Medicare IRMAA, explained.
IRMAA is an income-based surcharge on top of standard Medicare premiums. Here is how it works and when to fight it.
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What IRMAA is
IRMAA = Income-Related Monthly Adjustment Amount. It is an extra premium charged to higher-income Medicare enrollees on top of the standard Part B and Part D premiums.
IRMAA is based on your modified adjusted gross income from 2 years prior. So 2026 IRMAA is based on your 2024 tax return.
Income brackets
The income threshold and exact surcharge changes annually. Roughly, IRMAA kicks in when individual MAGI exceeds about $103,000 (or about $206,000 for couples filing jointly). The surcharge grows in tiers as income climbs.
For exact current-year numbers, check Medicare.gov or your most recent Initial IRMAA Determination notice from Social Security.
Appealing IRMAA — life-changing events
If your income dropped due to a "life-changing event," you can request a reconsideration. Qualifying events include:
- Marriage, divorce, or death of a spouse
- Work stoppage or reduction (including retirement)
- Loss of income-producing property
- Loss of pension income
- Receipt of settlement payment from an employer
File Form SSA-44 with Social Security and provide documentation of the event.
How to plan for IRMAA
- Track your modified adjusted gross income, especially around retirement income transitions
- Time large income events (Roth conversions, capital gains, business sales) carefully
- Bunch deductible expenses in IRMAA-threshold years
- Consult a tax professional if you are close to a bracket