IRMAA — the Income-Related Monthly Adjustment Amount — is the surcharge that high earners pay on top of standard Medicare premiums. It catches a lot of people off guard, because the income that triggers it is from two years ago.
Here's the full 2026 bracket table, who's affected, and how to appeal it if you've had a recent income drop.
The 2-Year Lookback Rule
Your 2026 IRMAA is based on your 2024 tax return. Social Security pulls your most recent IRS data — typically two years old — to determine your modified adjusted gross income (MAGI) and assign your bracket.
This is why a one-time event in 2024 — selling a property, taking a large IRA withdrawal, exercising stock options — can spike your 2026 Medicare cost even if you're back to a normal income now.
2026 IRMAA Brackets — Part B
| 2024 MAGI (Individual) | 2024 MAGI (Joint) | 2026 Part B Premium |
|---|---|---|
| ≤ $109,000 | ≤ $218,000 | $202.90 |
| $109,001 – $137,000 | $218,001 – $274,000 | $284.10 |
| $137,001 – $171,000 | $274,001 – $342,000 | $405.80 |
| $171,001 – $205,000 | $342,001 – $410,000 | $527.50 |
| $205,001 – $499,999 | $410,001 – $749,999 | $649.20 |
| ≥ $500,000 | ≥ $750,000 | $689.90 |
2026 IRMAA Brackets — Part D
Part D IRMAA is a separate surcharge added directly to your premium and billed by Medicare (not the plan).
| 2024 MAGI (Individual) | 2024 MAGI (Joint) | Extra Part D / month |
|---|---|---|
| ≤ $109,000 | ≤ $218,000 | $0 |
| $109,001 – $137,000 | $218,001 – $274,000 | $14.50 |
| $137,001 – $171,000 | $274,001 – $342,000 | $37.50 |
| $171,001 – $205,000 | $342,001 – $410,000 | $60.40 |
| $205,001 – $499,999 | $410,001 – $749,999 | $83.30 |
| ≥ $500,000 | ≥ $750,000 | $91.00 |
What Counts as MAGI
For IRMAA purposes, MAGI = your adjusted gross income (AGI) plus tax-exempt interest. Common items that count:
- Wages, self-employment income, pension and Social Security income
- Traditional IRA and 401(k) distributions
- Capital gains from selling stocks, a business, or a second home
- Rental income and dividends
- Municipal bond interest (tax-exempt but still counted here)
The Cliff Problem
One dollar over a threshold = the full higher premium
Meet Theresa — A One-Time Sale Cost Her $4,800
Theresa sold her late mother's house in 2024. The capital gain pushed her MAGI to $215,000 — a one-year spike. Her 2026 Part B premium jumped to $527.50/mo and her Part D surcharge added another $60.40/mo.
That's nearly $4,800 in extra Medicare costs from a single non-recurring event. The good news: she qualified for an appeal because her income returned to normal in 2025.
How to Appeal IRMAA (Form SSA-44)
You can appeal IRMAA if you've had a "life-changing event" that significantly reduced your income. Qualifying events include:
- Marriage, divorce, or death of a spouse
- Work stoppage or reduction (most common — retirement)
- Loss of income-producing property (not through your own choice)
- Loss or reduction of pension income
- Employer settlement payment
- Download Form SSA-44 from ssa.gov.
- Document the life-changing event with proof (termination letter, divorce decree, death certificate).
- Provide an estimate of your reduced MAGI for the current tax year.
- Submit to your local Social Security office — by mail, fax, or in person.
A successful SSA-44 appeal can bring your premium back to the standard rate retroactively for the year.
Planning Moves That Help
- Spread Roth conversions across multiple years to stay just under a bracket.
- Use Qualified Charitable Distributions (QCDs) from your IRA — they satisfy RMDs without raising MAGI.
- Manage capital gains timing — bunching or spreading large sales matters.
- Coordinate spouse income — at 75 and beyond, RMDs alone can push couples into IRMAA.
Avoid an IRMAA surprise.
We work alongside your tax advisor to plan withdrawals, conversions, and large sales so your future Medicare premiums stay where they should.
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