IRMAA
The surcharge that looks back two years
If your income was above a threshold two tax years ago, Medicare adds an amount to your Part B and Part D premiums. For 2026 the return that matters is your 2024 one — which is why it so often arrives as a surprise.
- 2024 income, 2026 premium
- Appealable on SSA-44
- Brackets shown
The lookback
Two years back, one year at a time
Nothing about IRMAA is retrospective punishment. It is a lag — and understanding the lag is what lets you plan around it.
It is a cliff, not a slope
One dollar over a threshold moves you into the whole bracket. There is no tapering and no partial step — which is why the arithmetic is worth doing in December rather than April.
It applies per person
A married couple who both have Medicare each pay their own surcharge on their own Part B and Part D premiums. The income tested is the household figure from the joint return.
It is reassessed every year
Your 2026 surcharge is based on your 2024 return. A single high year affects a single Medicare year, then drops away on its own — no appeal needed if the income genuinely fell.
The brackets
What each band adds, 2026
The surcharge is a flat monthly amount per band, added to the standard premium. The same bands drive both the Part B and the Part D adjustment.
| Single filer | Married filing jointly | Added to Part B | Added to Part D |
|---|---|---|---|
| At or below $109,000 | At or below $218,000 | None | None |
| Above $109,000 to $137,000 | Above $218,000 to $274,000 | +$74.00 | +$13.70 |
| Above $137,000 to $171,000 | Above $274,000 to $342,000 | +$185.00 | +$35.30 |
| Above $171,000 to $205,000 | Above $342,000 to $410,000 | +$296.00 | +$57.00 |
| Above $205,000 to $500,000 | Above $410,000 to $750,000 | +$407.00 | +$78.60 |
| $500,000 and above | $750,000 and above | +$444.00 | +$85.80 |
- One dollar over a threshold moves you into the entire band. There is no partial step.
- Each spouse pays their own surcharge on their own premiums, assessed on the joint income.
- Married filing separately reaches the top band at a far lower income than either other status.
MAGI
What goes into the income figure
Modified adjusted gross income for IRMAA is a short definition with expensive edges.
What counts
Your adjusted gross income plus tax-exempt interest. That is the whole definition — Social Security is in it to the extent it is taxable, and so is everything on the front of your return.
Capital gains count
Selling a rental, a second home or a large position in one tax year can lift you two brackets for a single year. The sale is long finished by the time the premium arrives.
Roth conversions count
A conversion is ordinary income in the year you do it. Converting in stages, with the brackets in front of you, is one of the few genuinely effective things a household can plan.
Roth withdrawals do not
Qualified withdrawals from a Roth account are not income, so they do not raise your MAGI. That is the argument for having some money there before 63.
Appealing
Six life-changing events that reset the assessment
Form SSA-44 is the mechanism. It asks what changed, when it changed, and what you now expect to earn — with evidence attached.
Work stoppage or reduction
Retiring, or cutting your hours, is the most common successful appeal. Form SSA-44 is the one to file, with evidence of the change.
Marriage, divorce or widowhood
Each is a qualifying event. A surviving spouse often files one in the year after a death, when the joint income no longer reflects reality.
Loss of income-producing property
A property lost to disaster or other events outside your control, where the income it produced has gone with it.
Loss of a pension
A pension that stops or is cut, including a plan failure.
Employer settlement
Income received from an employer settlement following bankruptcy or closure.
An amended or corrected return
If the return used was wrong, or was amended after assessment, the assessment can be revisited with the corrected figures.
We are not tax advisers and this is not tax advice. What we do is read the determination notice with you, identify whether a qualifying event applies, and help you get the form and the evidence to the right place before the deduction starts.
IRMAA
Questions about the surcharge
Because the Income-Related Monthly Adjustment Amount is based on your tax return from two years earlier. For 2026 the figure used is your modified adjusted gross income from 2024. Two people with identical circumstances today can pay very different premiums if one of them had a large one-off income two years ago.
Possibly not. Work stoppage is a qualifying life-changing event. File Form SSA-44 with evidence — a letter confirming the retirement date, and an estimate of the current year's income — and ask for the assessment to use that instead. This is the single most useful form on this page.
Yes. The same income brackets drive a surcharge on your Part D premium, paid to Medicare rather than to the drug plan, usually taken from Social Security alongside the Part B amount. It applies whether your drug cover is stand-alone or inside an Advantage plan.
No. The appeal route exists for the specific life-changing events listed above. If the income was genuinely earned and no qualifying event occurred, the surcharge stands for that year and then falls away as the two-year window rolls forward.
The Social Security Administration sends an initial determination notice, usually in late autumn, for the coming year. Read it when it arrives rather than in January — the appeal is much easier before the first payment is deducted.
Got a determination notice you did not expect?
Read it to us down the phone. In most cases we can tell you within ten minutes whether an appeal is available and which form to file.
- SSA-44 explained
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- Same-day reply
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