Medicare IRMAA Explained: 2026 Income Brackets, Surcharges, and How to Appeal

What is IRMAA and who has to pay it?

IRMAA stands for Income-Related Monthly Adjustment Amount. It is an extra amount added on top of the standard Medicare Part B and Part D premiums for people with higher incomes. It is not a separate plan or program — it is a surcharge built into what you already pay for Medicare.

IRMAA has applied to Part B since 2007 and to Part D since 2011. It affects only about 8% of people with Medicare. The large majority of beneficiaries earn below the first threshold and pay no IRMAA at all — just the standard premium.

If your income is below the first threshold, your IRMAA adjustment is $0.00 and you simply pay the 2026 standard Part B premium of $202.90 per month, plus whatever your Part D drug plan charges.

What income does Medicare look at, and from which year?

IRMAA is based on your Modified Adjusted Gross Income (MAGI), not just your salary. MAGI is your adjusted gross income from your tax return plus any tax-exempt interest income. It can include wages, Social Security benefits that are taxable, pensions, withdrawals from traditional IRAs and 401(k)s, capital gains, dividends, and interest.

Social Security looks at your tax return from two years before the premium year (the 'premium year minus 2' rule). For your 2026 premiums, SSA uses your 2024 tax return. If your 2024 return is not yet available, SSA will temporarily use your 2023 (three-years-prior) return instead.

This two-year lookback is why many people are surprised by an IRMAA bill: the income that triggers it may be from a year when you were still working or had a one-time gain, even if your income has since dropped.

2026 Part B IRMAA brackets and total premiums

The amounts below are based on your 2024 MAGI. The first figure in each bracket is the income range; the surcharge is the IRMAA amount added to the $202.90 standard premium; the last figure is your total monthly Part B premium.

• No IRMAA: MAGI $109,000 or less (single) / $218,000 or less (joint) — $0.00 surcharge — total $202.90/mo.
• Bracket 1: more than $109,000 up to $137,000 (single) / more than $218,000 up to $274,000 (joint) — +$81.20 — total $284.10/mo.
• Bracket 2: more than $137,000 up to $171,000 (single) / more than $274,000 up to $342,000 (joint) — +$202.90 — total $405.80/mo.
• Bracket 3: more than $171,000 up to $205,000 (single) / more than $342,000 up to $410,000 (joint) — +$324.60 — total $527.50/mo.
• Bracket 4: more than $205,000 and less than $500,000 (single) / more than $410,000 and less than $750,000 (joint) — +$446.30 — total $649.20/mo.
• Bracket 5 (top): $500,000 or more (single) / $750,000 or more (joint) — +$487.00 — total $689.90/mo, the highest 2026 Part B premium.

2026 Part D surcharges, and married-filing-separately rules

Part D IRMAA is added on top of whatever your individual drug plan charges, no matter which plan you pick. For context, the 2026 Part D national base beneficiary premium is $38.99 per month; your plan's own premium may be higher or lower than that. Importantly, the Part D IRMAA surcharge is paid to Medicare — usually deducted from your Social Security check or billed directly — not to your drug plan.

The 2026 Part D IRMAA surcharges follow the same income brackets as Part B:

• Bracket 1: +$14.50/mo
• Bracket 2: +$37.50/mo
• Bracket 3: +$60.40/mo
• Bracket 4: +$83.30/mo
• Bracket 5: +$91.00/mo
• Married filing separately (lived with spouse during the year), Part B: MAGI $109,000 or less = $0 ($202.90 total); more than $109,000 and less than $391,000 = +$446.30 ($649.20 total); $391,000 or more = +$487.00 ($689.90 total).
• Married filing separately (lived with spouse), Part D: $0 / +$83.30 / +$91.00 at the same $109,000 and $391,000 cutoffs.

The bracket cliff, and how IRMAA is recalculated each year

IRMAA brackets are a cliff, not a gradual phase-in. If you go over a threshold by even $1, you move into the next full bracket — and you pay that full surcharge for both Part B and Part D for the entire year. There is no partial or 'blended' rate within a bracket. This is why careful income planning near a threshold can matter a great deal.

IRMAA is not permanent. Social Security recalculates it every year using your most recent available tax return. If your income drops below a threshold, your IRMAA can go away the following year automatically when SSA reviews the newer return. If your income rises, you may move into a higher bracket.

Because of the two-year lookback, a one-time income spike can cause one year of IRMAA that then disappears once that high-income year falls out of the calculation.

How to lower or appeal your IRMAA

If a major life event has reduced your income, you can ask Social Security for a 'new initial determination' using a more recent tax year. SSA recognizes exactly eight qualifying life-changing events: (1) death of a spouse, (2) marriage, (3) divorce or annulment, (4) reduction in work, (5) work stoppage (such as retirement), (6) loss of income-producing property, (7) loss of an employer pension, and (8) receipt of a settlement payment from a current or former employer.

To request this reduction, file Form SSA-44 (Medicare IRMAA – Life-Changing Event). You report the income reduction — one that has already happened or is expected this year or next — and attach documentation of both the event and the income change. You can file it online or complete the PDF and fax or mail it to a Social Security office.

Be aware of what does NOT qualify. One-time income spikes such as capital gains from selling a home or other property, Roth IRA conversions, lottery or casino winnings, and cashing in bonds are non-qualifying events — you cannot use Form SSA-44 to undo IRMAA caused by them. Ordinary loss of dividend income, higher medical bills, loss of alimony or child support, and voluntarily selling income-producing property also do not qualify.

A 'new initial determination' is different from a formal appeal. If you simply disagree with SSA's decision — for example, the figure used was wrong, or you filed an amended or corrected tax return — you can file an appeal (a request for reconsideration). When SSA sets your IRMAA, it sends a notice explaining the decision and your appeal rights. The IRMAA appeals process is governed by federal regulations at 20 CFR 418.1301 through 418.1355.