What is IRMAA and how does it affect my Medicare premium?

IRMAA stands for Income-Related Monthly Adjustment Amount. It's an extra surcharge added to your Medicare Part B and Part D premiums if your modified adjusted gross income (MAGI) from two years ago exceeded certain thresholds.

In 2026, IRMAA kicks in if your 2024 MAGI was above:
- $106,000 (single filer)
- $212,000 (married filing jointly)

The surcharge increases in tiers. For 2026:

| 2024 MAGI (single) | 2024 MAGI (joint) | Part B IRMAA | Part D IRMAA |
|---|---|---|---|
| ≤ $106k | ≤ $212k | $0 (standard $202.90) | $0 |
| $106k–$133k | $212k–$266k | +$74.00 | +$13.70 |
| $133k–$167k | $266k–$334k | +$185.00 | +$35.30 |
| $167k–$200k | $334k–$400k | +$295.90 | +$57.00 |
| $200k–$500k | $400k–$750k | +$406.90 | +$78.60 |
| > $500k | > $750k | +$443.90 | +$85.80 |

(Numbers are 2026 IRMAA brackets per the official CMS announcement; verify at Medicare.gov for the latest.)

Why two years back? Social Security uses your most recent IRS-filed tax return when calculating your premium. So 2026 IRMAA is based on 2024 income (the 2024 return you filed in early 2025).

How to reduce IRMAA:

1. Life-changing event appeal (Form SSA-44): If your income has dropped because of one of these events — work stoppage/reduction, marriage/divorce/death of spouse, loss of pension, loss of income-producing property — you can file Form SSA-44 to ask Social Security to use a more recent year's income. This is the #1 underused IRMAA reduction tactic.

1. Income planning: Roth conversions, charitable contributions, tax-loss harvesting, and Qualified Charitable Distributions (QCDs) from IRAs can all reduce MAGI in years that count toward IRMAA.

1. Deferred income: Bunching deductible expenses or deferring capital gains into a single year can keep more years below the threshold.

Watch for: Selling a house with a large gain, receiving a one-time inheritance distribution, or a spike in IRA RMDs can push you into IRMAA for one year. SSA-44 doesn't help for one-time events not on the qualifying list.

What to do next: Call (866) 534-1886 — we coordinate with your tax professional and CFP to project IRMAA exposure across multiple years and recommend Medicare plan choices that minimize total premium + IRMAA cost. Free.