Medicare IRMAA: What It Is and How to Manage It in 2026
If your income is above a certain level, you pay more for Medicare. That extra amount is called IRMAA — the Income-Related Monthly Adjustment Amount. This hub explains exactly how IRMAA works in 2026, what the brackets are, and the legitimate ways to reduce or appeal it.
What IRMAA is
Most people pay the standard Medicare Part B premium — $202.90 per month in 2026. But if your income is above the first threshold, Medicare adds a surcharge to both your Part B and your Part D premiums. That surcharge is IRMAA. It is calculated by the Social Security Administration, deducted automatically (usually from your Social Security check), and recalculated every year.
IRMAA is a “cliff,” not a gradual phase-in: cross a threshold by even one dollar and you pay the full surcharge for that tier. That is what makes IRMAA planning so valuable — small changes in income can mean hundreds or thousands of dollars a year in extra premiums.
How the income lookback works
Medicare uses a two-year lookback. Your 2026 IRMAA is based on the Modified Adjusted Gross Income (MAGI) from your 2024 tax return — the most recent return the IRS has shared with Social Security. MAGI is your adjusted gross income plus any tax-exempt interest, so things like municipal bond interest still count.
Because of the lookback, a one-time income spike — selling a home, a large Roth conversion, capital gains, or taking a big retirement distribution — can raise your premiums two years later, even if your income has since returned to normal.
What IRMAA costs in 2026
IRMAA is tiered. In 2026 a single filer with MAGI at or below $109,000 (or a married couple at or below $218,000) pays no surcharge. Above those levels, the surcharge climbs through five tiers, reaching nearly $690 per month for Part B at the highest tier. Part D adds its own smaller surcharge on top. See the full 2026 IRMAA brackets and run your own numbers with our IRMAA calculator.
How to manage or reduce IRMAA
There are two distinct paths. If your income genuinely dropped because of a qualifying event, you can appeal using Form SSA-44 and ask Social Security to use your current income. If your income is simply high, the lever is proactive tax and withdrawal planning — managing your MAGI across years so you stay under the thresholds that matter to you. The list of qualifying life-changing events determines which path is open to you.
Explore the IRMAA hub
Plain-English explanation of the income-related surcharge and who pays it.
The full 2026 income thresholds and surcharge amounts, plus a calculator.
Use Form SSA-44 to request a reduction after a life-changing event.
Roth conversions, withdrawal timing, and moves that manage your MAGI.
The events the SSA accepts to recalculate your IRMAA mid-year.
How IRMAA affects high-income retirees in Florida, Texas, and Arizona.
Want a deeper read on the strategy side? See our guide to Medicare for high earners and how to lower your Medicare costs. When you’re ready, a licensed advisor can review your situation at no cost.
Frequently Asked Questions
What is IRMAA in simple terms?
IRMAA (Income-Related Monthly Adjustment Amount) is an extra amount added to your Medicare Part B and Part D premiums if your income is above a set threshold. It is not a separate bill — it is a surcharge layered on top of your normal premiums.
What income does Medicare use to decide my 2026 IRMAA?
Medicare uses a 2-year lookback, so your 2026 IRMAA is based on the Modified Adjusted Gross Income (MAGI) reported on your 2024 tax return.
How much is the standard Part B premium in 2026?
The standard 2026 Part B premium is $202.90 per month. IRMAA adds to that amount for higher-income beneficiaries; lower-income beneficiaries pay only the standard premium.
Can IRMAA be reduced or removed?
Yes. If your income dropped because of a qualifying life-changing event (such as retirement, divorce, or the death of a spouse), you can file Form SSA-44 to ask Social Security to use your more recent income instead.
Does IRMAA differ by state?
No. IRMAA is a federal calculation, so the thresholds and surcharge amounts are the same in every state. What differs by state is how many retirees have incomes high enough to trigger it.
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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 2026-06-11 by Lynsey Brennan, Licensed Medicare Advisor (FL #G007269).