What Is IRMAA? How High Income Raises Your Medicare Premiums (2026)

IRMAA is a surcharge on your Medicare Part B and Part D premiums that kicks in when your income exceeds $109,000 (single) or $218,000 (married filing jointly). At the highest bracket, you'll pay $689.90/month for Part B alone — more than triple the standard $202.90 premium. This guide explains how IRMAA works, what triggers it, and how to avoid paying more than you need to.

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How IRMAA Works

IRMAA stands for Income-Related Monthly Adjustment Amount. It's not a separate tax — it's an increase to your standard Medicare Part B and Part D premiums based on your income.

Here's the key: IRMAA uses your income from two years prior. Your 2024 tax return determines your 2026 premiums. Your 2025 return determines 2027 premiums. This two-year lookback catches many retirees off guard because a one-time income event — selling a home, converting a large IRA to Roth, cashing in stock options — triggers higher premiums two years later.

Medicare gets your income data directly from the IRS. You don't apply for IRMAA or self-report — the Social Security Administration (SSA) automatically applies it based on your Modified Adjusted Gross Income (MAGI) from your federal tax return.

What Counts as MAGI for IRMAA?

Your MAGI for IRMAA purposes is your Adjusted Gross Income (AGI) plus tax-exempt interest income. This includes:

• Wages, salaries, and self-employment income
• Taxable Social Security benefits
• Pension and annuity income
• Traditional IRA and 401(k) distributions (including RMDs)
• Roth conversion amounts
• Capital gains (including from selling a home above the exclusion)
• Rental income
• Tax-exempt interest (municipal bond interest)
• Dividend and interest income

What does not count:

• Roth IRA withdrawals (qualified distributions)
• Return of basis from non-deductible IRA contributions
• Health Savings Account (HSA) distributions for qualified medical expenses
• Loans (including reverse mortgage proceeds)
• Life insurance proceeds

Check your bracket instantly: Our IRMAA income bracket calculator shows exactly where your income falls and how much extra you'll pay.

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2026 IRMAA Brackets and Premiums

Part B IRMAA (2026)

Source: CMS 2026 Medicare Parts A & B Premiums Fact Sheet

Part D IRMAA (2026)

The same income brackets trigger surcharges on your Part D drug plan premium:

Source: CMS 2026 IRMAA brackets

Combined IRMAA Cost (Part B + Part D)

Here's the total annual extra cost per person at each bracket:

A couple in the top bracket pays nearly $14,000/year in IRMAA surcharges alone — on top of their base premiums of roughly $5,700/year combined. That's $20,000/year just in Medicare premiums.

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The Cliff Effect: Why $1 of Income Can Cost You $1,000+

IRMAA brackets are cliffs, not gradual. Earning $1 over a threshold puts you in the next bracket for the entire year. There's no phase-in.

Example: The $109,000 Cliff

A single retiree with $109,000 of MAGI pays $202.90/month for Part B. At $109,001, they pay $284.10/month — an increase of $974/year triggered by a single dollar of income.

Example: Roth Conversion Over the Line

You have $100,000 of base retirement income and convert $10,000 from a traditional IRA to a Roth. Your MAGI is $110,000 — just over the $109,000 threshold. Two years later, your Part B premium jumps by $81.20/month and your Part D adds $14.50/month. That $10,000 Roth conversion effectively cost you an extra $1,148 in Medicare premiums.

The lesson: know where the cliffs are before you make income decisions. A $9,000 Roth conversion keeps you under the threshold. A $10,000 conversion pushes you over it. The difference in Medicare premiums is $1,148.

Model conversions against IRMAA: Our Roth conversion calculator helps you find the optimal conversion amount that balances tax savings against IRMAA triggers.

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The 5 Most Common IRMAA Triggers

1. Roth Conversions

Converting a traditional IRA to a Roth adds the entire conversion amount to your MAGI. A $100,000 conversion on top of $120,000 of other income puts you at $220,000 — well into the second IRMAA bracket for single filers. The conversion is taxed in the current year, and the IRMAA surcharge hits two years later.

The trap: Aggressive Roth conversion strategies designed to reduce future RMDs can inadvertently trigger years of elevated Medicare premiums. A $150,000 annual conversion over 5 years could cost $5,000–$15,000 in total IRMAA surcharges depending on your other income. For more on conversion strategy, see our guide on the Roth conversion ladder.

2. Required Minimum Distributions (RMDs)

Large traditional IRA and 401(k) balances force large RMDs starting at age 73. A $2 million IRA generates an RMD of roughly $75,000 at age 73 — and that amount grows each year as you age. Combined with Social Security and pension income, RMDs can easily push retirees into IRMAA territory.

This is why RMD reduction strategies — including pre-RMD Roth conversions and qualified charitable distributions — are so important for managing Medicare costs.

3. Selling a Home

Capital gains from a home sale count toward MAGI, even after the $250,000 (single) or $500,000 (married) exclusion. If you sell a home with $600,000 in gains, $100,000 (or $350,000 for single filers) flows into your MAGI. This one-time spike triggers IRMAA two years later.

