What Is IRMAA?
IRMAA (Income-Related Monthly Adjustment Amount) is an additional charge added to your standard Medicare Part B premium if your income exceeds certain thresholds. It was introduced by the Medicare Modernization Act of 2003 and affects roughly 7% of Medicare beneficiaries — those with higher incomes.
The standard Part B premium for 2026 is $202.90 per month. If your modified adjusted gross income (MAGI) is above the first threshold, your monthly premium increases in steps, up to a maximum of $689.90 per month for the highest earners. IRMAA also applies to Medicare Part D prescription drug plans.
The 2-Year Lookback Rule
Medicare does not use your current-year income to calculate premiums. Instead, the Social Security Administration (SSA) uses your Modified Adjusted Gross Income from two tax years prior. For 2026 premiums, your 2024 tax return (filed in 2025) is the determining document.
This means a one-time income spike — such as selling a home, converting a traditional IRA to a Roth IRA, or realizing large capital gains — can push you into a higher IRMAA bracket two years later. If you've experienced a qualifying life-changing event (retirement, divorce, death of a spouse, etc.), you can file SSA-44 form to request that SSA use a more recent year's income instead.
2026 Medicare Part B IRMAA Brackets
The table below shows the six income tiers and corresponding monthly premiums. Note that "Married Filing Jointly" thresholds are approximately double the individual thresholds for most brackets.
| Individual MAGI | Married Filing Jointly | Monthly Premium |
|---|---|---|
| ≤ $109,000 | ≤ $218,000 | $202.90 |
| $109,001 – $137,000 | $218,001 – $274,000 | $284.10 |
| $137,001 – $171,000 | $274,001 – $342,000 | $405.80 |
| $171,001 – $205,000 | $342,001 – $410,000 | $527.50 |
| $205,001 – $500,000 | $410,001 – $750,000 | $649.20 |
| ≥ $500,000 | ≥ $750,000 | $689.90 |
How to Reduce or Appeal IRMAA
- Life-Changing Events (SSA-44): If you've retired, lost a spouse, divorced, or experienced another qualifying event, you can ask SSA to use a more recent tax year.
- Roth Conversion Planning: Spread large Roth conversions over multiple years to stay below IRMAA thresholds.
- Income Timing: Defer capital gains or other discretionary income to years where it won't push you into a higher bracket.
- Charitable Giving: Qualified Charitable Distributions (QCDs) from an IRA can satisfy Required Minimum Distributions without increasing MAGI.
Frequently Asked Questions
Is IRMAA permanent once I'm in a higher bracket?
No. IRMAA is recalculated every year based on your income from two years prior. If your income drops, your surcharge will decrease or disappear in the following determination period.
Does IRMAA apply to Medicare Advantage plans?
Yes. Even if you have a Medicare Advantage (Part C) plan, you still pay the Part B premium — including any IRMAA surcharge — in addition to your plan's premium.
What counts as MAGI for IRMAA?
Medicare MAGI is your Adjusted Gross Income (AGI) plus tax-exempt interest income (e.g., from municipal bonds). This is slightly different from the MAGI definition used for other tax purposes, so check your Form 1040 lines 11 and 2a.