If your income is above $109,000 as a single filer or $218,000 as a couple, Medicare adds a surcharge called IRMAA on top of your standard Part B and Part D premiums. The Income-Related Monthly Adjustment Amount is set by your tax return from two years earlier, and at the top tier it pushes the total Part B premium to $689.90 a month, against the standard $202.90. If the determination letter came as a surprise, two things matter most: the surcharge resets every year, and a life change like retirement lets you ask Social Security to recalculate it on Form SSA-44, with a full appeals ladder behind that if the answer is no.,

Who pays IRMAA

Most people never pay IRMAA. It applies only to the roughly highest-income slice of Medicare beneficiaries. For 2026, you pay the standard premium with no surcharge if your modified adjusted gross income (MAGI) is at or below $109,000 as a single filer or head of household, or at or below $218,000 if you're married filing jointly. Above those lines, a five-tier sliding scale adds a surcharge to both Part B and Part D.

Two features of IRMAA catch people off guard.

The first is the two-year lag. Social Security determines your 2026 surcharge from the MAGI reported on your 2024 federal tax return, the most recent return the IRS has finalized. So the income that sets your surcharge is income you earned two years before the bill arrives, often a year you were still working, sold a home, or took a large retirement-account distribution.

The second is that IRMAA uses MAGI, not the adjusted gross income on the front of your return. For IRMAA, MAGI is your AGI plus any tax-exempt interest, including interest from municipal bonds. That add-back surprises people who hold tax-free bonds and assume that income is invisible for Medicare purposes.

IRMAA is recalculated every year. Because it's tied to a tax return that's always two years back, a one-time income spike raises your premium for a single year and then drops off once a lower-income return cycles into the calculation.

The 2026 IRMAA brackets

The surcharge rises in five tiers. The table below gives the total monthly Part B premium at each tier (the standard $202.90 plus the Part B surcharge) and the Part D add-on you pay on top of your drug plan's own premium. The income brackets are based on your 2024 MAGI, per the Social Security Administration's 2026 sliding-scale tables.,

2024 MAGI (single / head of household) 2024 MAGI (married filing jointly) Total Part B premium Part D add-on
$109,000 or less $218,000 or less $202.90 (standard) $0
$109,000.01 – $137,000 $218,000.01 – $274,000 $284.10 +$14.50
$137,000.01 – $171,000 $274,000.01 – $342,000 $405.80 +$37.50
$171,000.01 – $205,000 $342,000.01 – $410,000 $527.50 +$60.40
$205,000.01 – $500,000 $410,000.01 – $750,000 $649.20 +$83.30
$500,000.01 or more $750,000.01 or more $689.90 +$91.00

Read the Part B column as a whole premium, not as the surcharge alone. The standard premium is $202.90, so the Part B surcharge by itself runs from $81.20 a month at the first tier to $487.00 a month at the top. Add the Part D surcharge and the combined IRMAA cost ranges from about $1,148 a year at the first tier to about $6,936 a year at the top.

A separate, compressed scale applies if you're married filing separately and lived with your spouse at any point during the year. You pay the standard premium at or below $109,000; a lower band covers income above $109,000 and below $391,000 ($649.20 Part B, plus $83.30 Part D); and the top band applies at $391,000 and above ($689.90 Part B, plus $91.00 Part D). There are no graduated middle brackets: a married-filing-separately filer just over $109,000 pays the same monthly surcharge a single filer wouldn't reach until MAGI passed $205,000, roughly $6,355 for the year, while the same couple filing jointly with combined MAGI below $218,000 would owe nothing. Unless there's a compelling non-tax reason to file separately, it's worth modeling both filing statuses before Medicare years.

What counts toward IRMAA's MAGI

The bracket you land in is driven entirely by one number, so it pays to know exactly what's in it. MAGI for IRMAA is your adjusted gross income (line 11 of Form 1040) plus tax-exempt interest income (line 2a). There is no asset or resource test: a large portfolio by itself doesn't trigger IRMAA; the income it throws off does.

