If you're on Medicare or approaching 65, understanding IRMAA — the Income-Related Monthly Adjustment Amount — is essential. IRMAA is a surcharge added to your standard Medicare Part B and Part D premiums when your income exceeds certain thresholds. For 2026, the standard Part B premium is $202.90 per month, but higher-income retirees can pay up to $689.90 per month — more than triple the base amount.[1]
Below, we break down every 2026 IRMAA tier, the exact surcharges for Part B and Part D, the two-year lookback rule, and how to appeal if your income has changed. All figures are sourced from CMS and SSA official announcements.
How IRMAA Works: The Basics
Medicare Part B covers outpatient care, doctor visits, and preventive services. Part D covers prescription drugs. Most beneficiaries pay the standard premium for each. However, the Social Security Administration reviews your tax return from two years prior — your 2024 MAGI determines your 2026 premiums — and assigns you to an IRMAA tier if your income exceeds the base threshold.[2]
IRMAA operates as a cliff at each tier. Exceed a threshold by even $1 and you pay the full surcharge for that tier for the entire year. There is no phase-in or gradual increase — it is all or nothing at each bracket boundary.
Your MAGI for IRMAA purposes is your adjusted gross income (AGI) plus tax-exempt interest income. This includes wages, pensions, IRA distributions, Roth conversions, capital gains, rental income, Social Security benefits, and municipal bond interest. Notably, Roth withdrawals (qualified distributions) are not included, which is one reason Roth conversions before Medicare enrollment can be so valuable.
2026 IRMAA Bracket Table: Single & Married Filing Jointly
The table below shows the six IRMAA tiers for 2026, the MAGI thresholds for single filers and married filing jointly, and the monthly Part B and Part D surcharges at each level.[1][3]
| Tier | Single MAGI | MFJ MAGI | Part B Premium | Part B Surcharge | Part D Surcharge |
|---|---|---|---|---|---|
| Base | ≤ $109,000 | ≤ $218,000 | $202.90 | $0.00 | $0.00 |
| Tier 1 | $109,001 – $137,000 | $218,001 – $274,000 | $284.10 | $81.20 | $14.50 |
| Tier 2 | $137,001 – $171,000 | $274,001 – $342,000 | $405.80 | $202.90 | $37.50 |
| Tier 3 | $171,001 – $205,000 | $342,001 – $410,000 | $527.50 | $324.60 | $60.40 |
| Tier 4 | $205,001 – $500,000 | $410,001 – $750,000 | $649.20 | $446.30 | $83.30 |
| Tier 5 | > $500,000 | > $750,000 | $689.90 | $487.00 | $91.00 |
All amounts are per person, per month. For a married couple both enrolled in Medicare, double the surcharges. At Tier 1, a couple pays an extra $2,296.80 per year in combined Part B and Part D surcharges. At Tier 5, the annual extra cost exceeds $13,872.
IRMAA Medicare Planner
Enter your income to see exactly which IRMAA tier you fall into and the total annual cost.
Married Filing Separately: The Compressed Brackets
If you file as Married Filing Separately (MFS), IRMAA brackets are dramatically compressed. There are only two thresholds instead of five:[2]
| MFS MAGI | Part B Surcharge | Part D Surcharge |
|---|---|---|
| ≤ $109,000 | $0.00 | $0.00 |
| $109,001 – $500,000 | $446.30 | $83.30 |
| > $500,000 | $487.00 | $91.00 |
This is a severe penalty. A MFS filer with MAGI of $110,000 jumps straight to Tier 4 surcharges ($446.30/month for Part B alone), while a single filer at the same income pays only the Tier 1 surcharge ($81.20/month). Unless there is a compelling reason to file separately — such as income-driven student loan repayment — most married Medicare beneficiaries should file jointly.
The 2-Year Lookback Rule
One of the most confusing aspects of IRMAA is the timing. Medicare does not use your current-year income. Instead, the Social Security Administration pulls your MAGI from two tax years prior.[2] For 2026 premiums, SSA uses your 2024 tax return (filed in 2025).
This lookback creates a planning gap. A retiree who did a large Roth conversion in 2024 may have temporarily high MAGI, triggering IRMAA surcharges in 2026 — even if their 2026 income is modest. Similarly, selling a home or business in a given year can cause an IRMAA spike two years later, long after the transaction is forgotten.
The lookback works in your favor too. If you retire in 2026 and your income drops significantly, your 2026 IRMAA is still based on your higher 2024 working income. But you can appeal using Form SSA-44 (see below).
