Medicare Premiums and Income
What Is Medicare IRMAA? How the Income Surcharge Works
IRMAA is an additional amount some higher-income Medicare beneficiaries pay for Part B and Part D. The result usually comes from an older federal tax return—not from the Medicare plan you choose.
Quick answer
IRMAA Is an Additional Medicare Premium Based on Income
IRMAA stands for Income-Related Monthly Adjustment Amount. Social Security generally looks at modified adjusted gross income from two years earlier. If that income is above the applicable threshold, an additional amount is added to Part B and, when you have Medicare drug coverage, Part D.
For 2026 premiums, Social Security generally uses 2024 federal tax information. IRMAA is recalculated for each premium year, so paying it one year does not automatically mean you will pay it forever.
How Medicare IRMAA Works
Social Security Gets Tax Data
The IRS provides your tax filing status and modified adjusted gross income. The information is generally from two years before the premium year.
Your Income Tier Is Applied
Income above the standard-premium threshold falls into one of five IRMAA levels. Crossing into the next level changes the monthly amount.
Part B and Part D Are Adjusted
Part B has a higher total premium. Part D has a separate IRMAA amount added to the premium for your prescription coverage.
IRMAA is not a late-enrollment penalty, and it does not buy additional benefits. It is the portion of Medicare Part B and Part D costs assigned to certain higher-income beneficiaries.
Current amounts
2026 Medicare IRMAA Brackets
The 2026 amounts below generally use modified adjusted gross income reported on a 2024 tax return. Part B figures show the total monthly Part B premium. Part D figures are added to the premium charged by the prescription plan.
| 2024 MAGI: Individual Return | 2024 MAGI: Joint Return | Total 2026 Part B Premium | 2026 Part D IRMAA |
|---|---|---|---|
| $109,000 or less | $218,000 or less | $202.90 | $0 |
| Above $109,000 through $137,000 | Above $218,000 through $274,000 | $284.10 | $14.50 plus plan premium |
| Above $137,000 through $171,000 | Above $274,000 through $342,000 | $405.80 | $37.50 plus plan premium |
| Above $171,000 through $205,000 | Above $342,000 through $410,000 | $527.50 | $60.40 plus plan premium |
| Above $205,000 and below $500,000 | Above $410,000 and below $750,000 | $649.20 | $83.30 plus plan premium |
| $500,000 or more | $750,000 or more | $689.90 | $91.00 plus plan premium |
Married beneficiaries who filed separately and lived with their spouse during part of the tax year have different brackets. Social Security makes the official determination. Premiums and thresholds change annually.
What Income Does Medicare Use?
For IRMAA, modified adjusted gross income generally means the adjusted gross income on Form 1040 plus tax-exempt interest. This is a specific Medicare calculation; it is not interchangeable with every other tax-law definition of MAGI.
Wages, taxable retirement distributions, Roth conversions, capital gains, pensions, business income and taxable interest may all affect adjusted gross income. Tax-exempt interest is added separately. Our guide to what counts as income for Medicare IRMAA explains the categories and important exceptions.
A transaction amount is not always the amount that counts
Selling a property, taking a retirement distribution or moving money between accounts does not necessarily add the entire transaction value to MAGI. The taxable amount reported on the return is what generally affects adjusted gross income. A qualified tax professional should calculate the tax result.
Why Medicare Usually Looks Back Two Years
Social Security needs completed tax information when it determines the next year’s Medicare premiums. That is why 2026 IRMAA generally uses 2024 tax information. If that return is unavailable, older available information may sometimes be used.
The lookback can produce a surprise after retirement. Someone may have lower income today but receive an IRMAA notice based on wages, a bonus or a retirement transaction from two years earlier. Retirement or another recognized life-changing event may support a request to use newer income information. See our SSA-44 and IRMAA appeal guide.
Does Changing Medicare Plans Remove IRMAA?
No. IRMAA is separate from the private Medicare plan you select.
- A Medicare Advantage enrollee still owes the applicable Part B premium and Part B IRMAA.
- If a Medicare Advantage plan includes Part D, the beneficiary can also owe Part D IRMAA directly to Medicare.
- A $0-premium Medicare Advantage or Part D plan does not eliminate an applicable IRMAA amount.
- A Medicare Supplement policy does not replace or reduce the Part B premium or Part B IRMAA.
Read Part B versus Part D IRMAA for a side-by-side explanation of the two adjustments and how they are billed.
Frequently asked questions
Medicare IRMAA Questions
Is IRMAA a tax?
No. IRMAA is an additional Medicare premium amount for Part B and Part D. Federal tax-return information is used to determine whether it applies.
Does everyone on Medicare pay IRMAA?
No. Most beneficiaries pay the standard Part B premium and no Part D IRMAA. The adjustment applies only when the MAGI used by Social Security exceeds the applicable threshold.
Is IRMAA permanent?
Not necessarily. Social Security redetermines IRMAA for each premium year using the tax information available for that year. Income changes can move a person into a different tier or remove IRMAA.
Can a Roth conversion increase IRMAA?
Yes. The taxable portion of a Roth conversion generally increases income in the conversion year and may affect Medicare premiums two years later. See our guide to IRA withdrawals, Roth conversions and IRMAA.
Who decides whether I owe IRMAA?
Social Security determines IRMAA using tax information supplied by the IRS. Your Medicare insurance carrier and Medicare broker do not make the official determination.
Medicare premiums and IRMAA series
Continue the IRMAA Guide Series
These guides separate the broad Medicare-and-tax issue from the narrower questions about income, retirement transactions, the two surcharges and requests for a new determination.
Official information
Medicare and Social Security Resources
Understand the complete Medicare cost
Compare Coverage Without Losing Sight of IRMAA
Thompson Medicare Brokerage helps people in Missouri and Illinois compare the private Medicare coverage options we represent while accounting for the Part B and Part D costs that sit outside the plan.
Social Security makes IRMAA decisions, and tax professionals should handle income and tax strategy. We can explain how the resulting Medicare costs fit into your coverage comparison.
This article provides general Medicare information and does not provide tax, investment, accounting or legal advice. IRMAA thresholds and premiums change annually. Social Security and Medicare make official eligibility, premium and appeal decisions.