IRMAA: The Medicare Surcharge Nobody Told You About
By Logan Steele · June 19, 2026 · 6 min read
Allow me to introduce you to IRMAA. She sounds like your favorite great-aunt — the one who pinches cheeks, mails birthday cards with two crisp dollar bills in them, and definitely has opinions about your haircut. In reality, IRMAA is the Income-Related Monthly Adjustment Amount — a polite name for an impolite surprise on your Medicare bill.
If you've ever heard a recent retiree mutter "my Medicare premium doubled and I have no idea why," congratulations: you've already met her.
What IRMAA actually does
Most people on Medicare pay the standard Part B premium and a modest Part D premium tied to their drug plan. IRMAA is a surcharge that gets added on top of both — but only if your income crossed certain thresholds. The kicker: she doesn't look at this year's income. She looks at your tax return from two years ago.
That two-year lookback is why a great 2024 — a Roth conversion, a house sale, a banner year at work, an inherited IRA you finally distributed — can show up in 2026 as a higher Medicare bill. Aunt IRMAA has a long memory.
The 2026 brackets (the short version)
Brackets are based on your Modified Adjusted Gross Income (MAGI) from your 2024 federal return. Here's the rough shape for 2026 — exact figures are released each fall by CMS, so treat these as the landscape, not a quote:
| 2024 MAGI (single) | 2024 MAGI (joint) | What it means |
|---|---|---|
| Up to ~$106K | Up to ~$212K | Standard premium. No IRMAA. |
| ~$106K – $133K | ~$212K – $266K | Tier 1 surcharge on Part B and Part D. |
| ~$133K – $167K | ~$266K – $334K | Tier 2. It starts to sting. |
| ~$167K – $200K | ~$334K – $400K | Tier 3. |
| ~$200K – $500K | ~$400K – $750K | Tier 4. |
| Over ~$500K | Over ~$750K | Top tier. Aunt IRMAA is fully in your business. |
Cross a threshold by even one dollar and the full tier applies — IRMAA is a cliff, not a slope. This is why the planning matters.
The triggers people don't see coming
- Roth conversions. A great long-term move that can generate a one-year MAGI spike — and a two-year-later premium spike.
- Selling a house. Even with the $250K / $500K capital gains exclusion, anything above it counts.
- Required Minimum Distributions. They start at 73 and they don't care how much income you actually need.
- Inherited IRAs. The 10-year drawdown rule has helped many beneficiaries discover IRMAA the hard way.
- A big bonus, exercised options, or a business sale. One great year. Two years of Medicare consequences.
Life changes that let you fight back
IRMAA isn't always final. The SSA has a short list of life-changing events that let you appeal using Form SSA-44. The big ones:
- Marriage, divorce, or death of a spouse
- You or your spouse stopped working or cut back hours
- Loss of an income-producing property (not from a sale)
- Loss or reduction of a pension
- An employer settlement payment from a bankruptcy
Retiring counts. Selling a rental on purpose doesn't. If you have a qualifying event, file SSA-44 with documentation — Social Security can use your estimated current income instead of that two-year-old tax return.
SSA-44 — "Medicare Income-Related Monthly Adjustment Amount – Life-Changing Event." It's two pages. If you've had a qualifying event, do not pay an inflated premium for two years out of politeness.
Planning moves that keep IRMAA off your back
- Spread Roth conversions across multiple years to stay under the next bracket.
- Use Qualified Charitable Distributions (QCDs) from IRAs once you're 70½ — they satisfy RMDs without bumping MAGI.
- Harvest losses in big capital-gain years.
- Time the house sale when possible. A few months earlier or later can move the tax year.
- Watch the cliff. If you're within $5,000 of the next bracket in December, that's a conversation worth having before year-end.
The takeaway
IRMAA is rarely the reason to skip a smart financial move — but she absolutely deserves a seat at the planning table. The clients who get surprised are almost always the ones who only met her when the bill showed up. The clients who plan ahead either avoid her, manage her, or at least know she's coming.
If you're approaching 65, already on Medicare, or planning a year with big income movement, let's run through your situation together. A twenty-minute call can save thousands.
Educational only — not tax or legal advice. IRMAA brackets and Medicare premiums are set annually by CMS and the IRS; check current figures before acting.