Health Insurance
IRMAA 2026: How High Income Triggers Extra Medicare Premiums
By the PolicyZen Team · Updated March 2026 · 8 min read
Most Medicare beneficiaries pay the standard Part B premium ($185/month in 2026). But if your income exceeded certain thresholds two years ago, you're paying significantly more — potentially up to $628.90/month for Part B alone, plus surcharges on Part D. This surcharge is called IRMAA: the Income-Related Monthly Adjustment Amount.
IRMAA uses your Modified Adjusted Gross Income (MAGI) from 2 years prior. Your 2026 Medicare premiums are based on your 2024 tax return. This creates a common surprise: someone who retired and took a large IRA distribution in 2024 finds their 2026 Medicare premiums significantly elevated — even though their current income is much lower.
2026 IRMAA Thresholds — Part B
| 2024 MAGI (Individual) | 2024 MAGI (Joint) | 2026 Part B Monthly Premium |
|---|
| ≤ $106,000 | ≤ $212,000 | $185.00 (standard) |
| $106,001 – $133,000 | $212,001 – $266,000 | $259.00 |
| $133,001 – $167,000 | $266,001 – $334,000 | $370.00 |
| $167,001 – $200,000 | $334,001 – $400,000 | $480.90 |
| $200,001 – $500,000 | $400,001 – $750,000 | $554.90 |
| > $500,000 | > $750,000 | $628.90 |
Note: 2026 IRMAA thresholds are projected estimates; SSA announces final amounts in fall 2025.
IRMAA on Part D
Part D also has IRMAA surcharges added on top of your plan premium, ranging from $13.70 to $85.80/month extra depending on income tier (2026 estimates).
The "Two Years Prior" Trap
This is where IRMAA surprises retirees. Common triggering events:
- Large IRA-to-Roth conversion (even if just a one-year event)
- Capital gains from selling a business, home, or investment portfolio
- Required Minimum Distributions (RMDs) beginning at age 73
- Final year of high W-2 income before retirement
Appealing IRMAA: Life-Changing Events
If your income has significantly decreased since the year SSA used to calculate your IRMAA, you can appeal using Form SSA-44. Qualifying life-changing events include: retirement or reduction in work hours, death of a spouse, divorce, loss of employer pension, or employer settlement payment. SSA can use more recent income data if a qualifying event occurred.
IRMAA planning is a legitimate retirement income strategy. Spreading IRA withdrawals or Roth conversions over multiple years (rather than taking large lump sums) can keep MAGI below IRMAA thresholds and save thousands in Medicare premiums annually. Coordinate with a financial planner around age 63 (two years before Medicare eligibility).
Frequently Asked Questions
What is IRMAA and who has to pay it?
IRMAA (Income-Related Monthly Adjustment Amount) is a surcharge added to Medicare Part B and Part D premiums for higher-income beneficiaries. In 2026, it applies to individuals with modified adjusted gross income (MAGI) above $106,000 and married couples above $212,000 (based on 2024 tax returns). The surcharge ranges from a few hundred to over $4,000 per year depending on income.
Why is IRMAA based on income from two years ago?
Medicare uses tax returns from two years prior (2024 returns for 2026 IRMAA) because those are the most recently filed and verified returns available. This 'two-year lookback' creates a trap for people who retired or had a one-time income event: a high-income year two years ago can trigger IRMAA even if your current income is much lower.
Can I appeal IRMAA if my income has changed?
Yes. If you experienced a qualifying life-changing event — retirement, divorce, death of a spouse, loss of income-producing property, or reduction in work hours — you can request an IRMAA adjustment using SSA Form SSA-44. You'll need to provide documentation of the event and an estimate of your current income. Approved appeals can reduce or eliminate the surcharge.
Does IRMAA apply to both Part B and Part D?
Yes. IRMAA surcharges are assessed on both Medicare Part B (medical coverage) and Part D (prescription drug coverage) premiums. The Part B surcharge is paid directly to Medicare; the Part D surcharge is paid to the plan. The surcharge amounts differ between Part B and Part D and are based on the same income thresholds.
How can I reduce IRMAA exposure in retirement?
Planning strategies include: Roth conversions in lower-income years before Medicare enrollment to reduce future taxable income, qualified charitable distributions (QCDs) from IRAs after age 70½ which don't count as MAGI, strategic timing of capital gains realizations, and coordinating Social Security claiming to manage MAGI. A financial advisor specializing in retirement income can help model these scenarios.
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