What is IRMAA, and why is my Medicare bill higher?
IRMAA is Medicare’s income surcharge. In 2026 it begins when modified adjusted gross income tops $109,000 for a single filer, and it raises both Part B and Part D premiums. The twist: it is based on your tax return from two years ago.
A two-year lookback
Social Security reads your tax return from two years back and assigns a bracket. Cross a threshold by one dollar and the whole surcharge tier applies for the year. Brackets adjust annually.
One big income year
Selling a home, a large Roth conversion, capital gains, or required minimum distributions at 63 or 64 can all show up as a Medicare surcharge at 65. It surprises new retirees constantly.
The SSA-44 appeal
If your income dropped because of a life-changing event, like retirement, marriage, divorce, or the death of a spouse, you can ask Social Security to use your current income instead. It is one form.
The planning angle
IRMAA is one of the few Medicare costs you can influence in advance. Retirees who coordinate Roth conversions, home sales, and withdrawal timing with their financial advisor often avoid brackets entirely.
We are brokers, not tax advisors, so we will not plan your conversions. What we will do is flag IRMAA exposure during your plan review so the conversation happens with your advisor before the surprise, not after. All 2026 Medicare costs here.
Related questions
Does IRMAA apply if I have Medicare Advantage? +
Yes. IRMAA attaches to your Part B and Part D premiums regardless of which plan type you choose, even when the Advantage plan itself has a low or zero premium.
Where does IRMAA start in 2026? +
Above $109,000 in modified adjusted gross income for a single filer, with higher thresholds for joint filers, based on your 2024 return. The brackets shift with inflation each year.
How do I know if I am paying it? +
Social Security mails an initial determination letter listing your bracket and premiums. If your Part B premium looks bigger than the standard $202.90, IRMAA is usually why.
High earner heading into Medicare? Get the surcharge math before it gets you.
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