IRMAA: Medicare High-Income Premium Surcharge (2026)

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 generally 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.1,2

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.1

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. Every SSA 2026 table is headed "If MAGI in 2024 (or 2023 if 2024 is not available)": when the IRS can't supply the two-years-prior return, the agency reaches back a third year instead. So the income that sets your surcharge is income you earned two years before the bill arrives, or three, often a year you were still working, sold a home, or took a large retirement-account distribution.3,1

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.3

IRMAA is recalculated every year, so 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, or on your 2023 MAGI if the IRS can't supply the 2024 return, per the Social Security Administration's 2026 sliding-scale tables.1,2

Exactly $500,000 falls in the top band, not below it.1

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.1

Neither column is the final bill. Social Security footnotes the Part B totals "Plus all applicable surcharges, minus Medicare Advantage Reduction," so a Part B late-enrollment penalty is added on top of the table figure and a Medicare Advantage plan that pays part of your Part B premium is subtracted from it. The Part D column adds "late enrollment or reenrollment fees" on top of both the add-on and your plan's own premium.1

A separate, compressed IRMAA scale applies by default if you file married filing separately, unless you tell Social Security you lived apart from your spouse for the whole year. When the IRS reports that filing status, SSA's instruction to its own staff is to assume the couple lived together at some point in the tax year. Living apart all year does put you back on the single-filer tiers, but it's something you have to allege, not something SSA works out on its own. Read a sentence about couples who lived together, decide it isn't about you, say nothing, and you're billed the compressed scale anyway. At $150,000 of MAGI that's $649.20 a month for Part B and $83.30 for Part D, against $405.80 and $37.50 on the single-filer tiers, roughly $3,470 more over the year.1

The scale has three rows: the standard premium at or below $109,000; one wide band above $109,000 and below $391,000 ($649.20 Part B, plus $83.30 Part D); and a top band at $391,000 and above ($689.90 Part B, plus $91.00 Part D). There are no graduated middle brackets, so a filer just over $109,000 pays the surcharge a single filer wouldn't reach until MAGI passed $205,000, roughly $6,355 for the year, while the same couple filing jointly under $218,000 would owe nothing. Unless there's a strong non-tax reason to file separately, model both statuses before Medicare years.1

What counts toward IRMAA's MAGI

The bracket you land in is driven by one number and your filing status, 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). IRMAA is based on your MAGI and tax filing status, not on assets or resources: a large portfolio by itself doesn't trigger IRMAA; the income it throws off does.3

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

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 2026.2

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. 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.3,4

The eight life-changing events

Social Security recognizes a specific list of qualifying events:4

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 bankruptcy or reorganization

The event doesn't have to be recent misfortune. Retirement is the classic case: filing Form SSA-44 with proof of the work stoppage and an estimate of current income lets Social Security recalculate on the lower figure instead of the working year the return still shows.1

How to file

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.4

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:

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.1

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.1

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.

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.3
• 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.
• Filing married-filing-separately without checking the scale. The compressed MFS brackets jump almost immediately to near-top surcharges, and Social Security applies them by default: it assumes an MFS couple lived together at some point in the year unless you tell it you lived apart for all of it.1
• Missing the separate Part D IRMAA bill. It comes from Medicare, not your drug plan, and nonpayment endangers the drug coverage itself.
• Letting a 60-day appeal window lapse. Each level of the appeal ladder runs on its own 60-day clock from the prior decision.

Learn More

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.