Income that counts:

  • Wages, self-employment income, and pension payments
  • Traditional IRA and 401(k)/403(b) withdrawals, including required minimum distributions (RMDs)
  • Roth conversions: the converted amount flows through AGI in the year you convert
  • Capital gains, dividends, and taxable interest
  • Tax-exempt municipal bond interest (added back for IRMAA even though it escapes income tax)
  • The taxable portion of Social Security benefits, since it's already inside AGI

Income that doesn't count:

  • Qualified Roth IRA distributions (they never enter AGI)
  • The nontaxable portion of Social Security benefits
  • A qualified charitable distribution (QCD): an amount sent directly from a traditional IRA to a qualifying charity is excluded from gross income and still satisfies the RMD requirement, which makes it one of the most effective tools for keeping an RMD from pushing you over a bracket line

The Roth distinction matters most in practice. Converting to a Roth raises MAGI once, in the conversion year, and can set off a one-year surcharge two years later; withdrawing from the Roth afterward never touches IRMAA again.

How you pay it

The Part B surcharge follows the same path as your standard Part B premium. If you collect Social Security, both come out of your monthly benefit before it's deposited. If you're not yet drawing Social Security, you're billed directly, usually quarterly, through Medicare Easy Pay or a paper bill. The standard Part B premium those bills are built on is $202.90 a month in 2026.

The Part D surcharge works differently, and the difference trips people up. You pay your Part D plan's premium to the private insurer that runs the plan, but the IRMAA add-on goes to Medicare, not the insurer. It's deducted from your Social Security benefit or billed separately, the same way the Part B surcharge is. So a beneficiary in a high tier can see two distinct charges tied to Part D: the plan premium paid to the carrier, and the IRMAA add-on paid to the government. That's true even on a zero-premium drug plan; the add-on arrives regardless of what the plan itself charges. Treat that separate bill seriously: unpaid Part D IRMAA is treated as an unpaid Part D premium, and prolonged nonpayment can cost you the drug coverage itself.

Social Security tells you about IRMAA by mail, typically in the weeks before the new premium year begins. The letter, called an initial determination, states which tier applies, the income figure it used, and the tax year it pulled from. Read it closely, because that letter is what you respond to if the figure is wrong or your situation has changed, and it starts the clock on your appeal rights.

Appealing IRMAA with Form SSA-44

If your income has dropped since the tax year Social Security used, you can ask for a new determination using Form SSA-44. The form applies when a life-changing event lowered your income. The mechanic that makes it so valuable: the appeal lets Social Security base your surcharge on a more recent or estimated year's income rather than the two-year-old return.

The eight life-changing events

Social Security recognizes a specific list of qualifying events:

  1. Marriage
  2. Divorce or annulment
  3. Death of a spouse
  4. Work stoppage: you or your spouse stopped working; retirement is by far the most common trigger
  5. Work reduction: you or your spouse significantly cut work hours
  6. Loss of income-producing property through a disaster or another event outside your control (not a voluntary sale)
  7. A scheduled cessation, termination, or reorganization of an employer's pension plan, including a pension that's been lost or reduced
  8. An employer settlement payment received because of the employer's closure, bankruptcy, or reorganization

The event doesn't have to be recent misfortune. Retirement is the classic case: someone who earned $200,000 while working in 2024 and retired in 2025 would otherwise pay a 2026 surcharge built on that working-year income, even though their actual 2026 income is far lower. Filing Form SSA-44 with proof of the work stoppage and an estimate of current income lets Social Security recalculate on the lower figure.

How to file

1
Step 1

Start from the initial determination letter

It names the tier, the income figure, and the tax year Social Security used, and your window to respond runs from its date, so don't set it aside.

2
Step 2

Match your situation to one of the eight events

If more than one applies (a spouse's death followed by your own retirement, for example), document each.

3
Step 3

Complete Form SSA-44

with the event, its date, and your estimated MAGI for the year you want Social Security to use. Estimate honestly and show your work: expected pension, Social Security, withdrawals, interest, and dividends.

4
Step 4

Attach proof

A marriage or death certificate, a divorce decree, a signed letter from the former employer confirming the retirement date, insurance documentation for a destroyed property, or the pension plan's termination notice.

5
Step 5

Submit it

by mail or in person at a local Social Security office (ssa.gov/locator). Filing in person lets a representative flag missing documentation on the spot. Social Security typically responds within a few months; if it approves, it adjusts the premium and refunds what you've overpaid.