Life-Changing Event Appeals (Form SSA-44)
If your income has decreased significantly due to a qualifying life-changing event, you can ask SSA to use a more recent year's income instead of the 2-year lookback. Qualifying events include:[4]
- Marriage, divorce, or annulment
- Death of a spouse
- Work stoppage (retirement, layoff, or termination)
- Work reduction (significant decrease in hours or self-employment income)
- Loss of income-producing property (due to disaster, fraud, or similar)
- Loss of or reduction in pension income
- Receipt of settlement payment from an employer or former employer
To file an appeal, complete Form SSA-44 and submit it to your local Social Security office along with documentation of the event and your estimated income. You can also request a review by phone at 1-800-772-1213. SSA typically processes these requests within a few weeks.
Important: A Roth conversion is not a qualifying life-changing event. If your MAGI is high because of a planned Roth conversion, you cannot appeal the resulting IRMAA surcharge. This is why sizing conversions to avoid IRMAA tiers — or at least to stay in the lowest possible tier — is critical.
The Annual Cost of Each IRMAA Tier
IRMAA surcharges add up quickly, especially for married couples. Here is the total annual extra cost per person at each tier (Part B surcharge + Part D surcharge, multiplied by 12 months):
- Tier 1: ($81.20 + $14.50) × 12 = $1,148.40/year per person
- Tier 2: ($202.90 + $37.50) × 12 = $2,884.80/year per person
- Tier 3: ($324.60 + $60.40) × 12 = $4,620.00/year per person
- Tier 4: ($446.30 + $83.30) × 12 = $6,355.20/year per person
- Tier 5: ($487.00 + $91.00) × 12 = $6,936.00/year per person
For a couple at Tier 3, the combined annual IRMAA cost is $9,240 — an amount that many retirees could avoid entirely with proper income planning in the lookback year.
Strategies to Minimize IRMAA
1. Size Roth conversions to stay below tier thresholds. If your 2024 MAGI is near a tier boundary, consider limiting your Roth conversion to stay just below. The cost of a small Roth conversion that triggers the next IRMAA tier can exceed the tax benefit of the conversion itself.[5]
2. Front-load conversions before age 63.Since IRMAA uses a 2-year lookback, conversions done at age 62 affect premiums at age 64 — your first partial year on Medicare (if you enroll at 65). Doing large conversions at ages 59–62 gives you the most runway before IRMAA applies.
3. Manage capital gains realizations. Long-term capital gains count toward MAGI. Spreading gains across multiple years or using tax-loss harvesting to offset gains can keep your MAGI below IRMAA thresholds.
4. Use QCDs to reduce MAGI. Qualified charitable distributions from an IRA (up to $111,000 in 2026) go directly to charity and are excluded from AGI. For charitably inclined retirees, QCDs can lower MAGI below IRMAA thresholds while satisfying RMDs.
5. Coordinate with your spouse.If only one spouse is on Medicare, the other spouse's income still counts toward household MAGI on a joint return. A younger spouse's Roth conversion can trigger IRMAA for the Medicare-enrolled spouse. Plan both spouses' income events together.
Roth Conversion Calculator
Model multi-year Roth conversions to find the optimal amount that avoids IRMAA tier jumps.
Key Takeaways
IRMAA is one of retirement's most impactful “hidden taxes.” The cliff-based structure means that even small income miscalculations can cost thousands of dollars per year. The 2-year lookback adds a timing complexity that catches many retirees off guard — especially those who do Roth conversions or sell appreciated assets without considering the downstream Medicare cost.
The good news: IRMAA is entirely plannable. By understanding the bracket thresholds, timing income events carefully, and using tools like our IRMAA calculator, you can keep your Medicare costs at the standard premium — or at least make an informed decision about when paying a surcharge is worth the long-term benefit.
Sources & References
- [1]CMS — 2026 Medicare Parts A & B Premiums and Deductibles https://www.cms.gov/newsroom/fact-sheets/2026-medicare-parts-b-premiums-and-deductibles
- [2]SSA — Medicare Premiums: Rules for Higher-Income Beneficiaries https://www.ssa.gov/benefits/medicare/medicare-premiums.html
- [3]CMS — 2026 Medicare Part D Income-Related Monthly Adjustment Amounts https://www.cms.gov/newsroom/fact-sheets/2026-medicare-parts-b-and-d-premiums-and-deductibles
- [4]SSA — Form SSA-44: Medicare Income-Related Monthly Adjustment Amount — Life-Changing Event https://www.ssa.gov/forms/ssa-44.html
- [5]IRS Revenue Procedure 2025-25 — Inflation Adjusted Items for 2026 https://www.irs.gov/irb/2025-15_IRB#REV-PROC-2025-25