4. Capital Gains Realizations

Selling appreciated investments — stocks, mutual funds, rental properties — generates capital gains that count toward MAGI. Rebalancing a large taxable portfolio or selling a rental property in a single year can create a six-figure income spike.

Tax-loss harvesting in taxable accounts can help offset gains that would push you over an IRMAA threshold. If you're selling a winner, look for losers to pair it with — the net gain is what flows into MAGI.

5. Working in Early Retirement

Consulting income, part-time work, or freelancing during the years around Medicare enrollment adds to your MAGI. Combined with other retirement income, even modest earned income can push you across a threshold.

The timing matters: If you're 63 and planning to wind down work before enrolling in Medicare at 65, remember that your age-63 income sets your age-65 premiums. Reducing hours or stopping consulting a year earlier than planned could save thousands in IRMAA costs during your first years on Medicare.

How Many People Pay IRMAA?

About 7% of Medicare beneficiaries pay IRMAA surcharges — roughly 4.5 million people. But the percentage is higher among retirees with traditional pensions, large IRA balances, or significant investment income. If you're reading this article, you're likely in or near the affected group.

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How to Reduce or Avoid IRMAA

Strategy 1: Manage Income Around the Cliffs

Know the thresholds and plan your income to stay below them — or accept the surcharge if the income-generating activity is worth more than the IRMAA cost.

If your projected MAGI is $112,000, reducing it by $3,000 (deferring a capital gain, contributing to an HSA, reducing a Roth conversion) saves $974/year in IRMAA.

Strategy 2: Spread Roth Conversions Across Multiple Years

Instead of converting $200,000 in one year (pushing deep into a high IRMAA bracket), convert $40,000–$50,000 per year over 4–5 years. Each year stays in a lower bracket — or avoids IRMAA entirely if you plan carefully around the thresholds.

Strategy 3: Use Qualified Charitable Distributions (QCDs)

If you're 70½ or older, you can donate up to $105,000 (2024 limit, indexed) directly from your IRA to a qualified charity. QCDs satisfy your RMD without adding to your MAGI. Every dollar directed through a QCD is a dollar that doesn't count toward IRMAA.

Strategy 4: Use Roth Withdrawals for Spending

Roth IRA distributions don't count as MAGI. In years when you need extra cash but are near an IRMAA threshold, pull from Roth accounts instead of traditional accounts. This requires having built Roth balances in advance through contributions or conversions.

Strategy 5: Time Capital Gains and Home Sales

If you're planning to sell a home or rebalance a portfolio, consider the IRMAA impact two years out. Splitting a large capital gain across two tax years (partial sale, installment sale) can keep you in a lower bracket in both years instead of a high bracket in one.

Strategy 6: Maximize HSA Contributions (If Still Working)

If you're 65+ and still working with a high-deductible health plan (and not yet enrolled in Medicare), HSA contributions reduce your AGI. The 2026 contribution limit is $4,300 (individual) or $8,550 (family), plus a $1,000 catch-up for those 55+.

Strategy 7: Consider Filing Status

For married couples, filing separately can sometimes reduce one spouse's IRMAA if their individual income is below $109,000 — but this comes with significant trade-offs (loss of deductions, higher tax rates on other income). Run the full numbers before changing filing status.

See your total IRMAA cost: Our IRMAA Medicare surcharge calculator shows your Part B and Part D surcharges based on your exact income and filing status.

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How to Appeal IRMAA

You can request a reduction if you experienced a life-changing event that lowered your income since the tax year IRMAA is based on. The SSA accepts these qualifying events:

How to File an Appeal

1. Complete Form SSA-44 (Medicare Income-Related Monthly Adjustment Amount — Life-Changing Event)
2. Provide documentation — tax returns, employer letters, divorce decree, death certificate
3. Submit to your local Social Security office (online, in person, or by mail)
4. SSA reviews and adjusts your premium, usually within 30–60 days

You cannot appeal simply because your income dropped without a qualifying life-changing event. If you had a one-time spike (Roth conversion, home sale) but no qualifying event, you'll pay the higher premium for that determination year.

The Most Common Successful Appeal: Retirement

If you retired in 2024 and your 2024 income was high (includes partial-year salary), your 2026 IRMAA is based on that high-income year. But your 2025 and future income may be much lower. File SSA-44 showing the work stoppage and your estimated lower income — SSA will use the more recent year instead.

What About Married Filing Separately?

If you're married filing separately and lived with your spouse at any point during the year, the IRMAA thresholds are dramatically lower — the first bracket starts at just $109,000 (the same as single filers), and you jump to near-maximum surcharges much faster. Filing separately rarely helps with IRMAA unless the spouses lived apart for the entire tax year. In almost all cases, married filing jointly produces the best combined IRMAA outcome.

Timeline: How Long Does IRMAA Last?

IRMAA is determined annually. A one-time income spike (home sale, large Roth conversion) triggers higher premiums for exactly one year — the year two years later. If your income returns to normal, your IRMAA drops back the following year. However, if your income is consistently above the thresholds (from pensions, RMDs, or investment income), you'll pay IRMAA indefinitely.

