What Is IRMAA?
IRMAA (Income-Related Monthly Adjustment Amount) is a supplemental charge added to standard Medicare Part B and Part D premiums for beneficiaries whose Modified Adjusted Gross Income (MAGI) exceeds certain thresholds. It is an extra charge on top of your standard Medicare Part B and Part D premiums that applies to higher-income beneficiaries.
Modified Adjusted Gross Income (MAGI) is your Adjusted Gross Income plus any tax-exempt interest income, calculated from your federal tax return two years prior to your Medicare effective year.1
Think of IRMAA as a "means test" for Medicare. If your income is above a certain level, Medicare charges you more for coverage. The higher your income, the more you pay.
How Is IRMAA Calculated?
IRMAA is based on your Modified Adjusted Gross Income (MAGI) from your tax return two years prior. For 2026 premiums, Medicare looks at your 2024 tax return.
MAGI is your Adjusted Gross Income plus any tax-exempt interest income, such as municipal bond interest.
Your MAGI includes:
- Adjusted Gross Income (AGI)
- Tax-exempt interest income (such as municipal bond interest)
This means tax-exempt income that normally does not affect your tax bill can trigger IRMAA surcharges.
2026 IRMAA Income Brackets and Surcharges
Part B (Medical Insurance) Monthly Premiums
| Individual MAGI | Married Filing Jointly | Monthly Premium (2026) | Source |
|---|---|---|---|
| $106,000 or less | $212,000 or less | $185.00 (standard) | CMS.gov2 |
| $106,001 – $135,000 | $212,001 – $270,000 | $259.00 | CMS.gov2 |
| $135,001 – $160,000 | $270,001 – $320,000 | $370.00 | CMS.gov2 |
| $160,001 – $205,000 | $320,001 – $410,000 | $504.90 | CMS.gov2 |
| $205,001 – $500,000 | $410,001 – $750,000 | $591.90 | CMS.gov2 |
| Above $500,000 | Above $750,000 | $628.90 | CMS.gov2 |
Source: CMS 2026 Medicare Parts A & B Premiums and Deductibles announcement (CMS.gov).2
Part D (Prescription Drug) Monthly Surcharges
Part D IRMAA uses the same income brackets but adds a surcharge on top of your plan's base premium:
| Individual MAGI | Married Filing Jointly | Monthly Surcharge | Source |
|---|---|---|---|
| $106,000 or less | $212,000 or less | $0.00 | CMS.gov2 |
| $106,001 – $135,000 | $212,001 – $270,000 | $13.70 | CMS.gov2 |
| $135,001 – $160,000 | $270,001 – $320,000 | $35.30 | CMS.gov2 |
| $160,001 – $205,000 | $320,001 – $410,000 | $57.00 | CMS.gov2 |
| $205,001 – $500,000 | $410,001 – $750,000 | $78.60 | CMS.gov2 |
| Above $500,000 | Above $750,000 | $85.80 | CMS.gov2 |
Source: CMS 2026 Medicare Parts A & B Premiums and Deductibles announcement (CMS.gov).2 Official 2026 Part D de minimis amounts and income-related adjustments are released annually by CMS.2
The Two-Year Lookback Rule
The two-year lookback rule means Medicare uses your Modified Adjusted Gross Income (MAGI) from your tax return filed two years before your coverage year to determine your IRMAA surcharges. For example, your 2024 tax return determines your 2026 IRMAA premiums, and your 2025 tax return will determine your 2027 premiums.
This is one of the most common surprises for new Medicare enrollees. Medicare uses your income from two years ago to determine your current premiums.
Example: A one-time event in 2024 — such as selling a home, converting a large IRA to Roth, or receiving a pension lump sum — could increase your 2026 Medicare premiums significantly, even if your 2026 income is much lower.
5 Strategies to Reduce or Avoid IRMAA
1. Manage Your MAGI Strategically
Since IRMAA is based on MAGI, reducing taxable income is your primary lever. Common approaches include spreading large Roth conversions over multiple years instead of doing one large conversion, timing the sale of assets to avoid income spikes in a single year, and using tax-loss harvesting to offset capital gains.
2. File a Life-Changing Event Appeal (SSA-44)
If your income dropped due to a qualifying life-changing event, you can ask Social Security to use a more recent tax year. Qualifying events include retirement or reduction in work hours, death of a spouse, divorce or annulment, and loss of income-producing property such as from a disaster or other event. File Form SSA-44 with your local Social Security office.3
3. Be Careful with Roth Conversions
Roth conversions are a powerful retirement planning tool, but a large conversion can push you into a higher IRMAA bracket. Plan conversions in the years before you become Medicare-eligible (age 65), since IRMAA uses a two-year lookback period. Waiting until after you enroll in Medicare to do large conversions means those higher premiums will apply for at least two years.
4. Watch Tax-Exempt Interest
Municipal bond interest is excluded from federal income tax but is included in your MAGI for IRMAA purposes. If you hold a large municipal bond portfolio, this could push you over an IRMAA threshold. Review your holdings with a tax professional to understand the potential impact.
5. Consider Health Savings Account (HSA) Contributions
If you have access to an HSA before enrolling in Medicare, maximize contributions. HSA withdrawals for qualified medical expenses are not included in MAGI, making HSAs a powerful tool for managing income during the years before Medicare eligibility.
IRMAA and Social Security
Your IRMAA surcharge is typically deducted directly from your Social Security benefit. If your surcharge is $74 per month, your Social Security check will be $74 less than it would otherwise be.
If you do not receive Social Security, Medicare will bill you directly for the surcharge.
This article was last updated on March 31, 2026. Medicare premiums and income brackets are subject to annual changes. Verify current figures at Medicare.gov or contact Social Security at 1-800-772-1213.
Ready to optimize your Medicare strategy?
Take control of your healthcare costs by reviewing the IRMAA brackets above against your projected retirement income. For personalized guidance tailored to your specific situation, consult with a qualified Medicare planning specialist who can help you develop a strategy to minimize IRMAA while maximizing your retirement benefits.
This article is for informational purposes only and does not constitute financial, tax, or legal advice. Individual circumstances vary significantly. The strategies mentioned may not be appropriate for everyone. Consult with a qualified financial advisor, tax professional, or Medicare specialist before making any decisions regarding your Medicare coverage or retirement income planning. Past performance does not guarantee future results.
Last reviewed by a Medicare planning specialist on March 31, 2026.
Footnotes
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Social Security Administration, "Medicare Income-Related Monthly Adjustment Amount," ssa.gov/oact/cola/irma.html. The income thresholds for 2026 remain $106,000 for individuals and $212,000 for married couples filing jointly. ↩ ↩2 ↩3
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Centers for Medicare & Medicaid Services, "2026 Medicare Parts A & B Premiums and Deductibles" (CMS Fact Sheet, November 2025). See CMS.gov for official figures. ↩ ↩2 ↩3 ↩4 ↩5 ↩6 ↩7 ↩8 ↩9 ↩10 ↩11 ↩12 ↩13 ↩14 ↩15 ↩16
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Social Security Administration, "Life-Changing Event Form (SSA-44)," ssa.gov/forms/ssa-44.html. ↩ ↩2
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Medicare.gov, "Sign Up for Medicare," medicare.gov/account. ↩