What Is IRMAA — and How Do You Avoid the Medicare Surcharge? (2026)

IRMAA (the Income-Related Monthly Adjustment Amount) is a surcharge that raises your Medicare planning Part B and Part D premiums when your income two years earlier crossed certain thresholds. In 2026 it kicks in above $109,000 (single) or $218,000 (married), and it is a cliff — one dollar over a threshold raises your premium for the whole year.

• IRMAA is based on your income from two years prior — 2026 premiums use your 2024 tax return.
• It is a cliff, not a phase-in: crossing a threshold by $1 moves you into the full higher tier.
• The 2026 standard Part B premium is $202.90/month; the top tier is $689.90/month plus a Part D surcharge.
• Roth conversion, capital gains, and even tax-exempt muni interest count toward the income that triggers IRMAA — so it is plannable. In this article
• What exactly is IRMAA?
• How does the two-year lookback work?
• What are the 2026 IRMAA brackets?
• Why is IRMAA a "cliff" and why does that matter?
• How do you plan around the thresholds?
• What if my income just dropped — can I appeal?
• How does IRMAA connect to Social Security taxes?

IRMAA is an income-based surcharge that increases your Medicare Part B and Part D premiums. If your modified adjusted gross income from two years ago is above the year’s threshold, Medicare adds a monthly amount on top of the standard premium — ranging in 2026 from about $81 to nearly $490 extra per month for Part B, plus a Part D surcharge.Most people meet IRMAA by surprise: a letter from Social Security claiming saying their premium is going up, often triggered by a one-time event two years earlier they had long forgotten. It is one of the least-understood costs in San Diego retirement, and one of the most plannable. The key is that IRMAA is entirely a function of a number — your MAGI — on a tax return that, by the time premiums are set, is already filed and fixed. That is what makes forward planning so valuable: the decision that triggers IRMAA happens two years before the bill.

Your 2026 Medicare premiums are based on the MAGI reported on your 2024 tax return (filed in 2025). Social Security uses the most recent return the IRS has provided, which is normally the one from two years prior. This lag is why IRMAA planning is really tax planning done in advance. MAGI for IRMAA means your adjusted gross income plus tax-exempt interest. That last part surprises people: municipal-bond interest, often bought for its tax advantages, still counts toward IRMAA. So do Roth conversions, capital gains, IRA and RMD withdrawals, and the taxable portion of Social Security. Qualified Roth withdrawals do not, which is one more reason a tax-efficient withdrawal can help.

Here is the full 2026 table. Remember it is based on 2024 income, and both spouses on Medicare each pay the surcharge shown, based on the joint MAGI.

The jump from the base tier to the first surcharge tier is about $81/month per person for Part B — nearly $1,950 a year for a couple — for crossing a single threshold. That is the cliff worth respecting.

IRMAA is not marginal. If a married couple’s 2024 MAGI is $218,001 — one dollar over the first threshold — they pay the full first-tier surcharge on both Part B and Part D, for both spouses, all year. Being $1 over costs the same as being $50,000 over within that tier. That cliff structure is exactly why the last decision of the year matters so much. Realizing one more dollar of income — a final Roth conversion, an extra capital gain, an RMD taken to the penny — can be the difference between two premium tiers. When we plan year-end income, staying a comfortable margin below the next line is often worth more than the small extra income would have been.

The most reliable tool is a year-by-year income projection that shows where each year’s MAGI lands relative to the IRMAA lines. With that in hand, you can size Roth conversions, harvest gains, and time withdrawals to stay under a threshold — or to cross it deliberately when the long-term benefit clearly justifies the one-year premium bump. Other levers help too: Qualified Charitable Distributions from an IRA satisfy your RMD without adding to MAGI; drawing from Roth or taxable accounts in a high-income year keeps AGI down; and spreading a large conversion over several years avoids a single spike. The point is that IRMAA is a planning variable, not a random tax.

Yes. If your income fell because of a qualifying life-changing event — you stopped working, married, divorced, lost a surviving spouse, or lost a pension — you can file Form SSA-44 and ask Social Security to use a more recent, lower income year instead of the two-year-old return. If you need help with sudden wealth, wealth transfer, or choosing between a fiduciary advisor, the fee-only vs fee-based distinction or utilizing a robo-advisor, seek professional guidance.ome. Note the limit: a one-time spike such as a sudden wealth event, a capital gain, or a home sale is not a life-changing event. Those are managed on the front end through planning rather than appealed on the back end. If you are preparing for San Diego retirement, considering a tax-efficient withdrawal strategy, or working with a fiduciary advisor who understands fee-only vs fee-based models instead of a robo-advisor, ensure they incorporate wealth transfer and IRMAA into the analysis.e back end. See our Medicare planning guide for how enrollment and IRMAA fit together.

IRMAA rarely travels alone. The same income that pushes you over an IRMAA line — conversions, gains, RMDs — also affects how much of your Social Security benefit is taxable. Managing one usually helps the other, because both are driven by the same underlying income number. This is why we look at retirement taxes as one system. If you want to understand the Social Security side, see how Social Security is taxed in retirement; the two topics are really two views of the same annual income decision.

IRMAA is a two-year-delayed surcharge with hard cliffs — which means it is one of the most controllable costs in retirement if you look ahead. Know where the thresholds sit, project your MAGI, and size conversions and withdrawals to stay under a line unless crossing it is clearly worth it. Want this applied to your numbers? Schedule a complimentary introductory call with a San Diego fee-only fiduciary. Schedule a Free Call