At a glance: IRMAA is an extra charge Medicare adds to your Part B and Part D premiums when your income passes set lines. For 2026, the lines start at $109,000 for single filers and $218,000 for married couples filing jointly — measured on your 2024 tax return. And IRMAA is a cliff, not a slope: land one dollar over a line and your household can owe $2,296.80 more for the entire year.
If your income two years ago crossed one of five lines, Medicare quietly charges you more: more for Part B, and more again for Part D drug coverage. The extra amount is called IRMAA — the Income-Related Monthly Adjustment Amount.
What is IRMAA, in plain English?
IRMAA is a surcharge, not a separate plan and not a tax you file. If your income is above a threshold, Social Security adds a set amount to your monthly Medicare premiums:
- An extra amount on top of your Part B premium (the medical insurance almost everyone on Medicare has), and
- An extra amount on top of your Part D premium (prescription drug coverage).
The idea behind it: Medicare premiums normally cover only part of the program's cost, and higher-income households cover a bigger share. Each tier raises your share in steps, up to the top, where a single person's Part B premium reaches $689.90 a month.
Two things about IRMAA surprise almost everyone:
- It is decided by Social Security, not by your Medicare plan. A Medicare Advantage plan does not shield you — the same surcharges apply on top of any premium your plan charges.
- It is per person. If both spouses are on Medicare and your joint income puts you in a tier, each of you pays that tier's surcharge. Every "couple" figure in this article counts both spouses for exactly that reason.
The two-year lookback: why your 2024 return sets your 2026 bill
Social Security does not look at what you earn now. It uses the tax return from two years earlier — the most recent return the IRS can provide when premiums are set. So your 2026 premiums are based on your 2024 tax return; your 2025 return will set your 2027 premiums, and so on, every year.
That lag explains the classic IRMAA shock. You retire at the end of 2024 with a final year of full salary. In 2026 — living on a pension and savings — a letter arrives pricing your Medicare as if you still had the job. Nothing is wrong with the letter; it is simply two years behind your life.
It also means the reverse: an income spike this year — a Roth conversion, a big capital gain, a large IRA withdrawal — does not raise this year's Medicare bill. It raises the bill two years from now. That two-year echo is the single most useful fact in this article.
The 2026 IRMAA brackets: Part B
For 2026, the standard Part B premium is $202.90 a month. If your 2024 MAGI (modified adjusted gross income — explained below) passed a bracket line, here is what is added, per the official CMS figures:
| Your 2024 MAGI — single | Your 2024 MAGI — married filing jointly | Part B surcharge, per month | Your total Part B premium |
|---|---|---|---|
| $109,000 or less | $218,000 or less | $0.00 | $202.90 |
| $109,001–$137,000 | $218,001–$274,000 | $81.20 | $284.10 |
| $137,001–$171,000 | $274,001–$342,000 | $202.90 | $405.80 |
| $171,001–$205,000 | $342,001–$410,000 | $324.60 | $527.50 |
| $205,001–$499,999 | $410,001–$749,999 | $446.30 | $649.20 |
| $500,000 or more | $750,000 or more | $487.00 | $689.90 |
Example: a couple filing jointly with a 2024 MAGI of $300,000 sits in the third row — each spouse pays $405.80 a month for Part B.
Married filing separately? The brackets are much harsher, and they are not in the table above. If you lived with your spouse during the year, your Part B surcharge jumps straight to $446.30 a month once MAGI passes $109,000 (total $649.20), and to $487.00 at $391,000 or more. One reason couples rarely file separately — run these numbers first if you do.
The 2026 IRMAA brackets: Part D
Part D has no standard premium — every drug plan charges its own. But the IRMAA part is the same for everyone: a fixed monthly surcharge on the same income tiers, added to whatever your plan charges:
| Your 2024 MAGI — single | Your 2024 MAGI — married filing jointly | Part D surcharge, per month |
|---|---|---|
| $109,000 or less | $218,000 or less | $0.00 |
| $109,001–$137,000 | $218,001–$274,000 | $14.50 |
| $137,001–$171,000 | $274,001–$342,000 | $37.50 |
| $171,001–$205,000 | $342,001–$410,000 | $60.40 |
| $205,001–$499,999 | $410,001–$749,999 | $83.30 |
| $500,000 or more | $750,000 or more | $91.00 |
The Part D surcharge is collected by Medicare itself — deducted from your Social Security check, or billed directly if you are not collecting benefits yet — not by your drug plan. (Filing separately: $83.30 a month above $109,000 of MAGI; $91.00 at $391,000 or more.)
