IRMAA: The Medicare Surcharge for Higher Incomes
Most people pay the same standard price for Medicare. But if your income is above a certain level, Medicare quietly charges you more — sometimes a lot more — through a surcharge called IRMAA. It catches folks off guard because it's based on a tax return from two years ago, and it can arrive right as you're settling into retirement. Here's exactly how it works in 2026, and the two things you can do about it.
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 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 can be so costly. Sell a piece of Kentucky farmland, take a big withdrawal, or do a large Roth conversion, and you might clear a bracket by a hair — and pay for it 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. For how claiming timing works, see Social Security 101: When Should You Claim?
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 section may be the most valuable thing on the page. 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.
Not sure if IRMAA applies to you? You can get a free Medicare review. A local Kentucky agent can help you read the notice and point you to the right next step — free, and no pressure.
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This article is general information, not tax, financial, or insurance advice for your specific situation, and Medicare rules and figures change every year. 2026 IRMAA amounts are from CMS and Social Security. Strategies to manage income should be reviewed with a qualified tax or financial professional. Tyler Insurance Group is not connected with or endorsed by the U.S. government or the federal Medicare program. For complete details, contact Medicare.gov or 1-800-MEDICARE.