Navigating IRMAA: Why Some Pay More for Medicare Part B and Part D

Medicare's Income-Related Monthly Adjustment Amount (IRMAA) means that if your modified adjusted gross income (MAGI) exceeds certain thresholds, you will pay an additional amount for your Medicare Part B and Part D premiums.

Key takeaways

• IRMAA adds to your standard Part B and Part D premiums if your income surpasses specific thresholds.
• The Social Security Administration (SSA) uses your tax return from two years prior to determine your IRMAA status.
• You can appeal an IRMAA determination if you've experienced a qualifying life-changing event that reduced your income.
• Appealing involves submitting Form SSA-44 and providing documentation to the SSA.
• IRMAA income thresholds and surcharge amounts are updated annually and vary by year.

What is IRMAA and why does it affect Medicare costs?

IRMAA, or Income-Related Monthly Adjustment Amount, is an additional premium that some Medicare beneficiaries pay for their Part B (medical insurance) and Part D (prescription drug coverage) based on their income. This extra amount is mandated by law to ensure that those with higher incomes contribute more towards the cost of their Medicare benefits.

The Social Security Administration (SSA) determines if you owe IRMAA based on the modified adjusted gross income (MAGI) reported on your IRS tax return from two years prior. For example, your 2026 Medicare premiums are generally based on your 2024 tax return. If your MAGI exceeds the annual thresholds set by Medicare, you will be subject to IRMAA.

The standard monthly premium for Medicare Part B in 2026 is $202.90. However, if your income falls into one of the IRMAA tiers, your Part B premium will be higher than this standard amount. Similarly, while your Part D premium itself is determined by your chosen plan, an IRMAA surcharge will be added to it if your income exceeds the Part D thresholds. This Part D IRMAA is in addition to the premium you pay to your prescription drug plan carrier, meaning your total costs for prescription drug coverage will be higher.

How are IRMAA tiers determined?

Your IRMAA determination is based on your modified adjusted gross income (MAGI), which includes your adjusted gross income plus any tax-exempt interest income. The SSA obtains this information directly from the IRS.

To determine your IRMAA, the SSA looks at your tax return from two years ago. This means that if you enroll in Medicare in 2026, your IRMAA will be based on your 2024 tax return. If you haven't filed a 2024 return yet, they might use your 2023 return temporarily and then adjust once the 2024 information is available.

There are several income brackets, or tiers, and each tier corresponds to a specific additional amount you'll pay for Part B and Part D. The income thresholds and the corresponding IRMAA surcharges are adjusted annually by the federal government. These thresholds are publicly released and can be found on Medicare.gov or the Social Security Administration's website. It's important to note that these thresholds vary based on your tax filing status (e.g., single, married filing jointly, married filing separately), reflecting different household income structures.

Even if your income fluctuates year to year, the two-year look-back period means there might be a delay between when your income changes and when your IRMAA status reflects that change. This can be especially important if you've recently retired or experienced a significant income reduction.

What are the IRMAA income thresholds for 2026?

Medicare sets specific income thresholds annually that determine if you'll pay an IRMAA. These thresholds and the corresponding additional premium amounts for both Part B and Part D are updated each year. To get the precise 2026 figures for these income brackets, you should visit Medicare.gov or contact the Social Security Administration directly. The actual dollar amounts for these thresholds are critical and vary based on your tax filing status, such as:

• Individual: If you file your taxes as "individual," "head of household," or "qualifying widow(er)" with a dependent child.
• Married filing jointly: If you file your taxes with your spouse as "married filing jointly."
• Married filing separately: If you file your taxes as "married filing separately" and you lived with your spouse at any time during the tax year.

For example, if you are an individual filer and your MAGI was above the lowest IRMAA threshold in 2024, you would pay an additional amount on top of the standard 2026 Part B premium of $202.90. The higher your income tier, the larger the additional amount will be. The same principle applies to Part D prescription drug coverage premiums; you'll pay a set IRMAA amount in addition to your plan's monthly premium if your income falls into one of the higher brackets. The Part B annual deductible for 2026 is $283, which is separate from your monthly premium and IRMAA amount.

How can I appeal an IRMAA decision?

If you believe your IRMAA determination is incorrect or if your income has significantly decreased since the tax year used by the SSA, you may be able to appeal the decision. The primary way to appeal is by filing Form SSA-44, "Medicare Income-Related Monthly Adjustment Amount – Life-Changing Event," with the Social Security Administration.

