Let’s answer what most people actually care about: Why am I paying more? Will this change next year? Can I appeal it? Yes, there are ways to lower it — and I’ll show you where to start.
What Is IRMAA?
IRMAA stands for Income-Related Monthly Adjustment Amount. It’s a surcharge added to your Medicare Part B (medical) and Part D (prescription drugs) when your income is above certain thresholds.
IRMAA uses a two-year lookback. For your 2026 premiums, Social Security looks at your 2024 tax return. If that income is over the threshold, you’re placed into an IRMAA bracket for the year.
Want the full 30,000-foot view first? Visit the hub: IRMAA Guide.
Who Has to Pay IRMAA?
- People whose MAGI (Modified Adjusted Gross Income) from two years ago is above the government’s limits.
- It applies whether you have Original Medicare + Medigap or a Medicare Advantage plan — IRMAA follows income, not plan type.
- Thresholds are inflation-indexed and updated annually. See details here: IRMAA Thresholds & What Counts Toward MAGI.
How IRMAA Shows Up on Your Bill
- Part B: You’ll see your base Part B premium plus an IRMAA add-on. If you get Social Security, it’s usually deducted automatically.
- Part D: You’ll pay your drug plan’s premium and a separate IRMAA amount billed by Medicare. Your plan doesn’t keep that surcharge — Medicare does.
New to Part D? Here’s what the drug benefit actually covers: What Does Medicare Part D Cover?
How IRMAA Is Calculated (Plain English)
Social Security uses your MAGI — that’s your AGI plus certain add-backs (like tax-exempt interest) — from two years prior. Cross a bracket by even one dollar and you land in the next surcharge tier for the entire year.
What typically pushes people over a bracket?
- Roth conversions concentrated in one year
- Large capital gains (selling stock, a business, or a second home)
- Final-year wages/bonuses before retirement
- RMDs stacked on top of other income
See exactly what counts (and what usually doesn’t) here: IRMAA Thresholds & What Counts Toward MAGI.
Can You Appeal IRMAA?
Usually, yes — if your income has dropped due to a qualifying life-changing event. Common examples:
- Retirement or significant reduction in work
- Marriage, divorce, or death of a spouse
- Loss of pension or income-producing property
You’ll use SSA-44 to request a reconsideration with documentation. Step-by-step help is here: IRMAA Appeals for High-Income Retirees.
Smart Ways to Plan Around IRMAA (Not Tax Advice)
- Spread income events (like conversions or asset sales) across tax years to avoid jumping a bracket.
- Coordinate RMDs with charitable strategies (e.g., qualified charitable distributions) when appropriate.
- Mind the bridge years around retirement when wages, bonuses and withdrawals can overlap.
Work with a fiduciary advisor or CPA who actually understands the two-year lookback. For common pitfalls across Medicare, read: Medicare Mistakes to Avoid.
What to Do Next
- Get the big picture: IRMAA Hub (2026 Guide)
- Check whether you’re over the line: IRMAA Thresholds & What Counts
- Think you qualify for a reduction? How to Appeal IRMAA (SSA-44)
- Know your drug coverage basics: What Does Medicare Part D Cover?
- Avoid the big pitfalls: Medicare Mistakes to Avoid
- Watch for yearly updates: Medicare Changes
- How to read plan notices: How to Read Your Medicare ANOC
- Find doctors & pharmacies: Medicare Provider Search Guide
- New to Medicare soon? Turning 65: Medicare Enrollment
- Understand out-of-pocket limits: Medicare Advantage MOOP
- Compare plan quality: Medicare Star Ratings
- Pharmacy savings myths: Can You Use GoodRx with Medicare?
- Check service area changes: 2026 Medicare Service Area Reductions
- Useful contacts: Medicare Help Lines
- Plan notice red flags: Medicare ANOC Red Flags
