What Is IRMAA?
Key Points
- IRMAA is an income-related monthly adjustment amount added to your Part B and Part D premiums if your income exceeds certain thresholds.
- The Social Security Administration determines your IRMAA based on your tax return from two years ago.
- If your income has dropped due to a qualifying life event, you can appeal using Form SSA-44.
Higher-income Medicare beneficiaries pay more for Part B and Part D. This surcharge is called IRMAA — and many people are surprised to learn they owe it. Here's how it works and what you can do if your income has changed.
What Is IRMAA?
IRMAA stands for Income-Related Monthly Adjustment Amount. It's a surcharge added to your standard Medicare Part B and Part D premiums if your income exceeds a certain threshold. The Social Security Administration (SSA) determines whether you owe IRMAA based on your modified adjusted gross income (MAGI) from your most recent federal tax return on file — typically two years prior.
For 2026, the standard Part B premium is $202.90 per month. Beneficiaries subject to IRMAA pay anywhere from $264.90 to $594.00 per month depending on their income bracket. Part D IRMAA is assessed separately and added on top of whatever your drug plan's premium is.
Who Pays IRMAA?
IRMAA applies to individuals whose MAGI exceeds $106,000 per year (or $212,000 for married couples filing jointly) based on the two-year-old tax return SSA has on file. If your income was above those thresholds in 2024, you may receive an IRMAA determination letter from Social Security before or shortly after your Medicare coverage begins.
The surcharge is tiered — higher income brackets pay progressively more. SSA sends a notice called an IRMAA determination letter that tells you exactly what you owe and when it will take effect.
What If Your Income Has Changed?
Because IRMAA is based on income from two years ago, it can feel unfair when your circumstances have changed significantly. If you've experienced a qualifying life event — such as retirement, divorce, the death of a spouse, loss of income-producing property, or reduced work hours — you may be able to appeal your IRMAA determination and have it based on a more recent year's income instead.
To appeal, you file Form SSA-44 (Medicare Income-Related Monthly Adjustment Amount — Life-Changing Event) with your local Social Security office. You'll need to provide documentation of the life event and an estimate or proof of your more recent income. If approved, your IRMAA surcharge will be adjusted — sometimes eliminated entirely.
Planning Around IRMAA
For people approaching Medicare who are still working or drawing down retirement accounts, income in the years just before age 65 can directly affect what you pay for Medicare. Large Roth conversions, capital gains events, or required minimum distributions can push you into a higher IRMAA bracket — sometimes by a significant amount.
Working with a financial advisor on Medicare-aware income planning before you turn 65 can help you avoid unnecessary IRMAA surcharges. And if you believe you've been assessed IRMAA incorrectly, don't hesitate to appeal — the SSA-44 process exists precisely for situations where the two-year lookback produces an unfair result.
Still Have Questions?
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