IRMAA Thresholds and What Counts Towards IRMAA

If you just want the basics on IRMAA before diving in, start here: Understanding IRMAA. If your income recently dropped (retired, spouse passed away, etc.), read how to fight the surcharge: IRMAA Appeals for High-Income Retirees.

Which Year’s Income Sets My 2026 IRMAA?

Medicare uses the “two-year lookback.” For 2026 premiums, Social Security looks at your 2024 MAGI. If that number is above the government’s income thresholds, you’ll be placed into an IRMAA bracket for Part B and Part D.

Heads up: SSA/CMS publish the official brackets each fall. When the 2026 brackets are released, we’ll update this page and the hub here: IRMAA. You can also review what Part D actually covers and why IRMAA is separate from your drug copays: What Does Medicare Part D Cover?

MAGI 101: What Counts Toward IRMAA

IRMAA is based on MAGI = your Adjusted Gross Income (AGI) plus certain add-backs. Here’s what typically pushes people over a bracket:

• Wages, salaries, bonuses (including partial-year pay before retirement)
• Taxable Social Security benefits
• Traditional IRA/401(k)/403(b) withdrawals and Required Minimum Distributions (RMDs)
• Capital gains (selling a house, business, rental, or large positions in a brokerage account)
• Interest and dividends (including short-term gains from fund distributions)
• Tax-exempt interest (e.g., municipal bond interest is added back for MAGI)
• Roth conversions (the converted amount is taxable in the year you convert)
• Business, rental, and K-1 income

Common surprise: one-time events—like a big Roth conversion, selling stock, or a severance package—can spike MAGI and trigger IRMAA for a full year two years later.

What Usually Doesn’t Count Toward IRMAA

• Roth IRA withdrawals (qualified)
• HSA contributions (pre-tax) and HSA withdrawals for qualified medical expenses
• Return of principal (e.g., selling an asset at no gain)
• Loans (proceeds aren’t income)

Edge cases exist—always confirm with your tax professional. If you’re still on an employer plan and weighing timing, see our guidance around Part B and planning: Medicare Mistakes to Avoid.

IRMAA Brackets: How to Read Them

IRMAA brackets are tiered. Cross a bracket by even one dollar and you jump to the next surcharge level for the year. A quick way to think about it:

• Base premium only – below the first threshold
• Bracket 1–5 – surcharges grow with income

Action step: When the official 2026 brackets are posted, locate your filing status (single or married filing jointly), find your 2024 MAGI, and note the Part B add-on and the separate Part D add-on. Those add to your plan premiums.

One-Time Spikes That Trigger IRMAA

• Large Roth conversions in one calendar year
• Asset sales creating big capital gains
• Final year wages/bonuses before retirement
• RMDs combined with other income sources

If your income has since fallen due to a life-changing event—retirement, divorce, death of a spouse, loss of pension—consider an appeal to recalculate: IRMAA Appeals for High-Income Retirees.

Planning Ideas to Manage IRMAA (Not Tax Advice)

• Spread conversions over multiple years instead of doing one large conversion
• Time capital gains across tax years to avoid jumping brackets
• Coordinate RMDs with charitable strategies (e.g., qualified charitable distributions may help reduce MAGI impact)
• Watch “bridge years” around retirement when wages + withdrawals overlap

Your situation is unique—coordinate with a fiduciary advisor or CPA who understands Medicare’s two-year lookback.

Related Reading & Next Steps

• Understanding IRMAA
• IRMAA Hub: 2026 Guide
• How to Appeal IRMAA (SSA-44)
• What Does Medicare Part D Cover?
• Medicare Mistakes to Avoid
• Medicare Changes
• How to Read Your Medicare ANOC
• Medicare Provider Search Guide
• Turning 65: Medicare Enrollment
• Medicare Advantage MOOP: Out-of-Pocket Limits
• Medicare Star Ratings Explained
• Can You Use GoodRx with Medicare?