Let's start with what IRMAA actually is, because the name scares people. IRMAA — the Income-Related Monthly Adjustment Amount — is a surcharge added to your Medicare Part B and Part D premiums if your income is above a certain level. It's not a penalty and it's not a mistake. It's simply Medicare asking higher earners to pay a bigger share.
The catch that trips people up: it's based on your income from two years ago — so your 2026 surcharge looks at your 2024 tax return. Let's break down who pays, how much, and what to do about it.
How IRMAA Works
Three things make IRMAA behave differently than most people expect:
- It uses a two-year lookback. Your 2026 premiums are set by your 2024 income. Sell a business in 2024? You could feel it in 2026.
- It's based on MAGI — your Modified Adjusted Gross Income, which is your AGI plus any tax-exempt interest (like municipal bond income). Retirement account withdrawals, capital gains, and Roth conversions all count.
- It's a cliff, not a slope. Go one dollar over a bracket and you owe the entire tier's surcharge — not a little more. That single dollar can cost you real money.
The Complete 2026 IRMAA Brackets
Here's every 2026 tier. Find your 2024 income and filing status — that's the row that sets your 2026 premium. The Part D surcharge is added on top of whatever your drug plan already charges.
| 2024 Income — Individual | 2024 Income — Married (Joint) | Part B Total /mo | Part D Surcharge /mo |
|---|---|---|---|
| $109,000 or less | $218,000 or less | $202.90 | $0 |
| $109,001 – $137,000 | $218,001 – $274,000 | $284.10 | +$14.50 |
| $137,001 – $171,000 | $274,001 – $342,000 | $405.90 | +$37.50 |
| $171,001 – $205,000 | $342,001 – $410,000 | $527.70 | +$60.40 |
| $205,001 – $500,000 | $410,001 – $750,000 | $649.50 | +$83.30 |
| Above $500,000 | Above $750,000 | $689.90 | +$91.00 |
The Cliff That Catches People
This is the part worth reading twice. IRMAA isn't gradual. A single retiree with $109,000 of income pays the standard $202.90. Earn just $1 more — $109,001 — and your Part B jumps to $284.10, plus a Part D surcharge on top. That's roughly $1,150 more per year triggered by one extra dollar.
How You Actually Pay IRMAA
- Part B IRMAA is added right onto your regular Part B premium — pulled from your Social Security check, or billed to you if you're not drawing Social Security yet.
- Part D IRMAA is different: you pay it directly to Medicare, not to your drug plan. You'll get a separate bill, and you owe it even if someone else (like a former employer) pays your actual Part D plan premium.
How to Fight IRMAA (The Part Most People Miss)
Here's the tool almost nobody uses: if a life-changing event dropped your income, you can appeal — and the approval rate for legitimate events is high. You file Form SSA-44 and ask Social Security to use your current income instead of the two-year-old number.
Qualifying life-changing events include:
- Retirement or reduced work hours — the most common one. If your 2024 return shows a full salary but you've since retired, this is your move.
- Marriage, divorce, or death of a spouse
- Loss of income-producing property or a pension
Common Questions
Does IRMAA last forever?
Does IRMAA apply to Medicare Part A?
Does selling my house trigger IRMAA?
Do both spouses pay IRMAA?
How do I appeal an IRMAA decision?
Your Next Step
IRMAA is one of those things that quietly costs high earners thousands — and quietly rewards the people who plan for it. Here's how to make sure you're on the right side of it:
- Watch the video above — we break down the brackets and the appeal process in plain English.
- Book a Blueprint consultation — we'll check whether you can appeal a current surcharge and help you see the cliffs before you hit them.
Your blueprint is waiting. Let's build it together.