IRMAA.
The Medicare surcharge high earners do not see coming.
IRMAA adds hundreds of dollars per month to Medicare Part B and Part D premiums if your income exceeds certain thresholds. It uses your income from two years ago. Every retirement distribution strategy needs to account for IRMAA brackets.
US-only. IRMAA is part of US Medicare (CMS).
IRMAA uses your income from two years ago to set your Medicare premium today. A large Roth conversionRoth conversionMoving money from a tax-deferred retirement account (where you'll owe tax later) into a Roth account (where everything grows and comes out tax-free). You pay regular income tax this year on the amount moved.Full definition in 2026 raises your Medicare premium in 2028. Going $1 over a bracket cliff jumps you to the next tier. Plan distributions and Roth conversions with IRMAA brackets in mind.
Section 1 · What IRMAA is
Medicare Part B covers outpatient medical care. The standard monthly Part B premium in 2026 is approximately $185 verify×DON'T TRUST, VERIFYClaim: Standard Medicare Part B premium in 2026 is approximately $185/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 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. approximately doubles thresholds):
- MAGI under $103,000: standard premium (~$185/month).
- $103,001 to $129,000: premium + ~$74/month.
- $129,001 to $161,000: premium + ~$185/month.
- $161,001 to $193,000: premium + ~$296/month.
- $193,001 to $500,000: premium + ~$370/month.
- Above $500,000: premium + ~$444/month verify×DON'T TRUST, VERIFYClaim: 2026 IRMAA brackets approximately as listed; verify exact thresholds with CMS.Verify at: CMS Medicare premium tables ↗IRMAA brackets adjust annually; verify before tax planning..
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 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 ↗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..
- CMS. Medicare premium tables · cms.gov.
- SSA Form SSA-44. Medicare IRMAA Life-Changing Event · ssa.gov/forms/ssa-44.pdf.