What doesn't qualify

Not every income change counts. A drop caused by selling investments, by a one-time capital gain falling off, by a Roth conversion you don't repeat, or by an IRA distribution you simply stopped taking is not a life-changing event under these rules. For those cases, the surcharge corrects itself the following year when a lower-income return enters the two-year calculation. If you disagree with Social Security's income figure itself (say, because the IRS data reflects a return you've since amended), that's handled as a correction request rather than a life-changing event, and it's worth raising with Social Security directly.

If Social Security says no

A denied SSA-44 isn't the end of the road. IRMAA determinations carry the same multi-level appeal rights as other Social Security decisions, and each level has a 60-day window from the previous decision:

1
Step 1

Reconsideration

The SSA-44 request is itself the reconsideration step. A denial arrives in writing and explains what fell short, often incomplete documentation of the event.

2
Step 2

Hearing before an Administrative Law Judge

You can request a hearing, present documents, and testify; a family member, representative, or attorney can appear with you. Well-documented life-changing-event appeals are regularly granted at this level after an initial denial, typically because the fuller record establishes what the first reviewer couldn't see.

3
Step 3

Appeals Council review

If the judge rules against you, you can ask Social Security's Appeals Council to review the decision on the written record.

4
Step 4

Federal district court

The final step is a civil action in the federal district court where you live. It's rarely worth the cost for a single year's surcharge, but can be for a dispute that affects multiple years.

Weigh each step against the dollars at stake: in 2026, a first-tier IRMAA surcharge is about $1,148 for the year and a top-tier surcharge about $6,936, and a strong ALJ appeal can recover a full year of wrongly assessed premiums. If you want help preparing a filing, a counselor at your State Health Insurance Assistance Program (SHIP, shiphelp.org) can review the notice and the form with you for free.

Planning around IRMAA

IRMAA has a feature worth understanding before you make income decisions in the years near retirement: the brackets are cliffs, not a gradual phase-in. One dollar of MAGI over a threshold moves you into the next tier in full. Crossing from $171,000 to $171,001 in single-filer MAGI, for example, raises your total 2026 Part B premium from $405.80 to $527.50 a month and your Part D add-on from $37.50 to $60.40, a jump of roughly $1,700 over the year. The surcharge doesn't scale with how far over the line you go.

Because of that, the dollars right below each threshold matter, and a handful of moves do most of the work:

  • Time large Roth conversions early. The two-year lag means income at age 63 sets the premium at 65. Conversions finished before that window never touch IRMAA; conversions after it do, so many retirees spread a large conversion across several years to stay in a lower tier each year instead of hitting a top tier once.
  • Use QCDs to blunt RMDs. Once required minimum distributions begin, they arrive every year whether you need the income or not. Routing some or all of an RMD directly to charity keeps it out of MAGI entirely.
  • Watch one-time events. A home sale beyond the federal home-sale exclusion, a business sale, or a lump-sum withdrawal lands in MAGI two years before you feel it. If a sale is coming, ask a tax advisor to model the IRMAA effect alongside the income tax; an installment structure or a shift of a few weeks across a year boundary can move the outcome a full tier.
  • Harvest losses near a line. Capital losses offset gains dollar-for-dollar; even a modest loss realized in December can hold MAGI under a bracket boundary and save a full year of surcharge.

The flip side is that the lag works in your favor too. A high-income year early in retirement raises your premium for exactly one year, then resolves on its own, no form required.

How the pieces play out

Common IRMAA mistakes

  • Not filing SSA-44 after retiring. Many new retirees don't know the form exists and quietly pay a surcharge built on their final working year. Filing in January after a December retirement is ideal.
  • Assuming municipal bond interest is invisible. Tax-exempt interest is added back into MAGI for IRMAA, and for retirees with large muni portfolios it's often exactly what crosses the first threshold.
  • Ignoring the cliffs. Barely over a line costs the same as far over it, so year-end income management right at a boundary is disproportionately valuable.
  • Forgetting Roth conversions count. The converted amount drives IRMAA two years later; spread conversions if the total would cross tiers.
  • Filing married-filing-separately without checking the scale. The compressed MFS brackets jump almost immediately to near-top surcharges.
  • Missing the separate Part D IRMAA bill. It comes from Medicare, not your drug plan, and nonpayment endangers the drug coverage itself.
  • Treating IRMAA as permanent. It resets every year from the newest available return; a one-time spike is one bad year, not a life sentence.
  • Letting a 60-day appeal window lapse. Each level of the appeal ladder runs on its own 60-day clock from the prior decision.

