What Is an IRMAA Surcharge? Medicare’s Higher-Income Premium Explained

An IRMAA surcharge (Income-Related Monthly Adjustment Amount) is an extra amount added to Medicare Part B and Part D premiums for beneficiaries whose income exceeds certain limits. In 2026, IRMAA begins when 2024 income exceeds $109,000 for individuals or $218,000 for married couples filing jointly.

Many people are surprised to learn that Medicare premiums are not the same for everyone. If your income is above certain limits, Medicare may add an extra charge to your Part B and Part D premiums. That extra charge is called IRMAA — and it can catch retirees off guard.

This is one of those Medicare rules that nobody tells you about until a bill shows up. So let’s walk through exactly what IRMAA is, who it applies to, how it’s calculated, and what you can do about it.

What Is an IRMAA Surcharge?

IRMAA stands for Income-Related Monthly Adjustment Amount. It’s a surcharge — an extra monthly charge — added to your standard Medicare Part B and Part D premiums if your income exceeds certain thresholds.

Think of it as Medicare’s way of asking higher earners to pay a larger share of their coverage costs. The standard 2026 Part B premium is $202.90 per month. If IRMAA applies to you in 2026, your total monthly Part B premium could range from $284.10 to $689.90, depending on your income tier.

It is not a penalty for doing something wrong. It is simply a tiered pricing system based on income — and it applies automatically once Social Security sees your tax return.

What Is IRMAA Based On?

IRMAA is based on your Modified Adjusted Gross Income (MAGI) — specifically, the MAGI reported on your federal tax return from two years prior.

So for 2026 Medicare premiums, Social Security is looking at your 2024 tax return. That’s the income year that determines whether you owe an IRMAA surcharge this year.

Your MAGI for IRMAA purposes includes:

• Wages, salaries, and self-employment income
• Social Security benefits (the taxable portion)
• Pension and retirement income
• Capital gains
• Taxable IRA and 401(k) distributions
• Interest and dividend income
• Tax-exempt interest, including certain municipal bond interest

For IRMAA, MAGI is generally your adjusted gross income plus any tax-exempt interest.

How Is IRMAA Calculated?

Social Security pulls your MAGI from the IRS each year and compares it against the current IRMAA income brackets. If your income falls into a surcharge tier, that extra amount is added to your monthly Part B premium — and to your Part D plan’s premium, if applicable.

You don’t calculate it yourself. Social Security sends you a letter called an Initial Determination Notice that tells you what your IRMAA surcharge will be for the upcoming year. If you disagree or your income has changed significantly, you can appeal.

2026 IRMAA Surcharge Brackets

There are five IRMAA income tiers above the base threshold. Here’s how the Part B surcharge breaks down for 2026.

Part B IRMAA Surcharge — 2026

Part D IRMAA Surcharge — 2026

If you have Medicare Part D drug coverage, IRMAA adds a surcharge on top of whatever premium your specific plan charges. The surcharge amounts for 2026 are listed below.

Not sure which tier applies to you? Use the Medicare IRMAA calculator to estimate how your income may affect your 2026 Part B and Part D premiums.

Is IRMAA Monthly or Yearly?

IRMAA surcharges are charged monthly — they’re added to your monthly Part B and Part D premiums. But your IRMAA tier is determined annually, based on the prior year’s income review.

In practical terms: you’ll usually receive a notice from Social Security near the end of each year letting you know what your IRMAA surcharge will be for the following year. That monthly amount stays in effect for the full calendar year, then gets recalculated.

Is IRMAA Permanent?

No. IRMAA is reassessed every year.

If your income drops below the threshold in a future year, your IRMAA surcharge will be removed the following year when Social Security reviews the updated tax data. There’s no lifetime designation or penalty attached to it.

Some retirees experience IRMAA for only a year or two, especially when it was triggered by a one-time income event like selling a highly appreciated asset, converting a large IRA, receiving a retirement buyout, or another significant income event. Others may continue paying IRMAA if their ongoing income — from pensions, required minimum distributions, or investment income — remains above the thresholds.

Does IRMAA Apply to Both Spouses?

Yes — each spouse is evaluated individually, and each can owe their own IRMAA surcharge.

If both spouses are enrolled in Medicare and both have income above the threshold, they will each pay their own surcharge. The thresholds for married couples filing jointly are roughly double the individual thresholds, but the surcharges are applied per person, not per household.

This is worth planning for. If both you and your spouse are on Medicare, an IRMAA surcharge on both enrollees can add up to hundreds of dollars more per month than most couples expect. IRMAA applies regardless of age or employment status — it even applies to people who receive Medicare on disability before age 65.

What Income Triggers IRMAA?

