IRMAA.
The Medicare surcharge high earners do not see coming.

Section 1 · What IRMAA is

Medicare Part B covers outpatient medical care. The standard monthly Part B premium in 2026 is approximately $202.90 verify×DON'T TRUST, VERIFYClaim: Standard Medicare Part B premium in 2026 is approximately $202.90/month.Verify at: CMS Medicare premiums ↗ Source 1 in the list belowCMS publishes the official Part B premium each fall for the following year..

IRMAA (Income-Related Monthly Adjustment Amount) is a surcharge added to Part B and Part D premiums if your income exceeds certain thresholds. The income used: your MAGIModified Adjusted Gross Income (MAGI)Your taxable income with certain deductions added back in. The IRS uses this slightly different number to decide if you qualify for some tax breaks.Full definition (Modified Adjusted Gross Incomegross incomeYour total income before any taxes or deductions are subtracted.) from TWO YEARS PRIOR. Your 2026 IRMAA surcharge is based on your 2024 MAGI.

Section 2 · The 2026 IRMAA brackets

Approximate structure for individual filers (MFJMarried Filing Jointly (MFJ)A tax filing status where a married couple combines their income and deductions on one tax return. doubles the thresholds, except the top tier, which starts at $750,000):

Crossing the $109K threshold by even $1 costs an extra $974/year. Crossing $137K adds another $1,460/year ($2,435/year over the standard premium). Crossing $171K adds another $1,460/year ($3,895/year over the standard premium). The cliff structure makes targeted income management around year-end materially valuable for near-bracket filers.

Section 3 · Why it matters for retirement planning

The IRMAA cliff effect

Going $1 over a threshold jumps you to the next full tier. There is no gradual phase-in. A $140,000 MAGI pays the same surcharge as a $170,000 MAGI. This creates a planning opportunity: if your income is near a threshold, deliberate management below the cliff saves significant money.

IRMAA interaction with Roth conversions

• Roth conversions add to MAGI in the year of conversion.
• This can push you into higher IRMAA brackets two years later.
• The optimal conversion amount considers (1) the current income tax cost, (2) the IRMAA surcharge two years later, and (3) the lifetime tax savings from growing in Roth.

Section 4 · Appeals

If your income dropped significantly from the 2-year lookback year (job loss, retirement, divorce, death of a spouse): you can appeal to SSASocial Security Administration (SSA)The federal agency that manages Social Security retirement, disability, and survivor benefit programs. to use a more recent year's income. File SSA Form SSA-44 with documentation verify×DON'T TRUST, VERIFYClaim: SSA Form SSA-44 is the IRMAA Life-Changing Event appeal form.Verify at: SSA Form SSA-44 ↗ Source 2 in the list belowQualifying life-changing events listed on the form: marriage, divorce, death of spouse, work stoppage, work reduction, loss of income-producing property, loss of pension income, employer settlement payment..