IRMAA and Medicare Advantage

Why the surcharge follows you into Advantage

A Medicare Advantage plan, also called Part C, is offered by a private insurer that agrees to provide your Part A and Part B benefits, and usually drug coverage, in one plan. To join, you must be enrolled in Part B and keep paying the Part B premium to Medicare. The plan is paid separately by Medicare for each member.

Because the Part B premium stays in place, so does the income-related part of it. Social Security sets your IRMAA from your tax return two years earlier, the same way for everyone, and the plan you choose has no effect on that decision. A plan advertised as "$0 premium" means $0 on top of what you already owe Medicare, not $0 in total.

Original Medicare compared with Medicare Advantage

The only way to avoid the Part D surcharge is to have no Part D coverage at all, which usually means keeping creditable coverage from an employer or retiree plan. An Advantage plan without drug coverage avoids the Part D surcharge, but you still pay the Part B surcharge, and going without creditable drug coverage can bring a late enrollment penalty later.

A worked example

Patricia is single and her 2024 MAGI was $130,000, which is tier one for 2026, $7,000 below the next cliff. She is choosing between a $0 Advantage plan with drug coverage and Original Medicare with a Medigap plan and a stand-alone drug plan.

Whatever she decides, $3,583.20 a year goes to Medicare. The plan comparison should focus on everything else: plan premiums, Medigap premiums, deductibles, copays, provider networks and the out-of-pocket maximum. Her IRMAA is the same in both columns.

Part B giveback plans

Some Advantage plans offer a "Part B giveback," which reduces the Part B premium deducted from your Social Security by a set amount each month. A giveback lowers what you pay, but it does not erase IRMAA, and the amount is the same whatever your tier. For an IRMAA payer, a giveback is a modest discount on a larger bill. Compare plans on their full value, not the giveback alone.

Things that are the same for every Medicare enrollee

• The income test. Modified adjusted gross income from two years earlier, against the limits for your filing status.
• The appeal routes. Form SSA-44 for life-changing events and reconsideration for wrong information work the same for Advantage members. The appeal checklist covers both.
• How it is collected. Usually deducted from your Social Security payment, or billed by Medicare if you do not receive benefits yet.
• The planning levers. Keeping MAGI below a limit through Roth conversion sizing, qualified charitable distributions and timing of sales.

Choosing a plan when you pay IRMAA

Since IRMAA is fixed by your income, it should not drive the choice between Advantage and Original Medicare. It is still useful to know the total. When you add up the cost of each option for the year, include the full Part B premium for your tier and the Part D surcharge, so the totals are realistic. People in higher tiers sometimes find that the extra cost of a Medigap plan is a smaller share of their total Medicare spending than they expected, which can make the predictability of Original Medicare more attractive.

Plan rules change each year during open enrollment, from October 15 to December 7. Your IRMAA for the coming year is usually decided around the same time, so it is a good moment to check your tier in the IRMAA calculator.

Frequently asked questions

Sources

• Medicare.gov: Compare Original Medicare and Medicare Advantage
• CMS: 2026 Medicare Parts B premiums and deductibles
• Social Security: Premiums, rules for higher-income beneficiaries

Related guides

• The Part D surcharge
• What is IRMAA?
• IRMAA and your Social Security check