If your income is above certain thresholds, you pay more for Medicare — a surcharge called IRMAA (Income-Related Monthly Adjustment Amount). Here’s how it works, the 2026 numbers, and what you can do about it.
What Is IRMAA?
IRMAA is an additional amount added to your Part B and Part D premiums if your income exceeds certain limits. It’s calculated using your Modified Adjusted Gross Income (MAGI) from two years prior. So your 2026 IRMAA surcharge is based on your 2024 income tax return.
2026 IRMAA Thresholds for Part B
The standard Part B premium in 2026 is $185/month. Higher earners pay more based on income brackets. Individual filers with income above $106,000 begin paying IRMAA surcharges. Joint filers with income above $212,000 do the same. The surcharge increases at higher income levels, reaching a maximum Part B premium of $628.90/month for individual filers with income above $500,000 (or joint filers above $750,000).
IRMAA Also Applies to Part D
IRMAA isn’t just for Part B. High earners also pay an additional surcharge on top of their Part D drug plan premium. This amount ranges from about $13 to $81 per month depending on your income bracket, and is charged in addition to whatever your plan’s own premium is.
How Social Security Notifies You
Social Security sends a letter called an IRMAA determination notice. If you owe a surcharge, it’s deducted directly from your Social Security benefit (or billed to you directly if you’re not yet receiving benefits).
Can You Appeal IRMAA?
Yes. If you’ve had a significant life-changing event — retirement, divorce, death of a spouse, or other event — that reduced your income from the year SSA used to calculate your surcharge, you can request a new determination using more recent income. File Form SSA-44 to initiate this process.
Planning Strategies
Some people approaching Medicare consider the timing of large income events — Roth conversions, asset sales, retirement distributions — with IRMAA thresholds in mind. A taxable income just above a bracket threshold can trigger a full year of surcharges, so the math is worth reviewing with a financial advisor. Medicare costs are part of retirement income planning, not an afterthought.
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