Add the two tables together and you get the real household cost of each tier. Per person, the combined surcharge runs $95.70, $240.40, $385.00, $529.60, or $578.00 a month across the five tiers. For a couple with both spouses on Medicare: $2,296.80 to $13,872.00 a year.
Check your own tier in two minutes with our free IRMAA Bracket Checker.
You do not have to hold all of this in your head. Our free one-page 2026 IRMAA Brackets Chart prints both tables, the cliff warning, and the MAGI formula on a single page. Get the free chart (PDF) → or have it sent to your inbox →.
Why IRMAA is a cliff, not a slope
Most income-based charges in American life phase in gradually. IRMAA does not. There is no partial surcharge for being a little bit over a line. Cross a bracket line by one dollar and you owe the entire next tier's surcharge — for all twelve months.
Here is the first line, in slow motion. A couple filing jointly, both on Medicare:
- 2024 MAGI of $218,000 exactly: no surcharge. They pay the standard premium, like everyone else.
- 2024 MAGI of $218,001: the full first tier applies. Each spouse owes $81.20 more for Part B and $14.50 more for Part D — $95.70 a month each, $191.40 a month for the household, $2,296.80 for the year.
One extra dollar of income. $2,296.80 of extra premiums. That dollar is, by a wide margin, the most expensive dollar they earned that year.
And the first line is the gentlest step. The same $1 slip at the $274,000 joint line moves a couple from tier one to tier two — an extra $3,472.80 a year. The lesson is not to fear income; it is to know exactly where the lines are before the year ends. Once January arrives, that year's MAGI is history — and the bill follows two years later like clockwork.
Meet David and Susan: the $218,001 surprise
David and Susan are a made-up example, but every figure below uses the real 2026 brackets above.
David, 68, and Susan, 67, retired in 2023 and are both on Medicare. Their income is steady by design: pensions, two Social Security checks, and some interest — about $205,000 a year of MAGI. Comfortably under the $218,000 joint line. No IRMAA.
In late 2024, David sold a small piece of land he had held for years — a one-time capital gain of about $13,000. Their 2024 MAGI landed at $218,001.
In 2026, each of their Part B premiums rose to $284.10, and each Part D bill picked up $14.50. Total extra cost for the year: $2,296.80 — triggered by one dollar of a gain they barely remember.
Could they appeal? No — and this matters. A one-time capital gain is not one of the life-changing events Social Security accepts for a re-price. Their fix was slower: nothing to file, one expensive year to pay, and a standing rule in their house ever since — before any December sale, check the line first.
The lines are knowable in advance. The only real mistake is not looking.
What counts as MAGI (and what surprises people)
Social Security uses a specific number called MAGI — modified adjusted gross income. For Medicare purposes it is refreshingly simple:
MAGI = your adjusted gross income (AGI) + your tax-exempt interest
On your Form 1040, that is line 11 (AGI) plus line 2a (tax-exempt interest). The IRS sends both figures to Social Security; there is no separate form to file.
Three things inside that definition catch retirees off guard:
- Tax-exempt interest counts. Municipal bond interest is free of federal income tax — but it is added back for IRMAA. A large muni portfolio can push a household over a line even when its taxable income looks low.
- Roth conversions count as income in the year you convert. The converted amount sits inside your AGI, so a conversion raises MAGI — and, two years later, possibly your premiums. (Qualified Roth withdrawals in retirement, by contrast, do not appear in AGI at all.)
- Most ordinary income is already inside AGI — wages, pensions, traditional IRA and 401(k) withdrawals including required minimum distributions, capital gains, dividends, and the taxable portion of Social Security benefits. If it raised your AGI, it raised your MAGI.
Check your tier in 3 steps
Step 1 — Pull your 2024 Form 1040. That is the return behind your 2026 premiums.
Step 2 — Add line 11 + line 2a. That sum is your MAGI for IRMAA purposes. Two lines, one addition — the whole calculation.
Step 3 — Find your row. Use your filing status from that return and the two tables above. Your row is your tier; the surcharge columns are what you pay, per person, per month.
If the answer puts you in a tier and your income has since dropped because of a life-changing event — retirement is the most common — do not just pay it. Read the next section.
