How do I know if I have to pay the Medicare IRMAA?

When you enroll in Medicare, you’re initially charged standard premiums until Social Security receives your income data from the IRS (via your federal tax return). If your income does in fact reach the IRMAA threshold, Social Security will automatically mail you a predetermination notice detailing how this determination was made and how to proceed if the information is incorrect or your situation has changed (see the aforementioned information regarding IRMMA appeals). The Social Security Administration also updates your IRMAA determination each year automatically based on your federal tax return.

How do I pay for IRMAA surcharges?

If you’re already receiving benefits from Social Security (and/or Railroad Retirement Board benefits) and Medicare Part B and D premiums are deducted from your benefit check, your IRMAA is deducted automatically in the same manner. If your Social Security check isn’t large enough to cover IRMAA or Medicare premiums aren’t automatically deducted from your benefit check, however, you’ll receive a bill for Part B and Part D IRMAAs.

If I choose a Medicare Advantage plan, is IRMAA still applicable?

Surcharges apply regardless of how you receive Medicare coverage, meaning those who enroll in a Medicare Advantage plan are still subject to Medicare Part B premiums plus any IRMAA surcharges.

Do IRMAA surcharges last forever?

Fortunately, Medicare premiums are recalculated on an annual basis; so if your income drops, your IRMAA status likely will as well.

Do capital gains count toward IRMAA?

Yes, capital gains count towards IRMAA since they are included in your modified adjusted gross income (MAGI) calculation.

Are IRMAA surcharges tax deductible?

If you itemize deductions, any medical and dental expenses—including IRMAA surcharges—for you, your spouse, or your dependents that go over 7.5% of your adjusted gross income (AGI) can be written off.

IRMAA: How to Avoid Medicare Surcharges

If you’ve never heard of IRMAA or don’t know anything about Medicare surcharges and how they work, don’t worry—you’re not alone! This post is here to help, not only explaining such things but also offering tips on how to avoid these surcharges.

Key Takeaways

IRMAA—the income-related monthly adjustment amount—is an extra charge added to Medicare Part B and Part D premiums when income eclipses a specific threshold.
IRMAA catches retirees off guard since it's based on tax returns from two years prior (e.g., your 2026 income determines your 2028 surcharge).
IRMAA can resurface later on in retirement since required minimum distributions (RMDs) and even capital gains count toward the modified adjusted gross income (MAGI) used to calculate it.
You can minimize or avoid IRMAA altogether by maximizing pre-tax contributions, performing Roth conversions, using qualified charitable distributions (QCDs), and delaying Social Security.
If a major life change (e.g., retirement, divorce, or the death of a spouse) lowers your income, you can appeal using Form SSA-44.

What is IRMAA?

IRMAA stands for "income-related monthly adjustment amount,” basically an extra charge you might see added to your monthly Medicare Part B and Part D premiums if your income is above a certain level (more on income thresholds shortly). In other words, if you earn more, Medicare asks you to pay a bit more for coverage.

How Medicare IRMAA is calculated

Each year, the Centers for Medicare & Medicaid Services (CMS) calculates the latest IRMAA amounts and publishes them in the Federal Register. The Social Security Administration (SSA) then uses your tax information to decide if you’ll pay more than the standard Medicare Part B or Part D premium. Just to be clear, your Medicare benefits stay exactly the same in this case—even if you end up paying extra due to an IRMAA surcharge.

Why IRMAA surprises many retirees

Here’s why IRMAA catches many people off guard: it’s based on your tax returns from two years prior. So, your 2026 income will determine if you pay an IRMAA surcharge in 2028, your 2027 income affects your IRMAA in 2029, and so on. If you recently retired and your income dropped, you might be surprised to see a higher Medicare premium than expected. That two-year lag is something many new enrollees don’t see coming.

IRMAA can also pop up again later in retirement, especially when you start taking required minimum distributions (RMDs) from your retirement accounts. Since it’s recalculated every year based on your previous two years of income, any increase—like those related to RMDs—can push you over the threshold.

2026 IRMAA brackets

Wondering how much extra you might pay for Medicare in 2026 due to IRMAA? If your modified adjusted gross income (MAGI) is above $218,000 for married couples filing jointly or $109,000 for individuals, you’ll be hit with an IRMAA surcharge—Social Security sending you an official letter explaining exactly how much your Medicare Part B and Part D premiums will increase. Let’s break down what this means for your budget:

2026 IRMAA Brackets

MAGI (Single)	MAGI (Married Filing Jointly)	Total Monthly Part B Premium	Part B IRMAA Surcharge	Part D IRMAA Surcharge
$0 – $109,000	$0 – $218,000	$202.90	$0.00	$0.00
$109,001 – $137,000	$218,001 – $274,000	$284.10	$81.20	$14.50
$137,001 – $171,000	$274,001 – $342,000	$405.80	$202.90	$37.50
$171,001 – $205,000	$342,001 – $410,000	$527.50	$324.60	$60.40
$205,001 – $499,999	$410,001 – $749,999	$649.20	$446.30	$83.30
$500,000+	$750,000+	$689.90	$487.00	$91.00

MAGI = Modified Adjusted Gross Income from 2 years prior (your 2024 income determines your 2026 IRMAA). Source: Centers for Medicare and Medicaid Services.

As you can see, IRMAA can easily add hundreds of dollars to your monthly Medicare bill if your income is above the threshold. Planning ahead for these extra costs is key to avoiding surprises when it comes time to pay your Medicare premiums.

How to avoid IRMAA surcharges

4 Strategies to Avoid IRMAA Surcharges

Each works by reducing the MAGI that determines your Medicare premiums.

Strategy 1

Maximize pre-tax contributions

Contributions to a 401(k), Traditional IRA, SEP IRA, or HSA reduce your taxable income today — and your MAGI two years from now.

