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 ↗CMS 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 MAGI (Modified Adjusted Gross Income) 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 (MFJ approximately doubles thresholds):

Crossing the $103K threshold by even $1 costs an extra $888/year. Crossing $129K: an extra $2,220/year. Crossing $161K: an extra $3,552/year. 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 $130,000 MAGI pays the same surcharge as $160,000 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, sale of a business): you can appeal to SSA 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 ↗Qualifying 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..