IRMAA is an income-based surcharge on Medicare Part B and Part D premiums. In 2026 it applies when your 2024 modified adjusted gross income was above $109,000 on an individual return or $218,000 on a joint return. Below are short, sourced answers to the questions people ask most often, with links to the full guides.
IRMAA at a glance
Key 2026 IRMAA facts
Item
2026
Standard Part B premium
$202.90 / month
First limit, individual return
$109,000
First limit, joint return
$218,000
Income year used
2024
Number of IRMAA tiers
5 above standard
Highest Part B premium
$689.90 / month
Part D surcharge range
$14.50 – $91.00 / month
Cost of the first cliff, one person
$1,148.40 / year
The basics
What does IRMAA stand for?
Income-Related Monthly Adjustment Amount. It is the extra amount added to Medicare Part B and Part D premiums for people with higher incomes.
Who decides whether I pay IRMAA?
Social Security, using income information it receives from the IRS. Medicare sets the amounts each year.
What are the 2026 IRMAA brackets?
Individual returns: $109,000 or less is standard, then tiers start at $109,001, $137,001, $171,001, $205,001 and $500,000. Joint returns: $218,001, $274,001, $342,001, $410,001 and $750,000. See the full 2026 brackets.
How much does IRMAA cost?
From $1,148.40 a year per person in tier one to $6,936 a year more than the standard premium in the top tier, counting Part B and the Part D surcharge.
Income and timing
Which income counts for IRMAA?
Adjusted gross income plus tax-exempt interest, from your federal return. Roth conversions, IRA withdrawals, capital gains and taxable Social Security count; qualified Roth withdrawals and QCDs do not.
Which year's income is used?
The tax return from two years before the premium year. 2026 premiums use 2024 income, and 2027 premiums will use 2025 income.
Is one dollar over the limit really a full tier?
Yes. IRMAA tiers are cliffs. At $109,001 on an individual return you pay the tier-one premium for the whole year.
Do the limits change each year?
The first four limits rise with inflation. The top limits of $500,000 and $750,000 are fixed in law.
Couples and survivors
How does IRMAA work for married couples?
On a joint return, combined MAGI is compared with the joint limits, and each spouse on Medicare pays the resulting tier.
Should married couples file separately to avoid IRMAA?
Rarely. If you lived together, the separate-filer table charges the tier-four amount from the first dollar over $109,000.
Why do widows often pay more?
A survivor moves to the individual limits, half the joint ones, while household income usually falls by less than half.
Appeals
Can I appeal IRMAA?
Yes. Use Form SSA-44 if a life-changing event lowered your income, or ask for a reconsideration within 60 days if the information was wrong. See the appeal checklist.
Which events qualify for Form SSA-44?
Marriage, divorce or annulment, death of a spouse, work stoppage, work reduction, loss of income-producing property, loss of pension income, and an employer settlement payment.
Does retiring count as a life-changing event?
Yes. Retirement is a work stoppage, the most common reason people file Form SSA-44.
Can I appeal IRMAA caused by a Roth conversion or a home sale?
No. Income you chose to create is not a life-changing event and not an error.
Plans and payment
Do Medicare Advantage members pay IRMAA?
Yes. They pay the Part B premium with IRMAA, and the Part D surcharge if the plan includes drug coverage.
Do I pay the Part D surcharge with a $0 drug plan?
Yes. The surcharge goes to Medicare, not the plan, so it applies regardless of the plan premium.
How is IRMAA paid?
It is usually deducted from your Social Security payment. If you do not receive benefits yet, Medicare bills you.
Planning
What is the best way to avoid IRMAA?
Know your headroom, the distance to the next limit, and keep planned income like Roth conversions and capital gains within it. QCDs help from age 70½.
When should Medicare planning start?
At 63. Income in the year you turn 63 sets your premium at 65.
Is it ever worth paying IRMAA?
Yes, sometimes. A larger Roth conversion can save more in future taxes than a year of higher premiums costs, especially if you use the whole tier.
How to use these answers
IRMAA rules are simple to state and easy to trip over in practice, mostly because of the two-year lookback and the cliff shape. If your situation is close to a limit, run your own numbers in the IRMAA calculator, then read the guide that matches your question. The amounts on this page are the official 2026 figures; when Medicare publishes 2027 amounts, we update every page within a week, and the methodology page lists the date each number was checked.
This site explains how IRMAA works; it is not individual tax or financial advice. For large decisions, such as multi-year Roth conversion plans or the sale of a business, a tax professional can model the full picture, including income tax brackets and state taxes.