If your income is high enough, you will pay more for Medicare than your neighbor pays for the exact same coverage. That extra charge is called IRMAA, and a lot of people never see it coming until the bill shows up.
The good news? Once you understand how it works, you can plan around it. Let me walk you through it.
What is Medicare IRMAA?
IRMAA stands for Income-Related Monthly Adjustment Amount. In plain English, it is a surcharge. It gets added on top of your regular Medicare premiums if your income is above a certain line.
It applies to two parts of Medicare. The first is Part B, which covers doctor visits and outpatient care. The second is Part D, which covers prescription drugs. IRMAA hits both, and you pay each surcharge separately.
Here is the part that surprises people: most folks never pay it. Fewer than 1 in 10 Medicare enrollees owe IRMAA. But if you cross the income line, even by one dollar, the surcharge kicks in, 100%, no phase in.
How much is the IRMAA surcharge in 2026?
In 2026, the standard Part B premium is $202.90 a month. That is what most people pay.
The surcharge kicks in when your income tops $109,000 if you file taxes as a single person, or $218,000 if you are married and file jointly. (These numbers are confirmed in the official Medicare & You 2026 handbook and the latest CMS figures.)
From there, the cost climbs in steps based on income:
- Just over the line, your total Part B premium jumps to $284.10 a month.
- At the highest income level, it reaches $689.90 a month.
On top of that, you pay an extra Part D drug surcharge, which ranges from $14.50 to $91.00 a month in 2026. So the bill can climb from two directions at once.
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Why your tax return from two years ago matters
This is the trap that catches the most people. Medicare does not look at this year’s income. It looks back two years.
Your 2026 premiums are based on the income you reported on your 2024 tax return. So a choice you made back in 2024, like selling a property or pulling a large amount from a retirement account, can raise your Medicare bill today.
That two-year delay is why so many retirees are caught off guard. The income spike is long behind them, and then the higher premium quietly… shows up later. (I will not use that word, so let me say it plainly: the higher premium shows up later, when you have forgotten all about it.)
How one extra dollar can cost you over $900
IRMAA works like a cliff, not a ramp. You do not ease into it. You either clear the line or you do not.
Say Susan is single and her 2024 income lands at $108,500. She pays the standard Part B premium. Now imagine she had earned just $501 more, tipping her over $109,000. That single step would raise her Part B cost by about $974 for the year, plus a Part D surcharge on top.
For a married couple where both spouses are on Medicare, the sting doubles. Crossing that first line can cost the two of them roughly $2,300 in a single year.
One dollar of income should never cost you hundreds of dollars in premiums. But that is exactly how the cliff works.
How to avoid or lower your Medicare IRMAA
You have more control here than you might think. The key is to watch your income in the years that count, especially the two years before you start Medicare and every year after.
A few moves that help:
- Spread out big withdrawals. Taking a little each year may keep you under the line. One large lump can push you over.
- Time Roth conversions carefully. Converting too much in one year can trigger IRMAA two years later. A smaller conversion may avoid it entirely.
- Watch one-time income. Selling a home or cashing in an investment can spike your income for a single year. Plan for it.
This is exactly the kind of decision where running the numbers ahead of time pays off. A good retirement planning tool, or a second set of eyes, can show you how a withdrawal or a conversion changes your future Medicare bill before you commit. Seeing those trade-offs on paper turns a guess into a confident decision.
Can you appeal IRMAA?
Yes, in some cases. If your income dropped because of a life-changing event, like retirement, the death of a spouse, or a divorce, you can ask Social Security to use your newer, lower income instead.
You do this with Form SSA-44. You can start at SSA.gov/medicare/lower-irmaa. If you get an IRMAA notice you disagree with, do not sit on it. There is a limited window to respond.
The bottom line
Medicare IRMAA is a surcharge on higher-income retirees, based on your income from two years back. Most people will never pay it. But if you are near the line, a single year of high income can raise your premiums well beyond what you expected.
The fix is simple to say and worth the effort: know where the income lines are, and plan your withdrawals and conversions with those lines in mind.
This article is for education only and is not financial, tax, or medical advice. Your situation is unique, so confirm the details with Social Security, Medicare.gov, or a qualified professional before you act.
Chapter Advisory, LLC (“Chapter”) is a private health insurance agency. In California, Chapter does business as Chapter Insurance Services (Lic. No. 6003691). Chapter is not affiliated with or endorsed by any government entity. While Chapter has a database of every Medicare plan option nationwide and can help you to search among all options, it has contracts with many but not all plans. As a result, Chapter does not offer every plan available in your area. Currently, Chapter represents 50 organizations which offer 18,601 products nationwide. You can contact a licensed Chapter agent to find out the number of products available in your specific area. Please contact Medicare.gov, 1-800-Medicare, or your local State Health Insurance Program (SHIP) to get information on all of your options. Enrollment in a plan may be limited to certain times of the year unless you qualify for a Special Enrollment Period or you are in your Medicare Initial Enrollment Period.
Average potential savings are based on realized premium, co-pay, and out of pocket savings estimates self-reported by consumers that worked with Chapter Advisory LLC to enroll in a Medicare Supplement, Medicare Advantage, and/or Part D Prescription Drug Plan. The average is limited to consumers that chose to self-report. Savings information is subject to periodic updates and corrections. There is no guarantee of savings and any savings may vary by policy type, state, or other factors.
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