Strategy 2

Roth IRA conversions

Convert pre-tax dollars to Roth before age 73 to shrink future RMDs. Qualified Roth withdrawals don’t count toward MAGI.

Strategy 3

Qualified Charitable Distributions

Age 70½+? Send up to $100K/year directly from your IRA to charity — satisfies RMDs without adding a dollar to MAGI.

Strategy 4

Delay Social Security

Holding off on benefits keeps Social Security income out of your MAGI calculation — and grows your future benefit at the same time.

Worried about getting hit with those extra IRMAA fees? Don’t stress! The great news is you can take practical steps to lower or even avoid these Medicare surcharges altogether by:

Maximizing your pre-tax contributions

If you have a 401(k), traditional or SEP IRA, or even a health savings account (HSA), putting more money into these accounts can reduce your taxable income and lower your modified adjusted gross income (MAGI). Maximizing your pre-tax contributions can thus help you steer clear of those extra IRMAA surcharges on your Medicare Part B and Part D premiums.

Performing Roth IRA conversions

Roth IRA conversions—the process of moving money from a traditional IRA, SEP, or SIMPLE IRA into a Roth IRA—is a powerful strategy to help avoid Medicare surcharges, shrinking your future IRA balances and reducing your required minimum distributions (RMDs) to have less taxable income down the road. Qualified withdrawals from a Roth IRA are tax-free, so they won’t cause the sudden income spike that triggers IRMAA. Just remember that you’ll owe taxes at the time of conversion, so it’s wise to talk to a tax advisor to make sure this move fits your financial plan before taking action.

Making qualified charitable distributions

Another tip is to use qualified charitable distributions (QCDs), sending money directly from your IRA to a qualified charity to lower your taxable income and avoid higher Medicare premiums due to IRMAA.

Delaying Social Security benefits

Thinking about when to start claiming your Social Security benefits? If you hold off, you’ll not only secure a bigger monthly check for life, but you might also dodge IRMAA surcharges for a while. That’s because Social Security income counts toward your modified adjusted gross income (MAGI), delaying it helping to possibly keep this number lower and in turn save you money on Medicare Part B and Part D premiums.

How to appeal IRMAA surcharges

Qualifying life events

7 reasons you can appeal IRMAA

If a major life event has lowered your income since the tax return Medicare used to set your IRMAA, you may qualify for a reduction.

Death of a spouse
Marriage
Divorce or annulment
Reduction or cessation of work hours
Loss or reduction of pension income
Loss of income-producing property
Employer settlement payment

How to file

Complete Form SSA-44 on the Social Security website, call 800-772-1213, or visit your local SSA office. Wait until you receive your official Medicare notice before filing — appeals take up to 90 days to process.

If you’ve been hit with an IRMAA surcharge on your Medicare premiums, don’t worry—you might have a chance to appeal. In fact, you could qualify for IRMAA reconsideration and potentially lower your Medicare costs if you’ve experienced a major life change. Here are some of the most common reasons Social Security will grant an IRMAA appeal:

· The death of a spouse

· Marriage

· A divorce or annulment

· A reduction (or complete cessation) of hours worked

· A reduction in or loss of pension income (due to a default, scheduled cessation, etc.)

· The loss of income-producing property beyond beneficiary control (such as a disaster, theft, or similar circumstances)

· An employer settlement payment wherein you or your spouse receives a settlement from an employer (or former employer) due to said employer’s bankruptcy or reorganization

The easiest way to initiate your IRMAA appeal is to fill out Form SSA-44 on the Social Security website. You can also call 800-772-1213 or contact your local Social Security office in person; just know it can take up to 90 days for Social Security to process an appeal. Make sure you wait until you receive your official Medicare notice showing IRMAA charges on your Part B and Part D premiums before filing.

Medicare surcharges: final thoughts

Understanding healthcare costs is critical for successful retirement planning. While jumping into a higher tax bracket is a good problem to have, doing so can unfortunately trigger these Medicare surcharges and thus require you to pay hundreds of extra dollars a month. Fortunately, the various strategies we just outlined can minimize (or even avoid!) these fees.

Still have questions about Medicare surcharges? Schedule a FREE discovery call with one of our CFP® professionals to get them answered.

Reviewed for accuracy

Paul Muller, AEP®, CFP®

Founder and Relationship Manager at Vision Retirement, with 25+ years in the financial industry.

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FAQs

When you enroll in Medicare, you’re initially charged standard premiums until Social Security receives your income data from the IRS (via your federal tax return). If your income does in fact reach the IRMAA threshold, Social Security will automatically mail you a predetermination notice detailing how this determination was made and how to proceed if the information is incorrect or your situation has changed (see the aforementioned information regarding IRMMA appeals). The Social Security Administration also updates your IRMAA determination each year automatically based on your federal tax return.
If you’re already receiving benefits from Social Security (and/or Railroad Retirement Board benefits) and Medicare Part B and D premiums are deducted from your benefit check, your IRMAA is deducted automatically in the same manner.
If your Social Security check isn’t large enough to cover IRMAA or Medicare premiums aren’t automatically deducted from your benefit check, however, you’ll receive a bill for Part B and Part D IRMAAs.
Surcharges apply regardless of how you receive Medicare coverage, meaning those who enroll in a Medicare Advantage plan are still subject to Medicare Part B premiums plus any IRMAA surcharges.
Fortunately, Medicare premiums are recalculated on an annual basis; so if your income drops, your IRMAA status likely will as well.
Yes, capital gains count towards IRMAA since they are included in your modified adjusted gross income (MAGI) calculation.
If you itemize deductions, any medical and dental expenses—including IRMAA surcharges—for you, your spouse, or your dependents that go over 7.5% of your adjusted gross income (AGI) can be written off.