For 2026, IRMAA kicks in when your 2024 MAGI exceeds:

• $109,000 if you file as an individual
• $218,000 if you file jointly as a married couple
• $109,000 if you’re married but file separately — though the surcharge tiers apply much more quickly than they do for joint filers

These 2026 IRMAA surcharge income limits are based on your 2024 tax return, because Medicare generally uses a two-year income lookback.

Does IRMAA Change Every Year?

Yes. The IRMAA brackets are generally adjusted each year, usually announced alongside the next year’s Medicare premium amounts. The thresholds are indexed to inflation, so they tend to rise modestly each year.

This means a few things worth knowing:

• If your income stays flat and the threshold increases, you might fall out of a surcharge tier without doing anything.
• If your income grows faster than the threshold adjustments, you could move into a higher tier over time.
• The surcharge dollar amounts can also change from year to year, separate from the bracket adjustments.

The brackets shown in this article reflect 2026 figures. Always confirm current-year amounts at Medicare.gov or with a licensed Medicare professional.

Can You Appeal an IRMAA Surcharge?

Yes — and this is one of the most important things to know.

If your income has dropped significantly since the year Medicare is using to calculate your surcharge, you have the right to request a reconsideration. This is called a Life-Changing Event appeal.

Qualifying life-changing events include:

• Retirement or reduction in work hours
• Death of a spouse
• Divorce or annulment
• Loss of income-producing property (due to disaster or other circumstances beyond your control)
• Reduction or loss of pension income
• Employer settlement payment received in a prior year

To appeal, you file SSA Form SSA-44 (Medicare Income-Related Monthly Adjustment Amount — Life-Changing Event) with your local Social Security office. You’ll need to provide documentation of the event and your estimated current income. If you disagree with an IRMAA determination, act promptly after receiving your notice — Social Security provides appeal and reconsideration options, and the SSA-44 is specifically for situations where a qualifying life-changing event reduced your income.

How Can Retirees Reduce the Chance of IRMAA?

Because IRMAA is based on income from two years ago, it rewards advance planning. There are a few strategies that financial planners and tax advisors commonly discuss with pre-retirees — though any approach here is worth reviewing with a qualified tax or financial professional before acting.

Roth Conversions Before Age 63

Roth IRA withdrawals generally do not count toward MAGI for IRMAA purposes. However, Roth conversions are taxable in the year converted and can increase MAGI, which may trigger IRMAA two years later. Converting traditional IRA funds to a Roth while you’re in a lower tax bracket can reduce future Medicare costs — but timing matters, and a large conversion in a single year can itself create a surcharge. This is also worth considering if you’re evaluating a Medicare Supplement plan change, since income shifts can affect what you pay across the board.

Managing Capital Gains Timing

If you have significant capital gains from selling assets, spreading them across tax years — rather than taking them all at once — can help keep your MAGI below or within a lower IRMAA tier.

Qualified Charitable Distributions (QCDs)

If you’re 70½ or older, you can donate directly from your IRA to a qualified charity. Amounts distributed this way don’t count as taxable income — which means they don’t count toward your MAGI, and don’t count toward IRMAA.

Staying Aware of the Two-Year Lag

The most common IRMAA surprise happens at age 65, when people first enroll in Medicare and don’t realize that a large income event from two years earlier — a business sale, a property sale, a retirement payout — is now being used to set their premiums. If you’re approaching Medicare eligibility, the Medicare enrollment checklist is a good place to start planning. The more aware you are of this lag, the better positioned you are to plan around it.

None of these strategies are guaranteed to eliminate IRMAA, and none of them substitute for professional financial or tax advice. They’re tools to be aware of, not a checklist to execute alone.

Frequently Asked Questions About IRMAA Surcharges

Final Thoughts

The people who are most blindsided by an IRMAA surcharge are usually those who had a good financial year — sold a property, took a large IRA distribution, received a retirement buyout — and didn’t realize that two years later, Medicare would be pricing their premiums based on that moment.

The people who handle it best are the ones who know the two-year lookback rule exists, watch for the annual Social Security determination letter, and reach out to a tax or financial advisor before making large income decisions in the years before and during Medicare enrollment.

If you’ve received an IRMAA surcharge notice and your income has genuinely dropped since that year, an appeal is absolutely worth pursuing. The SSA-44 form exists for exactly this reason.

And if you’re planning ahead and want to understand how Medicare costs fit into your overall retirement picture — that’s a conversation worth having with someone who can look at your full situation. Not a call center. Not an automated enrollment line. Someone who can take the time to understand your situation.

Not connected with or endorsed by the U.S. government or the federal Medicare program. Plan availability varies by location. This article is for educational purposes only and does not constitute financial, tax, or legal advice. IRMAA figures reflect 2026 Medicare amounts and are subject to change. Consult a qualified tax or financial professional before making income decisions that may affect your Medicare premiums.