Each year's determination arrives as a letter from SSA, typically in November or December, informing you of your premium for the upcoming year. If you disagree, you have 60 days to request reconsideration.

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IRMAA and Roth Conversions: The Balancing Act

Roth conversions and IRMAA create a natural tension. Conversions reduce future RMDs (lowering future IRMAA exposure) but increase current income (triggering current IRMAA). The question is whether the short-term IRMAA cost is worth the long-term tax and IRMAA savings.

When Conversions Are Worth the IRMAA Hit

• You're under 63: Conversions done before Medicare enrollment at 65 don't trigger IRMAA at all (there's a gap year depending on timing). Convert aggressively in your early 60s.
• Your future RMDs would be large: A $3 million IRA at 73 generates RMDs that push you into the top IRMAA brackets for life. Converting $100,000–$200,000/year in your 60s, even with some IRMAA cost, can permanently reduce future premiums.
• The IRMAA cost is small relative to tax savings: Paying $1,148/year in IRMAA to convert $50,000 at the 22% bracket (saving $50,000+ in future taxes at 32%+) is a clear win.

When Conversions Aren't Worth It

• You're already in a high IRMAA bracket: Additional conversions push you deeper into the top brackets with diminishing marginal benefit.
• The conversion is small: Converting $5,000 to trigger $1,148 in IRMAA makes no sense.
• You're over 73 with large RMDs: The RMD itself may already have you in a high bracket — adding conversion income on top creates a double hit with little benefit.

For a detailed walkthrough of conversion timing and strategy, see our guide on how to withdraw from retirement accounts tax-efficiently.

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IRMAA by the Numbers: What It Costs Over a Retirement

IRMAA isn't just a one-year cost. If your income consistently exceeds thresholds — from RMDs, pensions, or investment income — you'll pay elevated premiums for years or decades.

A couple in the second bracket for 20 years pays nearly $46,000 extra in Medicare premiums. That's a number worth planning around.

Project your full Medicare costs: Our Medicare Part B premium calculator factors in IRMAA to show your actual premium based on your income level.

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How IRMAA Fits Into Your Retirement Plan

IRMAA is one of those hidden costs that can quietly erode your retirement income if you don't plan for it. It connects directly to your withdrawal strategy, Roth conversion decisions, and investment income management — making it impossible to optimize in isolation.

If you want to model how different income scenarios affect your Medicare premiums alongside your taxes, Social Security, and overall retirement timeline, the Plan Builder lets you test withdrawal strategies and conversion amounts against IRMAA thresholds using your real numbers.

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Frequently Asked Questions

How is IRMAA calculated?

IRMAA is based on your Modified Adjusted Gross Income (MAGI) from your federal tax return filed two years prior. Medicare gets this data directly from the IRS. Your MAGI includes AGI plus any tax-exempt interest income. The surcharge is applied per person — both spouses pay it individually if their joint income exceeds the married threshold.

What income is used for IRMAA — last year or two years ago?

Two years ago. Your 2024 MAGI determines your 2026 IRMAA. Your 2025 MAGI determines your 2027 IRMAA. This lookback is why one-time income events like Roth conversions or home sales create delayed premium increases that feel like a surprise.

Can I appeal IRMAA?

Yes, but only if you experienced a qualifying life-changing event (retirement, divorce, death of spouse, loss of income-producing property, or similar). File Form SSA-44 with the Social Security Administration. You cannot appeal simply because your income dropped without a qualifying event.

Does Roth IRA income count toward IRMAA?

No. Qualified Roth IRA distributions are not included in MAGI and do not count toward IRMAA. However, Roth conversions (moving money from a traditional IRA to a Roth) do count as income in the year of conversion, which can trigger IRMAA two years later.

How much does IRMAA add to Medicare premiums?

At the lowest surcharge bracket ($109,001–$137,000 for single filers), IRMAA adds about $1,148 per person per year across Part B and Part D. At the highest bracket ($500,000+), it adds $6,936 per person per year. For a couple, double these amounts.

Does IRMAA affect Medicare Advantage premiums?

Yes. IRMAA surcharges apply to the Part B premium, which you pay regardless of whether you have Original Medicare or Medicare Advantage. If your MA plan includes Part D, the Part D IRMAA surcharge also applies. The surcharge is paid directly to Medicare, not to your MA plan.

What is the IRMAA threshold for 2026?

The first IRMAA threshold for 2026 is $109,000 for single filers and $218,000 for married filing jointly (based on 2024 MAGI). Above these thresholds, Part B premiums increase from $202.90 to $284.10/month, and Part D premiums increase by $14.50/month.

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This article is for educational purposes only and is not personalized financial advice. IRMAA thresholds and premiums change annually — verify current figures at Medicare.gov or with the Social Security Administration. Sources: CMS 2026 Medicare Parts A & B Premiums Fact Sheet, CMS IRMAA brackets, IRS MAGI rules.

Last updated: October 2026