To successfully appeal, you generally need to show that you've experienced a specific, qualifying "life-changing event" that caused your income to decrease significantly. These events typically include:

• Marriage
• Divorce or annulment
• Death of your spouse
• Work stoppage (you or your spouse stop working)
• Work reduction (you or your spouse reduce your work hours)
• Loss of income-producing property (e.g., sale of a business, natural disaster affecting rental property)
• Loss of pension income (e.g., termination of a pension plan, settlement)
• Receipt of a settlement payment (e.g., from an employer for back wages or wrongful termination)

When you submit Form SSA-44, you'll need to provide documentation to support your claim. This might include pay stubs, severance letters, divorce decrees, death certificates, or other official documents that verify your life-changing event and the resulting reduction in income. The SSA will review your information and determine if an adjustment to your IRMAA is warranted. For more details on Medicare costs and how they might be affected by income, you can also explore articles like "Understanding Your 2026 Medicare Costs: Premiums, Deductibles, and More".

Steps to Appeal IRMAA with Form SSA-44

1. Obtain Form SSA-44: You can download it from the Social Security Administration website (SSA.gov) or request a copy by calling the SSA.
2. Identify Your Life-Changing Event: Determine which qualifying event applies to your situation and the date it occurred.
3. Gather Documentation: Collect all necessary paperwork that proves your life-changing event and demonstrates your reduced income for the relevant year.
4. Complete the Form: Fill out Form SSA-44 accurately and completely, including your estimated current or projected income for the year.
5. Submit Your Appeal: Send the completed form and all supporting documents to your local Social Security office. You can usually do this by mail or in person. Keep copies of everything you submit for your records.

The SSA will review your appeal and notify you of their decision. If your appeal is approved, your IRMAA will be adjusted based on your new, lower income.

What if my income changed due to retirement?

Retirement is one of the most common reasons individuals experience a significant decrease in their modified adjusted gross income, making them potentially eligible for an IRMAA appeal. Since IRMAA uses tax data from two years prior, many people who retire suddenly find themselves paying higher Medicare premiums based on their previous working income.

If you recently stopped working or significantly reduced your work hours due to retirement, this counts as a "work stoppage" or "work reduction" life-changing event. You should complete Form SSA-44 and provide evidence of your retirement, such as a letter from your former employer confirming your retirement date or documentation of your pension or Social Security benefits.

By successfully appealing, you can potentially have your IRMAA recalculated based on your current, lower retirement income, which could reduce your monthly Part B and Part D premiums. This is a common scenario, and the SSA is accustomed to reviewing such appeals.

Keep in mind that the maximum plan deductible for Part D in 2026 is $615 (though some plans may have a lower or no deductible). Once your out-of-pocket costs for covered prescription drugs reach $2,100 in 2026, you will enter the catastrophic coverage phase, where your plan pays 100% of covered drugs for the rest of the year. This annual out-of-pocket cap applies regardless of whether you pay an IRMAA for Part D.

Can I avoid IRMAA?

For most individuals, avoiding IRMAA means managing their modified adjusted gross income (MAGI) to stay below the annual thresholds. This often involves careful financial planning and tax strategies.

Some common strategies people consider include:

• Tax-efficient withdrawal strategies: For those with retirement accounts, converting traditional IRA funds to a Roth IRA or taking withdrawals strategically can impact MAGI. However, these decisions have significant tax implications and should be discussed with a qualified financial advisor.
• Qualified Charitable Distributions (QCDs): If you are 70½ or older, you can make qualified charitable distributions directly from your IRA to an eligible charity. These distributions count towards your required minimum distributions (RMDs) but are not included in your MAGI, potentially helping to lower your IRMAA.
• Timing of income events: If possible, spreading out large income events over several years can help keep your MAGI below IRMAA thresholds.

It is important to remember that financial and tax planning decisions should always be made with the guidance of a qualified professional who understands your individual circumstances. The goal is to make choices that are most suitable for your overall financial health, not just to avoid IRMAA. While some strategies might reduce your MAGI, they may not be suitable for everyone. For other important considerations when planning for Medicare costs, you might find "5 Expensive Medicare Mistakes People Make (And How to Avoid Them)" a useful read.

Understanding the Impact of IRMAA on Your Medicare Costs

IRMAA directly impacts both your Medicare Part B and Part D premiums. It's an additional amount that the government requires you to pay if your income exceeds certain thresholds. This means that if you're subject to IRMAA, your total monthly cost for Medicare will be higher than someone with a lower income, even if you have the same Part B and Part D plans.

