Most people enrolling in Medicare expect to pay the standard monthly premium for Part B and Part D. What surprises many is that higher-income beneficiaries pay significantly more — sometimes hundreds of dollars extra every month. That surcharge is called IRMAA, and understanding it can save you from an unexpected bill.

What Does IRMAA Stand For?

IRMAA stands for Income-Related Monthly Adjustment Amount. It is a surcharge added on top of your standard Medicare Part B and Part D premiums if your income exceeds certain thresholds set by the Social Security Administration (SSA).

In plain terms: the more you earned two years ago, the more you pay for Medicare today.

How Does the SSA Determine Your IRMAA?

The SSA looks at your Modified Adjusted Gross Income (MAGI) from two years prior. So your 2026 Medicare premiums are based on your 2024 tax return. MAGI includes:

• Wages, salaries, and self-employment income
• Social Security benefits (the taxable portion)
• Interest, dividends, and capital gains
• IRA distributions and pension income
• Rental income

If your MAGI falls above the base threshold, you move into a higher IRMAA bracket and pay a larger premium.

2026 IRMAA Brackets at a Glance

The SSA adjusts IRMAA brackets annually for inflation. For 2026, the surcharges apply as follows (based on 2024 income):

Individual filers:

• Up to $106,000 — standard premium, no surcharge
• $106,001–$133,000 — moderate surcharge
• $133,001–$167,000 — higher surcharge
• $167,001–$200,000 — significant surcharge
• $200,001–$500,000 — substantial surcharge
• Above $500,000 — maximum surcharge

Joint filers have thresholds roughly double the individual amounts. Married filing separately uses a much lower threshold.

The exact dollar amounts change each year, so always verify current figures with Medicare.gov or your broker.

Part B vs. Part D: Both Are Affected

IRMAA applies to both Medicare Part B (medical coverage) and Medicare Part D (prescription drug coverage), though the surcharge amounts differ.

For Part B, the surcharge is added directly to your monthly premium. For Part D, the surcharge is added on top of whatever your specific plan charges — so your total out-of-pocket cost depends on both your plan premium and your IRMAA tier.

When Will You Find Out?

If you are subject to IRMAA, the SSA will send you a notice — typically in the fall before the coverage year begins. The notice explains your income bracket, the surcharge amount, and your right to appeal.

If you enroll in Medicare mid-year, you may receive the notice shortly after enrollment.

Can You Appeal IRMAA?

Yes — and this is important. You have the right to appeal your IRMAA determination if:

• Your income has significantly decreased since the tax year used (retirement, job loss, divorce, death of a spouse)
• The SSA used incorrect or outdated tax information
• You experienced a life-changing event such as marriage, divorce, or loss of income-producing property

To appeal, you file Form SSA-44 with your local Social Security office. You will need documentation of the life-changing event and your current or expected income.

Many beneficiaries who retire mid-year successfully appeal IRMAA because their current income is far lower than the two-year-old return the SSA used.

Strategies to Manage IRMAA

While you cannot eliminate IRMAA entirely if your income is high, there are planning strategies worth discussing with a financial advisor:

Roth conversions before Medicare: Converting traditional IRA funds to a Roth IRA before age 65 can reduce future MAGI and potentially lower your IRMAA bracket in retirement.

Timing capital gains: If you have flexibility in when you realize capital gains, spreading them across years can help keep MAGI below a threshold.

Qualified Charitable Distributions (QCDs): If you are 70½ or older, donating directly from your IRA to charity reduces your taxable income without increasing MAGI.

Review your bracket each year: IRMAA brackets are adjusted annually. A small change in income — or a change in the thresholds — can move you into a lower bracket.

What This Means for Your Medicare Plan Choice

IRMAA affects your base Part B and Part D premiums regardless of which Medicare plan you choose. However, your choice of plan still matters:

• A Medicare Advantage plan may bundle Part D coverage and offer lower additional premiums, which can partially offset IRMAA costs.
• A Medicare Supplement (Medigap) plan paired with a standalone Part D plan gives you more control over your drug coverage costs.

The right combination depends on your specific income level, health needs, and the plans available in your area.

Talk to a Local Medicare Expert

IRMAA adds a layer of complexity to Medicare planning that many people do not anticipate. If you are approaching Medicare eligibility — or already enrolled and surprised by a surcharge — it is worth sitting down with an independent broker who can walk through your specific situation.

James Hughes has helped hundreds of St. Louis-area residents navigate Medicare costs, plan comparisons, and IRMAA appeals. There is no cost for a consultation, and no obligation to enroll in any plan.

Call 314-229-6146 or visit the Contact page to schedule your free Medicare review.