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. This guide covers who pays, the exact 2026 brackets, how you're billed, and how to appeal after a life change.
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 $109,000.01 through $391,000 ($649.20 Part B, plus $83.30 Part D); and the top band applies at $391,000.01 and above ($689.90 Part B, plus $91.00 Part D). This scale is far steeper than the single-filer tiers, so married-filing-separately income reaches the highest surcharges quickly.
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 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.
Social Security tells you about IRMAA by mail. 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.
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, and Social Security recognizes a specific list of them:
- Marriage, divorce or annulment, or the death of a spouse
- You or your spouse stopped working or cut back your hours
- Loss of income-producing property through a disaster or other event outside your control
- Loss or reduction of a pension
- A scheduled cessation, termination, or reorganization of an employer's pension plan
- An employer settlement payment because of the employer's closure, bankruptcy, or reorganization
The mechanic that makes this 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. Retirement is the most common trigger. 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.
To file, complete the form, document the life-changing event (a marriage certificate, a death certificate, a signed statement from a former employer), and provide your estimated income for the affected year. You can mail it to Social Security or bring it to a local office.
Not every income change qualifies. A drop caused by selling investments, by a one-time capital gain falling off, 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 figure itself, rather than citing a life event, you file a different request for reconsideration through the agency's standard appeals process.
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 income, for example, raises your total 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. Decisions that push MAGI over a line two years before you'll feel it, a large Roth conversion, the timing of a home sale, or a lump-sum retirement-account withdrawal, can trigger a full tier of surcharge. A tax advisor can help you model the two-year-out effect before you act.
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.
Frequently asked questions
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.
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.
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.
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.
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.
Learn More
- What is Medicare? Parts A, B, C, and D explained
- How much does Medicare cost? Every 2026 figure
- Dual-eligible plans (FIDE-SNPs): Medicare and Medicaid together
- Medicare plans and coverage in California
- Medicare plans and coverage in Florida
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.