If you’re on Medicare — or about to enroll — and your income has climbed in recent years thanks to a big RMD, a Roth conversion, a home sale, or just a strong final working year, you may be in for a surprise on your Part B and Part D premium bill. It’s called IRMAA, and in 2026 it can add hundreds of dollars a month to what you pay. Here’s what you need to know: the exact income brackets, how much extra you’ll owe, why it catches so many retirees off guard, and — most importantly — how to appeal it if your income has since dropped.

What Is IRMAA and Who Pays It

IRMAA stands for Income-Related Monthly Adjustment Amount. It’s a surcharge added on top of the standard Medicare Part B and Part D premiums for people whose income is above a certain level. In other words, the more you earn, the more you pay for the same Medicare coverage everyone else gets.

A few key things to understand about how IRMAA works:

• It’s based on your Modified Adjusted Gross Income (MAGI) from your tax return filed two years prior — so your 2026 IRMAA is determined by your 2024 tax return.
• The standard 2026 Part B premium is $202.90/month. IRMAA is added on top of that amount, not instead of it.
• IRMAA applies separately to Part B (medical insurance) and Part D (prescription drug coverage), so high earners can see two separate add-ons.
• Roughly the wealthiest income tiers of Medicare beneficiaries pay IRMAA — most people never see it.

2026 IRMAA Income Brackets

The 2026 brackets are based on your 2024 MAGI. Here’s where the thresholds fall:

• Single filers: surcharge starts above $109,000 MAGI
• Married filing jointly: surcharge starts above $218,000 MAGI
• Married filing separately: same $109,000 starting threshold, but the top bracket hits much sooner and steeper

There are six IRMAA tiers in total. As your MAGI rises through each tier, both your Part B and Part D premiums increase:

• The Part B surcharge can add up to roughly $487/month at the highest income tier.
• The Part D surcharge can add up to roughly $91/month at the highest income tier.

That means a high-income couple at the top bracket could be paying well over $1,100 extra per month combined, on top of standard premiums. It adds up fast — which is exactly why it’s worth understanding the brackets before you’re surprised by a premium notice.

Common Reasons People Get Hit With IRMAA Unexpectedly

Many retirees are blindsided by IRMAA because the income that triggers it often isn’t “regular” income at all. The most common culprits include:

• A large Required Minimum Distribution (RMD) or Roth conversion in the lookback year — a bigger-than-usual withdrawal from a traditional IRA or 401(k) can push MAGI over a threshold for that one year only.
• A one-time capital gain, such as selling a home or a large investment position, which counts as income even though it’s not recurring.
• The first year on Medicare after a high-earning final work year — if you retired recently, your Medicare premiums may still reflect the salary you earned before you stopped working.

The frustrating part is that IRMAA is based on income from two years ago, so a one-time spike can trigger a surcharge in a year when your actual income has already gone back down.

How to Appeal or Reduce IRMAA — Form SSA-44

The good news: if your income has dropped since the tax year used to calculate your IRMAA, you can ask the Social Security Administration to use your more current income instead. The tool for this is Form SSA-44.

You can typically request a reconsideration if you’ve experienced one of these qualifying “life-changing events”:

• Retirement or a significant reduction in work hours
• Death of a spouse
• Divorce or annulment
• Loss of pension income
• Marriage
• Loss of income-producing property (through no fault of your own)
• An employer settlement payment that inflated a prior year’s income

To file Form SSA-44, you have a few options:

• Online through your SSA account
• By phone with the Social Security Administration
• In person at your local Social Security office

Be ready to include documentation that supports your life-changing event and your updated income estimate — for example, a retirement letter, a death certificate, a divorce decree, or a signed statement estimating your current-year income. The clearer your paperwork, the faster SSA can process the adjustment.

Planning Ahead to Avoid Future IRMAA Surcharges

If you’re not on Medicare yet, or you still have some control over your income timing, a little planning can go a long way:

• Time Roth conversions before Medicare enrollment. Since IRMAA looks back two years, converting funds well before you enroll can keep those conversions from affecting your premiums.
• Use Qualified Charitable Distributions (QCDs). If you’re charitably inclined, QCDs let you satisfy RMD requirements while excluding that amount from your MAGI.
• Coordinate RMD timing with IRMAA thresholds. Spreading out large distributions, rather than taking them all in one year, can help you stay under a bracket line.

Because the lookback is two years, decisions you make today can affect your premiums well into the future — so it’s worth reviewing your income strategy with this in mind, ideally with a tax or financial professional.

FAQ

Does IRMAA apply to Medicare Advantage plans too?
If your Medicare Advantage plan includes drug coverage, the Part D portion of IRMAA can still apply, even though the Part B surcharge is billed separately regardless of which plan type you have.

How often are the brackets reviewed?
The IRMAA income brackets are generally adjusted each year based on inflation, so it’s worth checking the current thresholds annually rather than assuming they stay the same.

Can I appeal every year if my income stays high?
Appeals through Form SSA-44 are meant for specific life-changing events, not simply for having a high income. If your income remains elevated without a qualifying event, the standard IRMAA brackets will continue to apply based on your MAGI from two years prior.

Bottom line: IRMAA can catch retirees off guard, especially in the first year or two after a big income event. But between understanding the 2026 brackets, knowing which situations trigger surcharges, and using Form SSA-44 when your circumstances change, you have real tools to manage — and sometimes reduce — what you pay. For the most current thresholds and to start an appeal, visit the official Social Security Administration Medicare premiums page linked throughout this article.