This week: IRMAA is the income surcharge that quietly raises Medicare premiums for higher earners. Here’s what it is, who it hits, how it’s figured from income two years back, the 2026 brackets, and how clients can appeal it.
Medicare isn’t one flat price. For higher-income beneficiaries, the Income-Related Monthly Adjustment Amount (IRMAA) adds a surcharge on top of the standard Part B and Part D premiums. It affects roughly 8% of people on Medicare, and it catches a lot of them by surprise.
What IRMAA is, and who pays it
IRMAA is an extra amount added to both your Part B and Part D premiums when your income is above a set threshold. The standard 2026 Part B premium is $202.90 a month. With IRMAA, higher earners pay anywhere from $284.10 up to $689.90 a month for Part B, plus an extra $14.50 to $91.00 a month on top of their Part D drug plan premium.
It’s based on your income from two years ago
Here’s the part that trips people up: your 2026 IRMAA is based on the Modified Adjusted Gross Income (MAGI) from your 2024 tax return, filed in 2025. Medicare always looks back two years. So a client who had high income in 2024, even from a one-time event like selling a property or doing a large Roth conversion, can get hit with higher premiums in 2026.
It’s a cliff, not a slope
IRMAA works in tiers, and crossing a threshold by even $1 bumps you into the next tier’s full surcharge. One extra dollar of income can raise premiums by over $1,000 a year, and for a married couple both on Medicare, it hits each of them.
The 2026 IRMAA brackets
Based on 2024 MAGI. The Part D amount is added to whatever your drug plan charges.
| Single MAGI (2024) | Joint MAGI (2024) | Part B total/mo | Part D add-on/mo |
|---|---|---|---|
| $109,000 or less | $218,000 or less | $202.90 | $0.00 (plan only) |
| $109,001–$137,000 | $218,001–$274,000 | $284.10 | +$14.50 |
| $137,001–$171,000 | $274,001–$342,000 | $405.80 | +$37.50 |
| $171,001–$205,000 | $342,001–$410,000 | $527.50 | +$60.40 |
| $205,001–under $500,000 | $410,001–under $750,000 | $649.20 | +$83.30 |
| $500,000 or more | $750,000 or more | $689.90 | +$91.00 |
Married filing separately (and lived with your spouse at any point in the year): $109,000 or less pays the standard amount; above $109,000 and under $391,000 pays $649.20 for Part B plus $83.30 for Part D; $391,000 or more pays $689.90 plus $91.00. Source: CMS 2026 Medicare Parts A & B Premiums fact sheet.
There’s an appeal process
If a client’s income has dropped because of a life-changing event, retirement or reduced work hours, marriage, divorce, death of a spouse, or loss of a pension or income-producing property, they don’t have to just accept an IRMAA based on two-year-old income. They can file Form SSA-44 with the Social Security Administration to ask that the surcharge be recalculated using their current, lower income.
Why it matters to you
IRMAA is one of the most common Medicare surprises, and a great place to add value. Flag it for higher-income clients approaching 65, and especially for the newly retired: their 2024 income may have been high, but a quick SSA-44 can undo an unfair surcharge. It’s also a reason to coordinate with clients’ tax advisors before big income events, like Roth conversions or capital gains, in the years right before and during Medicare.
Key takeaways
- IRMAA is an income surcharge on Part B and Part D premiums, affecting about 8% of beneficiaries.
- 2026 IRMAA is based on 2024 MAGI, a two-year look-back.
- It’s a cliff: $1 over a threshold triggers the full next-tier surcharge.
- A life-changing event can be appealed with Form SSA-44.
Check yourself
A client retired in late 2025 and has little income now, but had $200,000 of MAGI in 2024 from selling a business. Why is their 2026 Medicare premium high, and what can they do?
2026 IRMAA uses 2024 income, so the one-time 2024 spike pushed them into a higher tier. Because retirement is a qualifying life-changing event, they can file Form SSA-44 to have IRMAA recalculated on their current, lower income.