Understanding IRMAA and Medicare Income Surcharges
If your Medicare premiums seem higher than expected, you may be paying an additional cost known as IRMAA. Many Medicare beneficiaries are surprised to learn that Medicare premiums can be affected by income, not just age or enrollment status.
IRMAA can increase what you pay each month for Medicare Part B and Medicare Part D. Understanding how it works can help you plan ahead and avoid unexpected premium increases.
What Is IRMAA?
IRMAA stands for Income-Related Monthly Adjustment Amount.
It is an additional surcharge added to your Medicare premiums if your income is above certain limits set by Medicare. This surcharge may apply to:
- Medicare Part B
- Medicare Part D prescription drug coverage
The Social Security Administration uses your tax return from two years prior to determine whether you owe IRMAA. For example, your 2026 Medicare premiums are generally based on your 2024 tax return.
Which Parts of Medicare Are Affected by IRMAA?
IRMAA may increase your monthly costs for:
Medicare Part B
Part B covers services such as doctor visits, outpatient care, preventive services, and other medical services.
Medicare Part D
Part D covers prescription drug coverage. Even if you have a Medicare Advantage plan that includes drug coverage, you may still owe a separate Part D IRMAA surcharge.
Who Pays IRMAA?
Most Medicare beneficiaries do not pay IRMAA. It usually applies only to individuals or married couples with higher incomes.
Some common situations that may cause IRMAA include:
- Large withdrawals from retirement accounts
- Selling investments, property, or other assets
- Receiving a pension payout
- Continuing to work while enrolled in Medicare
- A temporary increase in taxable income
Example: How IRMAA Can Happen
Susan retired at age 66 and took a large withdrawal from her 401(k) to pay off her mortgage. Although her income went down after retirement, Medicare used the higher-income tax year to calculate her premiums.
As a result, Susan had to pay higher Medicare costs temporarily.
This is one reason it is important to understand how retirement income decisions may affect Medicare premiums.
Can IRMAA Be Reduced?
Yes. If your income has gone down because of certain life-changing events, you may be able to request a reduction in your IRMAA surcharge.
Qualifying life-changing events may include:
- Retirement
- Marriage
- Divorce
- Death of a spouse
- Loss of income-producing property
- Reduction in work hours
- Loss or reduction of pension income
To request a review, you can file an appeal with Social Security using Form SSA-44.
Is IRMAA Permanent?
No. IRMAA is not always permanent.
Medicare reviews your income each year. If your income decreases, your premiums may go back down in a future year.
Does IRMAA Affect Medicare Advantage Plans?
IRMAA does not directly increase your Medicare Advantage plan premium. However, it can still affect your overall Medicare costs.
That is because IRMAA applies to Medicare Part B and Part D costs, even if your Medicare Advantage plan includes prescription drug coverage.
Can You Avoid IRMAA?
In some cases, careful income planning may help reduce the chance of triggering IRMAA.
Examples may include planning retirement account withdrawals, managing taxable income, and understanding how major financial decisions may affect future Medicare premiums.
Because every situation is different, it may be helpful to speak with a licensed insurance agent, financial advisor, or tax professional.
2026 Medicare Part B Premiums Based on 2024 Income
The chart below shows the estimated Medicare Part B monthly premium amounts for 2026 based on 2024 income.
| Individual Tax Return | Joint Tax Return | Married & Separate Tax Return | You Pay Each Month in 2026 |
|---|---|---|---|
| $109,000 or less | $218,000 or less | $109,000 or less | $202.90 |
| Above $109,000 up to $137,000 | Above $218,000 up to $274,000 | Not applicable | $284.10 |
| Above $137,000 up to $171,000 | Above $274,000 up to $342,000 | Not applicable | $405.80 |
| Above $171,000 up to $205,000 | Above $342,000 up to $410,000 | Not applicable | $527.50 |
| Above $205,000 and less than $500,000 | Above $410,000 and less than $750,000 | Above $109,000 and less than $391,000 | $649.20 |
| $500,000 or above | $750,000 or above | $391,000 or above | $689.90 |
If you have questions about your Part B premium, you can call Social Security at 1-800-772-1213. TTY users can call 1-800-325-0778.
If you pay a late enrollment penalty, your monthly premium may be higher.
2026 Part B Deductible
The 2026 Medicare Part B deductible is $283. You pay this deductible once each year before Original Medicare begins to pay for covered Part B services.
Medicare Advantage Plans
Medicare Advantage plans, also known as Part C, are offered by private insurance companies approved by Medicare.
Plan premiums, benefits, networks, and out-of-pocket costs can vary by area. To review available Medicare Advantage plan options, speak with one of our licensed agents.
TTY users can also call Medicare at 1-877-486-2048.
2026 Medicare Part D IRMAA Amounts Based on 2024 Income
The chart below shows the estimated Medicare Part D income-related monthly adjustment amounts for 2026. If your income is above a certain limit, you may pay this amount in addition to your prescription drug plan premium.
| Individual Tax Return | Joint Tax Return | Married & Separate Tax Return | You Pay Each Month in 2026 |
|---|---|---|---|
| $109,000 or less | $218,000 or less | $109,000 or less | Your plan premium |
| Above $109,000 up to $137,000 | Above $218,000 up to $274,000 | Not applicable | $14.50 + your plan premium |
| Above $137,000 up to $171,000 | Above $274,000 up to $342,000 | Not applicable | $37.50 + your plan premium |
| Above $171,000 up to $205,000 | Above $342,000 up to $410,000 | Not applicable | $60.40 + your plan premium |
| Above $205,000 and less than $500,000 | Above $410,000 and less than $750,000 | Above $109,000 and less than $391,000 | $83.30 + your plan premium |
| $500,000 or above | $750,000 or above | $391,000 or above | $91.00 + your plan premium |
Final Thoughts
IRMAA can be confusing, especially if your income changed because of retirement, selling property, or taking money from retirement accounts. The good news is that IRMAA is reviewed each year, and you may be able to appeal if your income has gone down due to a qualifying life-changing event.
Understanding how income affects Medicare premiums can help you plan ahead, avoid surprises, and make more informed decisions about your Medicare coverage.
For help reviewing your Medicare options, speak with a licensed Medicare agent who can explain the plans available in your area.
