IRMAA: The Medicare Surcharge for Higher Incomes (2026)

By Austin Tyler   ·  Tyler Insurance Group  ·  Updated July 2026

Most people pay the same price for Medicare. Higher earners don't — and it has nothing to do with their health. It's an income surcharge called IRMAA, and it surprises more new retirees than almost anything else in Medicare. Here's how it works in 2026, and the two things you can do about it.

The quick answer

IRMAA is an extra charge added to your Medicare Part B and Part D premiums when your income is above a set level. About 8% of people pay it. For 2026 it starts above $109,000 (single) or $218,000 (joint) — based on your income from two years earlier (2024). You can plan to reduce it, and you can appeal it after a life-changing event.

What IRMAA actually is

IRMAA stands for the Income-Related Monthly Adjustment Amount. In plain English, it's an extra charge added on top of your Part B and Part D premiums if your income is high enough. Only about 8% of people on Medicare pay it, but for those who do, it's real money.

The number Social Security looks at is your modified adjusted gross income (MAGI) — basically your adjusted gross income plus any tax-exempt interest. And here's the catch that surprises everyone: it uses your MAGI from two years ago.

The two-year look-back.

Your 2026 IRMAA is based on the income on your 2024 tax return. So a good year back in 2024 — a large Roth conversion, the sale of a business or a rental property, a big capital gain — can raise your Medicare premiums today, even if your income has since dropped.

The 2026 IRMAA brackets

The standard Part B premium in 2026 is $202.90 a month. If your 2024 income was above the thresholds below, you pay that plus a Part B surcharge, plus a Part D surcharge. Here's the full ladder:

Your 2024 income (single)	Married, joint	Part B total / month	Part D extra / month
$109,000 or less	$218,000 or less	$202.90 (standard)	$0
$109,001 – $137,000	$218,001 – $274,000	$284.10	+$14.50
$137,001 – $171,000	$274,001 – $342,000	$405.90	+$37.50
$171,001 – $205,000	$342,001 – $410,000	$527.70	+$60.40
$205,001 – $500,000	$410,001 – $750,000	$649.50	+$83.30
Above $500,000	Above $750,000	$689.90	+$91.00

 

Each person pays their own IRMAA, so a married couple who are both on Medicare each pay these amounts. Married-filing-separately has its own separate thresholds. Figures are the 2026 amounts from CMS.

The "one dollar over" trap

Here's the part that stings: IRMAA is a cliff, not a slope. Go one dollar over a bracket line and you pay the entire higher surcharge for the whole year, not a little bit more. Crossing that first line costs a single filer roughly $1,150 for the year in extra Part B and Part D premiums. At the very top, IRMAA adds close to $6,900 a year per person. That's why a one-time event — selling a property, a large withdrawal, or a big Roth conversion — can be so costly two years later.

How to lower or avoid it (plan ahead)

Because IRMAA is driven by your income, the way to manage it is to manage your MAGI — ideally in the years before it counts. Common strategies people use with their tax or financial advisor include:

• Pre-tax retirement contributions while you're still working, which lower your MAGI.
• Timing Roth conversions carefully, or spreading them across years, so a single year doesn't spike you into a higher bracket (doing conversions before you're on Medicare can help).
• Qualified charitable distributions (QCDs) at age 70½ or older — giving directly from an IRA to charity keeps that money out of your MAGI.
• Managing capital gains and required minimum distributions (RMDs) so a one-time sale doesn't push you over a line.
• Coordinating when you claim Social Security and other income sources.

This is genuine tax planning, so it's worth doing with a tax professional or financial advisor who can run your numbers. The point is simple: with a little foresight, you can often stay under a bracket instead of tripping over it.

How to appeal IRMAA (this is the big one)

If you just retired, this may be the most valuable part. Because IRMAA looks back two years, someone who was working and earning well in 2024 can get an IRMAA bill in 2026 — even though they're now retired on a much smaller income. You don't have to just accept it.

You can ask Social Security to use your current income instead, by filing Form SSA-44, if your income dropped because of a life-changing event:

• Work stoppage or reduction — including retirement.
• Marriage, divorce, or the death of a spouse.
• Loss of income-producing property or a pension.

Fill out SSA-44, estimate your new income, attach proof (like a letter from your employer or a benefits statement), and submit it. You generally have 60 days from the date on your IRMAA notice to file. One honest caution: the appeal has to be tied to one of those listed life events — “my income just went down” on its own usually won't qualify.

Quick recap

• IRMAA is an income-based surcharge added to your Part B and Part D premiums; about 8% of people on Medicare pay it.
• For 2026 it starts above $109,000 (single) or $218,000 (joint), based on your 2024 income (the two-year look-back).
• It's a cliff: one dollar over a bracket triggers the full surcharge — from about $1,150 up to nearly $6,900 a year per person.
• You can lower it with planning — pre-tax contributions, Roth timing, QCDs, and managing gains — ideally with a tax advisor.
• If your income dropped from a life event like retirement, appeal with Form SSA-44 within 60 days of your notice.

Common questions

What is IRMAA?

IRMAA (the Income-Related Monthly Adjustment Amount) is a surcharge added to your Medicare Part B and Part D premiums if your income is above a set level. About 8% of people with Medicare pay it. It's based on your modified adjusted gross income from your tax return two years earlier.

What are the 2026 income limits for IRMAA?

For 2026, IRMAA starts when your modified adjusted gross income is above $109,000 for a single filer or $218,000 for a married couple filing jointly. Because of the two-year look-back, your 2026 surcharge is based on the income reported on your 2024 tax return.

How much is the IRMAA surcharge in 2026?

In 2026, IRMAA adds between $81.20 and $487.00 per month to your Part B premium (on top of the standard $202.90), and between $14.50 and $91.00 per month to your Part D premium. The exact amount depends on which of the five income tiers you fall in. At the top bracket that's about $6,900 a year in extra premiums per person.

How can I lower or avoid IRMAA?

Because IRMAA is based on your income, planning ahead is what helps: pre-tax retirement contributions while you're still working, timing Roth conversions carefully, using qualified charitable distributions (QCDs) at 70.5 or older, and managing capital gains and required minimum distributions so a one-time spike doesn't push you into a higher bracket. This is tax planning, so it's best coordinated with a tax or financial advisor.

Can I appeal IRMAA?

Yes. If your income has dropped because of a life-changing event — retirement or reduced work hours, marriage or divorce, the death of a spouse, or the loss of income-producing property — you can file Form SSA-44 with Social Security to have them use your more recent income instead. You generally have 60 days from the date of your IRMAA notice to appeal.

Wondering how IRMAA affects you?

Our licensed agents can help you make sense of your Medicare notices and costs — free, with no pressure and no call center — and point you to the right next step if you think you can appeal.