For most people, the Medicare Part B premium in 2026 is $202.90 a month. But if your income is above a certain line, Medicare adds a surcharge on top — and it applies to both Part B and your drug coverage. That surcharge is called IRMAA, and it surprises a lot of new beneficiaries.
What IRMAA actually is
IRMAA — the Income-Related Monthly Adjustment Amount — is an extra charge layered onto your Medicare premiums when your income is high enough. It’s not a separate bill; it’s added to the Part B premium that comes out of your Social Security check, and to the Part D premium you pay your drug plan.
Two things make IRMAA trip people up:
- It’s a cliff, not a ramp. Go one dollar over a bracket and you pay the full surcharge for that bracket — there’s no gradual phase-in.
- It looks back two years. Your 2026 IRMAA is based on your 2024 income, because that’s the most recent tax return the IRS has shared with Social Security.
The 2026 IRMAA brackets
IRMAA is based on your modified adjusted gross income (MAGI) — your adjusted gross income (line 11 of Form 1040) plus any tax-exempt interest. Here’s the full 2026 schedule for both Part B and Part D:
| MAGI — single (2024) | MAGI — joint (2024) | Part B premium | Part D surcharge |
|---|---|---|---|
| $109,000 or less | $218,000 or less | $202.90 | +$0.00 |
| $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 – $500,000 | $410,001 – $750,000 | $649.20 | +$83.30 |
| Above $500,000 | Above $750,000 | $689.90 | +$91.00 |
The Part D surcharge is added to whatever your drug plan’s monthly premium already is — even if you’re enrolled in a $0-premium Medicare Advantage plan that includes drug coverage. Both surcharges are charged per person, so a married couple who both cross the threshold each pay their own IRMAA.
You can see exactly where you land — and what it costs for the year — with the IRMAA Calculator.
The two-year lookback, and why it matters
Because IRMAA uses your tax return from two years ago, a single big year can follow you. Common triggers:
- Selling a home or other property with a large capital gain
- A Roth conversion
- Taking a large IRA or 401(k) distribution
- The final working year before retirement, when income is still high
The catch: the surcharge hits after you’ve retired and your income has often already dropped. That mismatch is the single most common IRMAA complaint I hear.
How to appeal IRMAA
If your income fell because of a life-changing event, you don’t have to just accept the bill. Social Security recognizes events including:
- Marriage, divorce, or the death of a spouse
- You or your spouse stopping work or reducing hours (retirement counts)
- Loss of an income-producing property or a pension
To request a reduction, file Form SSA-44 (“Medicare Income-Related Monthly Adjustment Amount – Life-Changing Event”) with documentation of the change. If approved, Social Security uses a more recent year’s income instead of the two-year-old return.
Planning around the brackets
Because IRMAA is a cliff, staying just under a threshold can be worth real money. A few strategies worth discussing with a tax advisor:
- Spread out withdrawals so no single year spikes your MAGI over a line.
- Time Roth conversions in lower-income years, before you start Medicare if possible.
- Watch tax-exempt interest — it counts toward MAGI even though it’s not taxable.
IRMAA is one of those Medicare details that’s invisible until it shows up on your statement. If you’re near a bracket — or you just got an IRMAA notice you weren’t expecting — run your numbers in the IRMAA Calculator first, then let’s talk through whether an appeal makes sense for your situation.