicare age. The following strategies are worth discussing with a qualified financial advisor before making any changes to your income or investment structure.
Roth Conversions Before Medicare Age
Withdrawals from Roth IRAs are not counted as MAGI for IRMAA purposes. Converting traditional IRA funds to Roth while you are still working — or during the gap years before Medicare — can reduce taxable income once you are on Medicare. The conversions themselves are taxable in the year they occur, so timing matters.
Manage Realized Capital Gains
Large one-time income events — such as selling a property or business — can push you into a higher IRMAA bracket for a future year. If you have control over the timing of these events, coordinating with a financial planner two years ahead of Medicare enrollment can help minimize the impact.
Qualified Charitable Distributions (QCDs)
If you are 70½ or older, directing up to $105,000 per year from your IRA directly to a qualified charity counts toward your required minimum distribution but is excluded from taxable income — and therefore not counted in your MAGI for IRMAA purposes.
Health Savings Account (HSA) Contributions
Contributions to an HSA reduce your AGI dollar-for-dollar. You cannot contribute to an HSA once enrolled in Medicare, so this strategy applies in the years immediately before enrollment.
Frequently Asked Questions
Does IRMAA apply to Medicare Advantage plans?
Yes. The Part B IRMAA surcharge applies even if you are enrolled in a Medicare Advantage plan, because you still pay the Part B premium. The Part D IRMAA also applies if your MA plan includes prescription drug coverage (MAPD).
How often do IRMAA brackets change?
CMS adjusts brackets annually, typically announcing the following year's figures each November. Thresholds are indexed to inflation. Always verify current amounts on the official CMS Medicare premiums fact sheet or by using our free 2026 IRMAA calculator.
Can I avoid IRMAA if I just turned 65?
IRMAA applies from your first year on Medicare if your income two years prior exceeded the threshold. There is no exemption for newly enrolled beneficiaries. However, if you recently retired and your income dropped, you may qualify for an appeal using SSA Form SSA-44 (PDF).
What counts as MAGI for IRMAA?
For Medicare IRMAA, MAGI is your Adjusted Gross Income (Line 11 of IRS Form 1040) plus tax-exempt interest income (Line 2a). It does not include non-taxable Social Security benefits, Roth IRA withdrawals, or qualified charitable distributions.
Find Your 2026 IRMAA Tier
Not sure which bracket applies to you? Use our free Medicare IRMAA Calculator to enter your 2024 income and filing status and instantly see your 2026 Part B premium and Part D surcharge. It takes under a minute and requires no personal information.
If you are also concerned about what a late enrollment penalty might cost, the late enrollment penalty calculator can estimate that figure as well.
Real-Life Perspective
Margaret, 67 discovered her IRMAA surcharge only after receiving her SSA notice. Her income had dropped at retirement — she filed an appeal using Form SSA-44 and had her premium reduced the following year.
David, 64 learned about IRMAA the year before Medicare eligibility. He worked with his advisor to time a property sale differently and stayed in a lower bracket for his first two years on Medicare.
The difference in both cases was not luck. It was having the information early enough to act on it.
Key Takeaways
- IRMAA affects roughly 8% of Medicare beneficiaries and can add hundreds or thousands of dollars per year to your healthcare costs.
- In 2026, surcharges begin for individuals with 2024 MAGI above $109,000 and joint filers above $218,000.
- The standard 2026 Part B premium is $202.90/month; the highest IRMAA tier reaches $689.90/month.
- Part D plans carry separate surcharges ranging from $14.50 to $91.00/month.
- CMS uses your tax return from two years prior — 2024 income determines 2026 premiums.
- You can appeal IRMAA if your income dropped due to a qualifying life-changing event using SSA Form SSA-44 (PDF).
This article is provided for educational purposes only and does not constitute financial, legal, or official Medicare advice. Premium figures are based on official CMS data published November 14, 2025, and are subject to annual change. Consult a licensed Medicare advisor or the Social Security Administration for guidance specific to your situation.
Sources: CMS — 2026 Medicare Parts A & B Premiums and Deductibles (November 14, 2025) | Social Security Administration — Medicare Premiums and IRMAA