What can lower your IRMAA later
You cannot rewrite a closed tax year, and nobody can negotiate with a bracket table. But IRMAA is re-decided every year, so there are two honest levers: fix the past when the rules allow it, and shape the future while there is still time.
If your income already dropped: the appeal
If the income on that two-year-old return no longer reflects your life because of a qualifying life-changing event — work stoppage or reduction (retirement), marriage, divorce, death of a spouse, loss of pension income, and a few others — Social Security can re-price your current premiums using your newer, lower income. The tool is Form SSA-44, and a successful request can be worth thousands a year for a couple. Our companion guide walks through it completely: Retired and Hit With a Medicare Surcharge? How to Appeal IRMAA With Form SSA-44.
Note what the appeal is not: it does not help with a one-time capital gain, a Roth conversion, or a house sale — none of those is a life-changing event on Social Security's list. David and Susan, above, had no appeal. Only a lesson.
If the spike is still ahead of you: plan around the lines
For income you have not received yet, the levers are about timing and size — and all of them work two years in advance:
- Know your number before December. Estimate your MAGI in the fall, while the year is still open. Being $3,000 over a line in November is a problem you can still solve; discovering it on a premium notice two years later is not.
- Size Roth conversions to the bracket, not just the tax bracket. A conversion fills income up to a point you choose. Many households convert up to — but not past — the next IRMAA line.
- Spread big gains across tax years when you genuinely have the choice. Two smaller sales in different years can cost far less in premiums than one large sale in a single year.
- Remember charitable tools exist. Retirees over 70½ can often give from an IRA in ways that keep the amount out of AGI entirely; whether that fits you is a question for your tax professional.
- Watch required minimum distributions. RMDs are income you cannot decline, and they grow with the account. The households surprised by IRMAA at 75 usually had the warning signs at 65.
All of this is general education, not a plan for your household — a wrong move can cost more in tax than it saves in premiums. Talk it through with a qualified tax or financial professional who sees your whole return before a big conversion or sale, not after.
Frequently asked questions
Is IRMAA based on my gross income or my taxable income?
Neither, exactly. It is based on MAGI: adjusted gross income (Form 1040, line 11) plus tax-exempt interest (line 2a), measured before your standard or itemized deduction — so it is usually higher than your taxable income.
Which tax year decides my 2026 IRMAA?
Your 2024 return. Social Security uses the return from two years earlier — or, rarely, the most recent return the IRS can provide.
Do capital gains count toward IRMAA?
Yes. Capital gains are part of your AGI, so they count in full — and because IRMAA is a cliff, a one-time gain can raise your premiums for exactly one year, two years after the sale, then disappear.
My spouse and I file jointly. Do we each pay IRMAA?
Yes — the surcharge is per person. If your joint MAGI puts you in a tier and both of you are on Medicare, each of you pays that tier's Part B and Part D surcharges. That is why the couple figures here are double the per-person ones.
What happens if my income is $1 over a bracket line?
You owe the full next tier for the whole year — there is no partial step. At the first joint line, that $1 costs a couple $2,296.80 across twelve months. Knowing your MAGI before the year closes is the only defense.
Keep the chart where you can see it: the free 2026 IRMAA Brackets Chart puts both tables, the $1-cliff warning, and the MAGI formula on one printable page — the page David and Susan now keep in their tax folder. Get the free chart (PDF) → or have it emailed to you →.
Sources & official figures
- CMS — 2026 Medicare Parts A & B Premiums and Deductibles (standard Part B premium and all 2026 Part B and Part D IRMAA amounts; released November 14, 2025): https://www.cms.gov/newsroom/fact-sheets/2026-medicare-parts-b-premiums-deductibles
- Social Security Administration — POMS HI 01101.010, Modified Adjusted Gross Income (MAGI) (MAGI definition, two-year lookback, 2026 thresholds): https://secure.ssa.gov/apps10/poms.Nsf/lnx/0601101010
- Social Security Administration — Request to lower an IRMAA (Form SSA-44 and the life-changing-event appeal): https://www.ssa.gov/medicare/lower-irmaa
Last updated: October 22, 2026 — figures checked against CMS and Social Security sources on that date.
Disclaimer: The Retirement Desk publishes education, not financial, tax, or legal advice. David and Susan are a hypothetical example; your figures and outcome will differ. Rules and amounts change every year — confirm your situation with Social Security, the IRS, or a qualified professional before you act.
Filed under: Medicare & IRMAA — The Retirement Desk, the situation-first retirement money desk for Americans 60–75.
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