Most people on Medicare pay the standard Part B premium, which is $202.90 a month in 2026. However, if you cross an income threshold by a single dollar, that number jumps to $284.10 — plus an extra charge on your Part D drug coverage. Cross the next threshold and it jumps again.
That surcharge is called IRMAA, short for income-related monthly adjustment amount. It affects fewer than 10% of Medicare beneficiaries, but it can easily catch retirees who aren’t closely watching their income. And for a married couple on Medicare, crossing a threshold can cost thousands of dollars a year.
How IRMAA Works
Two features make IRMAA especially tricky:
First, there’s a two-year lookback. Your 2026 Medicare premiums are based on the modified adjusted gross income (MAGI) reported on your 2024 tax return. Your 2025 income sets your 2027 premiums. Whatever you do with your income this year shows up on your Medicare bill in 2028. By the time the notice arrives from Social Security, the income that triggered it is two years in the past and there is nothing left to adjust.
Second, IRMAA works like a cliff, not a traditional tax bracket. There’s no gradual phase-in. Instead, crossing an income threshold moves you to a higher Medicare premium. A single filer with $137,000 of 2024 MAGI pays one amount. At $137,001, that person crosses the next IRMAA threshold and pays the higher surcharge for all 12 months of 2026.
It also applies per person. A married couple where both spouses are on Medicare pays the surcharge twice, based on one joint income figure.
The 2026 IRMAA Thresholds
These are based on your 2024 MAGI. The Part B column is the total monthly premium, not the surcharge. The Part D column is the surcharge added on top of whatever your drug plan charges.
2024 MAGI (single)2024 MAGI (joint)Part B/monthPart D/monthAnnual IRMAA cost per person
$109,000 or less$218,000 or less$202.90$0$0
$109,001 to $137,000$218,001 to $274,000$284.10$14.50$1,148.40
$137,001 to $171,000$274,001 to $342,000$405.80$37.50$2,884.80
$171,001 to $205,000$342,001 to $410,000$527.50$60.40$4,620.00
$205,001 to $499,999$410,001 to $749,999$649.20$83.30$6,355.20
$500,000 or more$750,000 or more$689.90$91.00$6,936.00
Married filing separately runs on a different and much harsher scale if you lived with your spouse at any point during the year. It skips the middle tiers entirely, so one dollar over $109,000 lands you in the second-highest tier.
The first four income thresholds adjust for inflation each year. The threshold for the highest IRMAA tier is different: It has remained at $500,000 for single filers and $750,000 for married couples filing jointly since 2020 and won’t be adjusted for inflation again until 2028.
What Counts Toward MAGI
For IRMAA purposes, MAGI is your adjusted gross income plus any tax-exempt interest. That means the municipal bond income you bought partly for its tax treatment still counts here. So does the taxable portion of your Social Security benefits, your pension, your required minimum distributions (RMDs), capital gains, and any Roth conversion you do.
Qualified withdrawals from a Roth IRA do not count. Neither do qualified HSA withdrawals for eligible medical expenses, return of principal on a bond or CD, or the proceeds of a home sale that fall under the capital gains exclusion.
How To Avoid or Reduce IRMAA
Know where the lines are before December. The single most useful habit is running a rough MAGI projection in the fall, once you know your dividends, interest, and RMD, and then leaving a buffer below the nearest threshold. A few thousand dollars of cushion protects you from a surprise year-end capital gains distribution from a mutual fund, which is the kind of thing that pushes people over a threshold.
Size Roth conversions around the IRMAA thresholds, not just the tax brackets. Conversions are one of the few large income events you fully control, and the IRMAA cost of crossing a threshold has to be part of the math. Sometimes the answer is to stop just short. Sometimes it is to go well past, since once you’ve accepted a tier, you may as well use more of it. What you want to avoid is crossing an IRMAA threshold by a small amount simply because you weren’t paying attention to your MAGI.
Use qualified charitable distributions. If you’re 70½ or older and give to charity anyway, a qualified charitable distribution (QCD) lets you send money directly from your IRA to an eligible charity. The distribution is reported on your tax return but, when properly handled, isn’t included in your adjusted gross income (AGI). That means it also doesn’t increase the MAGI used to calculate IRMAA. It can also satisfy all or part of your RMD. That’s what makes a QCD particularly useful for managing IRMAA: It can satisfy an RMD without pushing your MAGI higher.
Spread out one-time income events. Selling a rental property, exercising options, or liquidating a concentrated stock position can blow through several tiers at once. An installment sale, splitting a sale across two tax years, harvesting losses, or donating appreciated shares instead of cash can all keep the spike contained.
Frequently Asked Questions
Can I Appeal IRMAA?
Yes, you can appeal IRMAA if you have had a “life-changing” event. Social Security will recalculate your premium using current income rather than the two-year-old return if you had one of these: marriage, divorce/annulment, work stoppage or reduction, loss of income-producing property, loss or reduction of certain pension income, or an employer settlement payment.
Retirement is a particularly important example. A new retiree may initially receive an IRMAA notice based on their final high-income working year even though their current income is substantially lower. In that situation, don’t assume you’re stuck with the surcharge.
To appeal, file Form SSA-44 with documentation.
Is IRMAA Permanent?
IRMAA isn’t necessarily permanent. Your surcharge is recalculated each year based on the applicable tax return. If a one-time income spike pushes you over an IRMAA threshold, you’ll generally pay the higher premium for that Medicare premium year. If your income comes back down, your IRMAA can come back down, too.
Is IRMAA Worse for a Surviving Spouse?
Yes, IRMAA can become even more pronounced for a surviving spouse. Most of the lower IRMAA thresholds for a single filer are half the joint-filer amounts, so a widow or widower who retains much of the couple’s income can suddenly find themselves in a much higher IRMAA tier — on top of potentially higher income taxes.
Final Thoughts
IRMAA is a good example of why retirement tax planning isn’t just about your federal income tax bracket. The same Roth conversion, investment gain or IRA withdrawal that looks perfectly reasonable from a tax perspective could also increase your Medicare premiums two years later.
And timing matters. Your 2027 Medicare premiums will be based on income you earned in 2025, so there’s nothing you can do now to change that number. But your 2026 income will help determine what you pay for Medicare in 2028.
That makes the months before December 31 an important planning window. Estimate your MAGI, know where the IRMAA thresholds are and pay particular attention to income you can control, such as Roth conversions, investment sales and IRA withdrawals.
You shouldn’t make a financial decision just to avoid IRMAA. Sometimes realizing income and paying the higher Medicare premium will still be the better move. But you don’t want to cross an IRMAA threshold by a few dollars — and pay hundreds or thousands more for Medicare — simply because you didn’t know the cliff was there.
Note: IRMAA thresholds and premium amounts change annually. Figures here are the 2026 amounts published by CMS in November 2025.
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