What Is IRMAA? Medicare's Income Surcharge Explained

Where IRMAA comes from

Most people on Medicare pay the standard Part B premium, which covers about a quarter of what Part B costs. Congress decided in 2003 that higher-income enrollees should pay a bigger share, and the surcharge on Part B began in 2007. A matching surcharge on Part D prescription coverage followed in 2011. Together they are known as IRMAA.

IRMAA is not a tax and it is not a penalty for doing something wrong. It is a premium adjustment. Social Security decides whether you owe it, using income information from the IRS, and it usually deducts the amount from your monthly Social Security payment along with your regular Part B premium. If you do not receive Social Security yet, Medicare sends you a bill instead.

The six tiers in 2026

There is a standard tier and five IRMAA tiers above it. The table shows the monthly Part B premium, the monthly Part D add-on, and what one person and a couple pay over a full year. The Part D add-on is charged on top of whatever your drug plan costs, even if your plan premium is $0.

2026 IRMAA tiers and yearly cost (Part B plus Part D surcharge)
Individual MAGI	Joint MAGI	Part B / mo	Part D / mo	Per person / yr	Couple / yr
Up to $109,000	Up to $218,000	$202.90	$0.00	$2,434.80	$4,869.60
$109,001 – $137,000	$218,001 – $274,000	$284.10	$14.50	$3,583.20	$7,166.40
$137,001 – $171,000	$274,001 – $342,000	$405.80	$37.50	$5,319.60	$10,639.20
$171,001 – $205,000	$342,001 – $410,000	$527.50	$60.40	$7,054.80	$14,109.60
$205,001 – $499,999	$410,001 – $749,999	$649.20	$83.30	$8,790.00	$17,580.00
$500,000 or more	$750,000 or more	$689.90	$91.00	$9,370.80	$18,741.60

The couple column assumes both spouses are on Medicare. Each person on Medicare pays their own premium, so a joint return in tier two means two tier-two premiums. Married people who file separately and lived together during the year face a harsher table with only three levels; the 2026 brackets page lists it.

Why people call them cliffs

Income tax brackets are marginal: moving into a higher bracket only raises the tax on the dollars above the line. IRMAA works differently. If your MAGI is $109,000, you pay the standard premium. If it is $109,001, you pay the tier-one premium for the entire year. That single dollar costs one person $1,148.40 in 2026, and a married couple both on Medicare $2,296.80.

$1,148Cost of the first dollar over $109,000, one person, 2026
$1,736Cost of crossing from tier one to tier two
$6,936Yearly gap between the standard tier and the top tier

Because of these jumps, the useful question is not "what bracket am I in?" but "how far am I from the next edge, and what would cross it?" That is what the IRMAA calculator shows: your tier, the yearly cost, and the dollars of headroom before the next cliff.

Which income counts

Social Security uses modified adjusted gross income, or MAGI. For IRMAA, that is the adjusted gross income on line 11 of your federal Form 1040 plus any tax-exempt interest from line 2a. It includes wages, pensions, traditional IRA and 401(k) withdrawals, the taxable part of your Social Security, interest, dividends, capital gains and Roth conversions. It does not include withdrawals from a Roth IRA or money sent directly from an IRA to a charity as a qualified charitable distribution.

The year matters as much as the amount. Your 2026 premium is based on your 2024 tax return. This two-year lookback means that a large Roth conversion, a home sale or a big year of work can raise your premium two years later, long after the income itself is gone. The guide to the two-year lookback has a year-by-year table.

Who pays IRMAA

Only a small share of Medicare enrollees pay IRMAA, but the group is larger than many people expect. It often includes:

People still working at 65 or later, whose salary sets their first premiums.
Retirees with large pensions or required minimum distributions from big IRAs.
Anyone who converted to a Roth, sold a home or a business, or realized large capital gains two years earlier.
Widows and widowers, who move from the joint limits to the lower individual limits while household income often stays similar.

IRMAA applies whether you have Original Medicare or a Medicare Advantage plan. Advantage members still pay the Part B premium, and the Part D add-on applies to the drug coverage built into most Advantage plans.

Can you get it reduced?

There are two ways. If your income dropped because of a life-changing event, such as retirement, the death of a spouse, divorce or the loss of a pension, you can ask Social Security to use a more recent year with Form SSA-44. If Social Security used wrong information, you can ask for a reconsideration. Our appeal checklist shows which route fits and what documents to gather.

For future years, planning is the main lever: keeping a Roth conversion within your headroom, using qualified charitable distributions, and timing sales. The guide to 10 ways to lower IRMAA covers them.

See exactly where your income sits and how far you are from the next cliff.

Open the IRMAA calculator

Frequently asked questions

Is IRMAA charged every year?

Social Security reviews it every year using your most recent tax return on file. If your income falls below the limit, the surcharge stops for the next premium year without any action from you.

Does IRMAA apply to both spouses?

Yes. Each spouse on Medicare pays their own Part B premium, so on a joint return in an IRMAA tier both spouses pay the higher amount.

Do I pay IRMAA if I have a $0 Part D plan?

Yes. The Part D surcharge is paid to Medicare, not to your plan, so it applies even when your plan premium is zero.

Is IRMAA the same as the Medicare late enrollment penalty?

No. The late enrollment penalty is for signing up late and lasts as long as you have coverage. IRMAA depends only on income and can change every year.

When will the 2027 amounts be known?

Medicare usually announces the next year's premiums and limits in the fall. Until then you can use our projected 2027 brackets.

What is IRMAA? Medicare's income surcharge explained