Frequently Asked Questions

What income does IRMAA use?

It uses your modified adjusted gross income (MAGI), which is your adjusted gross income plus any tax-exempt interest, such as municipal bond interest. For 2026, Social Security uses the MAGI from your 2024 federal tax return. There is no asset test.

Why is my 2026 IRMAA based on a two-year-old return?

Social Security uses the most recent tax return the IRS has finalized, which is always two years back. When it sets your 2026 surcharge, your 2025 return isn't filed yet, so it uses 2024.

What are the eight life-changing events for an IRMAA appeal?

Marriage; divorce or annulment; death of a spouse; work stoppage; work reduction; loss of income-producing property through an event beyond your control; a scheduled cessation, termination, or reorganization of an employer's pension plan; and an employer settlement payment tied to the employer's closure, bankruptcy, or reorganization. Voluntary transactions (asset sales, Roth conversions, RMDs, bonuses) do not qualify.

Does IRMAA apply to Medicare Advantage?

Yes. The Part B IRMAA surcharge is owed regardless of how you receive your benefits, because Medicare Advantage enrollees still pay the Part B premium. If your plan includes drug coverage, the Part D IRMAA add-on applies as well and is paid to Medicare, not the plan.

Can I get IRMAA reduced after I retire?

Often, yes. A work stoppage or reduction is a recognized life-changing event. File Form SSA-44 with proof of the event and an estimate of your current income, and Social Security can recalculate the surcharge on the lower figure instead of the two-year-old return.

What happens if my SSA-44 is denied?

You can appeal within 60 days to a hearing before an Administrative Law Judge, then to Social Security's Appeals Council, and finally to federal district court. Well-documented life-changing-event appeals are regularly granted at the hearing level, so a denial for thin paperwork is worth a second try with a fuller record.

Do Roth conversions or Roth withdrawals count toward IRMAA?

Conversions do; withdrawals don't. The amount you convert flows through AGI in the conversion year and drives IRMAA two years later. Qualified distributions from the Roth afterward never enter MAGI.

Does selling my house trigger IRMAA?

It can. Gain on a primary residence above the federal home-sale exclusion flows into AGI, and the gain on a second home or rental is fully taxable. Either can raise the surcharge two years after the sale, so it's worth modeling before you close if you're near a bracket line.

Is the Part D surcharge paid to my drug plan?

No. You pay your plan's premium to the insurer, but the Part D IRMAA add-on goes to Medicare, usually deducted from your Social Security benefit or billed separately. It applies even if your drug plan's own premium is $0.

Is IRMAA permanent once I'm in a tier?

No. Social Security recalculates it every year from the newest available return, automatically. A one-time income spike produces exactly one surcharged year; you don't need to file anything for the premium to come back down.

Learn More

MedicareWhat is Medicare? Parts A, B, C, and D explainedWhat is Medicare? A plain guide to Parts A, B, C, and D, who qualifies, 2026 costs, when to enroll, and what it doesn't cover, with help-paying options. MedicareHow much does Medicare cost? Every 2026 figureHow much does Medicare cost in 2026? Part A, B, C, and D premiums, deductibles, and coinsurance, plus IRMAA and ways to lower your Medicare costs. MedicareDual-eligible plans (FIDE-SNPs): Medicare and Medicaid togetherFIDE-SNPs are the high-integration dual-eligible plans replacing the MMP demonstration on 1/1/2026: definitions, state landscape, and family pitfalls. MedicareMedicare plans and coverage in CaliforniaMedicare in California for 2026: Part A, Part B, Medicare Advantage, Part D, Medigap and the birthday rule, plus programs that help pay your costs. MedicareMedicare plans and coverage in FloridaMedicare in Florida for 2026: Part A, Part B, Medicare Advantage, Part D, and Medigap rules, plus the programs that help Floridians pay their costs.

Find personalized help checking whether IRMAA applies to you and whether you can appeal it at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.

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Brevy Care Team

Expert eldercare guidance from Brevy's team of healthcare professionals and researchers.