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IRMAA Medicare Surcharges: What High Earners Need to Know
IRMAA — the Income-Related Monthly Adjustment Amount — is a surcharge added to your Medicare Part B and Part D premiums when your income crosses certain thresholds. The surprise is the timing: it is based on your tax return from two years ago, so a one-time spike — a home sale, a Roth conversion, a year of high capital gains — can raise your premiums long after the money is gone. The good news: some triggers can be appealed, and many can be planned around.
What is IRMAA and who pays it?
IRMAA is an income-based surcharge added to Medicare Part B and Part D premiums for higher earners. Social Security determines it using your modified adjusted gross income (MAGI) from your tax return two years prior. At the top bracket it can add hundreds of dollars per month — up to roughly $628/month combined per person.
- IRMAA uses your income from 2 years ago — 2026 surcharges are based on your 2024 tax return.
- It applies per person, so a married couple can each owe a surcharge.
- Certain life-changing events let you appeal to have it reduced or removed.
Key Takeaways
- IRMAA is based on your modified adjusted gross income (MAGI) from two years ago.
- It is a cliff, not a phase-in: one dollar over a bracket can cost hundreds per month.
- Life-changing events — retirement, divorce, death of a spouse — are grounds to appeal.
- Roth conversions, home sales, and large capital gains are common one-time triggers.
The costly mistakes to avoid
Where people in this situation lose the most money.
An unexpected surcharge from two-year-old income
Because IRMAA uses a tax return from two years prior, the surcharge can hit in a year your income is already much lower — for example, your first year of retirement.
A home sale that pushes you over a bracket
A large capital gain from selling a home or investment can spike your MAGI for one year and trigger IRMAA the following year-plus — even though it was a one-time event.
Roth conversions that quietly raise your premiums
Converting a traditional IRA to a Roth adds to your MAGI. Done without IRMAA in mind, a conversion can cost you far more in surcharges than expected.
Not knowing you can appeal
Many people pay IRMAA for years without realizing that a qualifying life-changing event lets them request a reduction using Form SSA-44.
Guides, tools & resources
Understand the surcharge
Reduce or appeal it
Frequently Asked Questions
How much can IRMAA add to my Medicare premiums in 2026?
At the highest income bracket, IRMAA can add several hundred dollars per month on top of the standard Part B and Part D premiums — roughly $628/month combined per person at the top tier. The exact amount depends on which income bracket your MAGI falls into.
What year of income does IRMAA use?
IRMAA uses your modified adjusted gross income (MAGI) from your tax return two years earlier. So your 2026 surcharge is based on your 2024 federal tax return. This two-year lookback is why a one-time income event can affect your premiums later.
Can I appeal or reduce my IRMAA?
Yes. If you experienced a qualifying life-changing event — such as retirement, marriage, divorce, the death of a spouse, or loss of income — you can file Form SSA-44 with the Social Security Administration to request that IRMAA be recalculated using your reduced income.
Does a Roth conversion trigger IRMAA?
It can. The taxable amount of a Roth conversion increases your MAGI for that year, which could push you into a higher IRMAA bracket two years later. Planning conversions with IRMAA brackets in mind — and spreading them across years — can limit the surcharge impact.
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Get My Free ReviewThis information is for educational purposes only and is not legal, tax, or insurance advice. Medicare rules, premiums, and income thresholds change annually — confirm current figures with Medicare.gov, the Social Security Administration, or a licensed advisor. HealthPlan Connect is not affiliated with or endorsed by the federal Medicare program or any government agency. Last reviewed 2026-06-12 by Lynsey Brennan, Licensed Medicare Advisor (FL License #G007269).