What is IRMAA, and who pays it in 2026?
IRMAA is the income-related monthly adjustment amount — an extra charge added to Medicare Part B and Part D premiums for higher-income households. In 2026 it begins above $109,000 in modified adjusted gross income for a single filer and $218,000 for a couple filing jointly, based on the 2024 tax return.
- 2026 IRMAA is based on modified adjusted gross income from the 2024 tax return.
- The first bracket starts above $109,000 (single) and $218,000 (married filing jointly).
- There are 6 brackets in total; the surcharge applies to Part B and Part D separately.
- Married filing separately uses different, narrower brackets.
- A life-changing event can be reported on form SSA-44 to have a newer income used instead.
Why it is based on a two-year-old tax return
Social Security sets your premium from the most recent tax return the IRS has finished processing, which in practice is the one from two years ago. So a 2026 premium reflects 2024 income. That lag is what catches people out: the year you retire, your income usually drops sharply, but the surcharge that arrives is calculated from the higher income you earned while still working.
It is also a cliff, not a slope. Crossing a bracket threshold by a single dollar moves you into the whole next tier. A capital gain, a Roth conversion, or the sale of a house in the wrong year can raise a Medicare premium two years later by more than the gain seemed worth.
How to have a newer income used
If your income has gone down because of a life-changing event, Social Security can recalculate using the newer figure. The qualifying events are specific: marriage, divorce or annulment, the death of a spouse, you or your spouse stopping work or reducing hours, loss of income-producing property, or loss of a pension. Retirement counts, which is the one most people need.
The form is SSA-44. It asks for the event, the date, and an estimate of the new income, with supporting evidence — a letter from an employer, for example. Filing it is the difference between paying a surcharge based on your working income and paying one based on what you actually live on now.
Planning around the brackets
Because the thresholds are fixed and the calculation is public, IRMAA is one of the few Medicare costs you can plan around. Anyone weighing a Roth conversion, a property sale, or the timing of a retirement-account withdrawal in the years just before or during Medicare should check what that income does to the bracket two years out. That is a conversation for a tax professional; we can tell you which bracket a figure lands in, and our estimator will show it.
Sources
- SSA — Medicare premiums: rules for higher-income beneficiaries Social Security Administration
- CMS 2026 Medicare Parts A & B premiums and deductibles Centers for Medicare & Medicaid Services
Run the numbers yourself
IRMAA estimator
See whether your income adds a surcharge to your Part B premium — and how much.