Meet IRMAA
No, it's not your scary aunt at Thanksgiving. IRMAA is a Medicare surcharge that catches a lot of folks off guard. Here's what it is, who pays it, and how the choices you make today can show up in your Medicare bill years from now.
Medicare uses
for single filers
pay IRMAA
What Exactly Is IRMAA?
IRMAA stands for Income Related Monthly Adjustment Amount. It's an extra charge added to your Medicare Part B and Part D premiums if your income exceeds certain thresholds. Think of it as a surcharge for higher earners. The standard Part B premium in 2026 is $202.90 per month. But if your income is high enough, you could be paying more than triple that.
Check Your IRMAA Tier
2026 IRMAA Brackets at a Glance
| Single Filer | Joint Filer | Part B Total | Part D Add | Extra/Year |
|---|---|---|---|---|
| ≤ $109,000 | ≤ $218,000 | $202.90 | $0 | $0 |
| $109,001 to $137,000 | $218,001 to $274,000 | $284.10 | $14.50 | $1,148 |
| $137,001 to $171,000 | $274,001 to $342,000 | $405.80 | $37.50 | $2,885 |
| $171,001 to $205,000 | $342,001 to $410,000 | $527.50 | $60.50 | $4,621 |
| $205,001 to $500,000 | $410,001 to $750,000 | $649.20 | $83.50 | $6,358 |
| > $500,000 | > $750,000 | $689.90 | $91.00 | $6,936 |
The Two Year Lookback
Here's what trips people up: Medicare doesn't look at what you're earning now. It looks at what you earned two years ago. Your 2026 premiums are based on your 2024 tax return. Your 2027 premiums will be based on 2025.
This creates a timing problem. A big Roth conversion you do this year won't affect your Medicare bill until two years from now. By then, you may have forgotten all about it. Then the letter arrives, and suddenly your premium has jumped.
"The choices you make today show up in your Medicare bill later. A Roth conversion, a big stock sale, even a one time bonus can trigger IRMAA years down the road."
What Can Trigger IRMAA?
The Cliff Effect
IRMAA doesn't work like tax brackets. There's no gradual phase in. Go one dollar over a threshold, and you pay the full surcharge for that entire tier. For the entire year.
For a married couple, if you cross from Tier 0 to Tier 1, that single dollar costs you about $2,297 for the year. From Tier 1 to Tier 2, going over by a dollar costs an additional $3,475. These are real dollars that can add up quickly.
Ways to Plan Around It
If you're approaching Medicare age, there are things you can do. Time big income events, like Roth conversions or stock sales, before you turn 63. That way, the income hits your record before the lookback window affects your Medicare premiums.
Qualified Charitable Distributions (QCDs) can help once you hit 70½. They satisfy your RMD requirement without adding to your income. And withdrawals from Roth accounts don't count toward IRMAA at all.
Most importantly, keep a buffer. If you're close to a threshold, stay a few thousand dollars below it. Mutual fund capital gains distributions in December can sneak up on you and push you over the line unexpectedly.
You Might Be Able to Appeal
If your income has dropped significantly since the year Medicare is using, you may be able to request a new determination. This requires a qualifying "life changing event" and Form SSA 44. Social Security reviews the request and can adjust your premiums going forward.
This Is Exactly the Kind of Thing to Plan For
IRMAA isn't something most people think about until the letter arrives. By then, it's too late. With a little foresight, you can make income decisions that reduce or avoid these surcharges entirely. We're happy to help you think through it.