Income-Related Monthly Adjustment Amount (IRMAA)

IRMAA, the Income-Related Monthly Adjustment Amount, is an extra charge added to your Medicare Part B and Part D premiums if your income is above certain thresholds. It is essentially a high-income surcharge: the more you earn, the more you pay above the standard premium. Social Security determines IRMAA using your tax return from two years earlier.

For beneficiaries, IRMAA can come as a surprise because it is based on a two-year lookback. A one-time income spike — selling a home, a large IRA withdrawal, or a Roth conversion — can push you into a higher bracket. If your income has since dropped due to a life-changing event like retirement, you can appeal using Form SSA-44.

For example, a couple with $220,000 in income could each pay roughly $70 or more per month on top of the standard $185 Part B premium, plus an added Part D amount — hundreds of dollars more per year, per spouse.

Have questions about IRMAA? Get a free Medicare review and we will help you plan around the income thresholds and appeal if you qualify.