What Is IRMAA? Medicare Premium Surcharges Explained for 2026

If you're approaching Medicare eligibility or are already enrolled, you may have heard the term IRMAA mentioned in passing — perhaps by a financial advisor, a fellow retiree, or even in a letter from Social Security. Understanding IRMAA is important because for some beneficiaries, it can add thousands of dollars per year to the cost of Medicare coverage without any warning.

This guide explains exactly what IRMAA is, who pays it, how much it costs in 2026, and — most importantly — what you can do about it.

What Does IRMAA Stand For?

IRMAA stands for Income-Related Monthly Adjustment Amount. It is a surcharge added to your standard Medicare Part B and Part D premiums if your income exceeds certain thresholds. In simple terms, Medicare charges higher earners more for their coverage.

IRMAA is not a penalty — it is a built-in feature of the Medicare program designed to shift a greater share of program costs to beneficiaries with higher incomes. It was introduced as part of the Medicare Modernization Act of 2003 for Part B, and later extended to Part D drug coverage in 2011.

Who Pays IRMAA?

Roughly 8% of Medicare beneficiaries pay IRMAA in any given year — meaning the vast majority of people on Medicare pay only the standard premium. However, the surcharge can apply to more people than you might expect, particularly retirees who:

• Sold a home or investment property in a recent tax year
• Completed a Roth IRA conversion
• Took a large distribution from a traditional IRA or 401(k) or 403(b)
• Received an inheritance or large capital gain
• Had two incomes and have not yet adjusted their tax filing status

The key thing to understand is that IRMAA is based on your income from two years prior — not your current income. This lag means that a one-time high-income event can result in higher Medicare premiums years later, long after the money has been spent or taxes have been paid.

How Much Is IRMAA in 2026?

In 2026, the standard Medicare Part B premium is $202.90 per month. If your income triggers IRMAA, that amount increases based on which income bracket you fall into. The surcharge also applies to Part D drug coverage, adding an additional monthly fee on top of whatever your drug plan charges.

The table below shows the 2026 IRMAA brackets for individuals and married couples filing jointly, along with the total Part B premium at each tier:

At the highest income tier, a single Medicare beneficiary pays $689.90 per month for Part B alone — compared to the standard $202.90. Add the Part D surcharge of $91.00 per month and the total IRMAA impact reaches $578 per month, or nearly $6,900 per year — per person. For a married couple both on Medicare at the highest tier, the combined annual impact can exceed $13,800.

What Is the IRMAA Cliff?

One of the most frustrating aspects of IRMAA is what financial planners call the "cliff effect." Unlike a graduated tax, IRMAA operates in brackets — crossing from one bracket into the next triggers the full surcharge for that bracket, not just on the income above the threshold.

For example, a single filer with $135,999 in income pays the Tier 1 Part B premium of $284.10 per month. A single filer with $136,001 — just $2 more — jumps to the Tier 2 premium of $394.00 per month. That $2 of additional income costs an extra $1,319 in annual Medicare premiums.

This makes year-end income planning critically important for Medicare beneficiaries. Strategic decisions about when to take IRA distributions, whether to complete a Roth conversion, or when to realize capital gains can have significant Medicare premium implications.

Can You Appeal an IRMAA Determination?

Yes — and this is an important option that many beneficiaries don't know about. If your income has dropped significantly since the year Medicare is basing your premium on, you can appeal using SSA Form SSA-44 — the Medicare Income-Related Monthly Adjustment Amount Life-Changing Event form.

Qualifying life-changing events that allow you to request a lower premium determination include:

• Marriage, divorce, or death of a spouse
• Retirement or reduction in work hours
• Loss of income-producing property due to disaster or other circumstances
• Loss of pension income
• Receipt of an employer settlement payment

Note that a one-time income spike — such as selling a home or taking a large IRA distribution — does not qualify as a life-changing event for IRMAA appeal purposes, even if your income has since returned to a lower level. Appeals must be based on a qualifying event that caused a permanent or ongoing reduction in income.

How to Avoid or Reduce IRMAA

While there is no way to eliminate IRMAA if your income genuinely exceeds the thresholds, careful income planning can help you stay in a lower bracket or avoid the surcharge entirely. Strategies worth discussing with a financial advisor include:

• Spreading IRA distributions over multiple years rather than taking large lump sums
• Timing Roth conversions carefully — converting too much in one year can trigger or worsen IRMAA
• Using Qualified Charitable Distributions (QCDs) from IRAs for charitable giving, which reduces MAGI without appearing as income
• Managing capital gains realization across tax years
• Coordinating Social Security claiming with other income sources to stay below IRMAA thresholds

IRMAA and Medicare Advantage Plans

It's worth noting that IRMAA applies to Medicare Part B and Part D regardless of whether you are enrolled in Original Medicare or a Medicare Advantage plan. If you are in a Medicare Advantage plan that includes prescription drug coverage, you still pay the standard Part B premium plus any applicable IRMAA surcharge directly to Medicare — in addition to any plan premium your Medicare Advantage carrier charges.

Medicare Supplement (Medigap) plans do not affect IRMAA. Your Medigap premiums are paid separately to your insurance company and have no bearing on what Medicare charges you for Part B.

How IRMAA Is Determined and Communicated

If the Social Security Administration determines that your income exceeds the IRMAA threshold, they will send you a notice — typically in late November or early December for the following year. The notice will state your income level, the IRMAA amount being applied, and instructions for appealing if you believe the determination is incorrect or if your circumstances have changed.

Many beneficiaries are caught off guard by this notice because they were not aware that Medicare premiums could increase based on income. Understanding IRMAA before you turn 65 — and planning your income accordingly in the years leading up to Medicare eligibility — is one of the most valuable things you can do for your retirement financial health.

Summary: Key IRMAA Facts for 2026

• IRMAA is a surcharge added to Medicare Part B and Part D premiums for higher-income beneficiaries
• The standard 2026 Part B premium is $202.90/month — IRMAA can push this to $689.90/month
• IRMAA is based on your income from two years ago — 2026 premiums use your 2024 tax return
• The surcharge operates in brackets — crossing a threshold triggers the full bracket surcharge
• You can appeal an IRMAA determination if you experienced a qualifying life-changing event
• Careful income planning can help you stay in a lower IRMAA bracket or avoid the surcharge