Understanding IRMAA: Medicare’s High-Income Surcharge
If your income is above a certain level, you may pay a higher monthly premium for Medicare Part B (medical insurance) and Medicare Part D (prescription coverage). This extra fee is called IRMAA—the Income-Related Monthly Adjustment Amount.
How IRMAA Works
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Who pays it: Only top-earning Medicare beneficiaries (roughly 8% of people on Medicare).
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How it is calculated: The government looks at your tax return from two years prior (for example, your 2026 premiums are based on your 2024 tax return).
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The metric used: Social Security looks at your Modified Adjusted Gross Income (MAGI), which includes:
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Your adjusted gross income (AGI)
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Tax-exempt interest
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Taxable Social Security benefits
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Capital gains and IRA/401(k) distributions
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Annual updates: Social Security re-evaluates your income every year. If your income drops, your premium drops accordingly in future years.
Common IRMAA Thresholds (Single vs. Married)
If your income exceeds the base threshold, you pay a tiered surcharge on top of standard Medicare premiums:
|
Part B premiums If your MAGI in 2024 was: |
You pay each month (in 2026) | ||
|---|---|---|---|
| File individual tax return | File joint tax return | File married & separate tax return | |
| $109,000 or less | $218,000 or less | $109,000 or less | $202.90 |
| above $109,000 up to $137,000 | above $218,000 up to $274,000 | Not applicable | $284.10 |
| above $137,000 up to $171,000 | above $274,000 up to $342,000 | Not applicable | $405.80 |
| above $171,000 up to $205,000 | above $342,000 up to $410,000 | Not applicable | $527.50 |
| above $205,000 and less than $500,000 | above $410,000 and less than $750,000 | above $109,000 and less than $391,000 | $649.20 |
| $500,000 or above | $750,000 or above | $391,000 or above | $689.90 |
(Note: Exact dollar limits update every year in late fall.)
How to Pay IRMAA
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Automatic Deduction: If you receive Social Security benefits, IRMAA is automatically deducted from your monthly check along with your standard Medicare premium.
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Direct Billing: If you do not draw Social Security yet, you will receive a bill in the mail (Medicare Premium Bill, Form CMS-500).
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Important: Keep up with payments—failing to pay IRMAA can cause you to lose your Medicare coverage.
How to Appeal an IRMAA Surcharge
If your income has decreased significantly since your tax return from two years ago, you do not have to pay the higher rate.
1. Qualifying “Life-Changing Events”
You can request a reduction if your income dropped due to:
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Work reduction or retirement
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Death of a spouse
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Marriage or divorce
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Loss of income-producing property
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Loss or reduction of pension income
2. How to File
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Complete Form SSA-44 (Medicare Income-Related Monthly Adjustment Amount – Life-Changing Event).
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Attach proof (such as a tax return, marriage certificate, death certificate, or a letter from an employer confirming retirement).
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Mail or deliver the form to your local Social Security office within 60 days of receiving your IRMAA notice.
Quick FAQs
Can I avoid IRMAA with financial planning?
Yes. Strategic decisions—like staggering IRA distributions, utilizing Roth conversions early, or managing capital gains—can help keep your MAGI below the surcharge thresholds.
Are both spouses charged if filing jointly?
Yes. If you file taxes jointly and exceed the married threshold, both you and your spouse pay an IRMAA surcharge on your individual Medicare premiums.