For Part B, the IRMAA is added directly to your standard monthly premium. This combined amount is usually deducted from your Social Security benefit. If your Social Security benefit isn't large enough to cover it, or if you aren't receiving Social Security benefits yet, you'll receive a bill from Medicare.

For Part D, the IRMAA is a separate surcharge that you'll pay in addition to your plan's monthly premium. This Part D IRMAA is also typically deducted from your Social Security benefit or billed directly by Medicare, not by your specific Part D plan. The amount depends on your income tier, similar to Part B. It's important to keep track of these additional costs when budgeting for your overall healthcare expenses.

Frequently Asked Questions

What is Modified Adjusted Gross Income (MAGI) for IRMAA purposes?

MAGI for IRMAA is your adjusted gross income (AGI) as reported on your tax return, plus certain tax-exempt interest income. The SSA uses this figure from your tax return two years prior to the current Medicare year.

What if I don't file taxes or only file jointly with my spouse?

If you don't file a tax return, the SSA will use information from the IRS to determine your income. If you file jointly with your spouse, your combined MAGI will be used to determine your IRMAA. For married couples, separate income thresholds apply when filing jointly, which are typically double the individual thresholds.

How will I know if I have to pay IRMAA?

The Social Security Administration (SSA) will send you a notice, usually called an Initial IRMAA determination notice, if they determine you owe an IRMAA for Part B and/or Part D. This notice will explain how your IRMAA was calculated and provide instructions on how to appeal if you believe the determination is incorrect.

Can IRMAA change from year to year?

Yes, your IRMAA can change annually. The income thresholds are updated each year, and your income itself can fluctuate. Since IRMAA is based on a two-year look-back, your IRMAA status in 2026 is based on your 2024 income, and your 2027 IRMAA will be based on your 2025 income.

Does IRMAA apply to Medicare Advantage plans?

IRMAA applies to your Medicare Part B premium, regardless of whether you have Original Medicare or a Medicare Advantage plan. If your Medicare Advantage plan includes prescription drug coverage (most do), the Part D IRMAA surcharge will also apply. However, IRMAA does not apply to the premium you pay directly to your Medicare Advantage plan for its additional benefits beyond what Original Medicare covers.

What if I'm not collecting Social Security benefits yet?

If you are not yet receiving Social Security benefits, Medicare will send you a bill directly for your Part B premium, including any IRMAA, and your Part D IRMAA. It is important to pay these bills on time to avoid disruption in coverage.

Action Plan: Steps to take this week

1. Review your most recent SSA IRMAA notice: Understand how your IRMAA was determined and the income year used.
2. Check your tax returns from two years ago: Compare your Modified Adjusted Gross Income (MAGI) with the current year's IRMAA thresholds (available on Medicare.gov) to understand the basis for your premium.
3. Identify any life-changing events: If your income has significantly decreased due to a qualifying event since the tax year used for IRMAA, gather documentation related to that event.
4. Download Form SSA-44: Visit SSA.gov to download the "Medicare Income-Related Monthly Adjustment Amount – Life-Changing Event" form.
5. Contact the Social Security Administration (SSA): If you have questions about your IRMAA determination or need help with the appeal process, call the SSA directly or visit your local office.

Worked Example: Maria's IRMAA Appeal

Maria, 67, retired from her job as a software engineer at the end of 2024. In 2026, she received a notice from the Social Security Administration stating she would owe an IRMAA for her Medicare Part B and Part D premiums. This determination was based on her 2024 tax return, which showed her full working salary. Maria's current income in 2026, however, consisted only of her Social Security benefits and a small pension, a significant reduction from her working income.

Recognizing that her retirement was a qualifying life-changing event (work stoppage), Maria decided to appeal. She downloaded Form SSA-44 from SSA.gov, carefully filled it out, indicating her retirement date and her projected lower income for 2026. She attached a copy of her retirement letter from her former employer and a recent bank statement showing her current pension deposits. She mailed the form and documents to her local Social Security office, keeping copies for her records. After a few weeks, Maria received a new notice from the SSA confirming her appeal was approved and her IRMAA would be removed, significantly lowering her monthly Medicare costs.

Who this article is not for

This article is not for individuals who have consistently low incomes that remain below Medicare's IRMAA thresholds, as IRMAA would not apply to their situation. If you are still working and have employer-sponsored health coverage, you may have different considerations for Medicare enrollment; consider reading "Working Past 65? When to Delay Medicare Enrollment" instead.

Have questions? Call 1-877-443-3251 for free, no-obligation help from a licensed agent.

We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options. Medicare has neither reviewed nor endorsed this information.