IRMAA: How It Works, How to Avoid It, and How to Appeal

IRMAA, the Income-Related Monthly Adjustment Amount, is an extra charge on Medicare Part B and Part D premiums when your income is above set limits. For 2026 it starts above $109,000 for a single filer and $218,000 for a joint return, using your 2024 tax return. It is recalculated yearly, and you can ask Social Security to review it.

This guide explains how IRMAA is figured, the 2026 income brackets, planning steps that may lower it, and how to request a lower amount or appeal. It is educational information, not tax or legal advice. Medicare and tax rules change and the right move depends on your own return, so review specifics with your tax professional. Our shorter overview is The Hidden Tax: IRMAA.

What is IRMAA and how does it work?

IRMAA is a surcharge on top of your regular Medicare premiums, not a tax. Part B (medical insurance) has a standard monthly premium of $202.90 in 2026. If your income is above a threshold, you pay that premium plus an income-related amount. Part D (prescription drug coverage) works the same way: you pay your plan's premium plus an IRMAA. Sources: CMS 2026 premiums fact sheet and Medicare.gov costs, checked October 15, 2026.

Social Security generally withholds the Part D surcharge from your benefit payment, even if you pay your drug plan's premium directly to the plan. If your benefit is too small to cover it, CMS bills you. Source: SSA Program Operations Manual, HI 01101.001, checked October 15, 2026.

There is a two-year lookback. Social Security uses the income on your tax return from two years earlier. Premiums for 2026 are generally based on your 2024 return, and if the IRS cannot provide that return, Social Security may use the one from three years back. Income you report for 2026 would generally set your 2028 premiums. Source: SSA Program Operations Manual, HI 01101.010, checked October 15, 2026.

The income measure is MAGI. Modified adjusted gross income is your adjusted gross income (line 11 of Form 1040) plus any tax-exempt interest (line 2a). Items that flow into adjusted gross income include wages, pension income, traditional IRA and 401(k) withdrawals, the taxable part of Social Security benefits, interest, dividends, capital gains, and the taxable amount of a Roth conversion. These are common examples, not a complete list.

The tiers work like cliffs, not like tax brackets. Once your income is above a threshold, the full surcharge for that tier applies for the whole year. A single filer with 2024 income of $109,000 pays no surcharge in 2026. At $109,001, the Part B surcharge is $81.20 a month and the Part D surcharge is $14.50, a combined $95.70 a month, or $1,148.40 over a year.

This is a hypothetical example and is not representative of any specific investment. Your results may vary.

Who pays. The surcharge is set for each person enrolled in Medicare, using the income on your tax return. On a joint return, if both spouses are enrolled, each generally pays the surcharge. It is not permanent: it is recalculated each year from the return two years back, so it can fall when your income falls. Social Security mails an annual notice that shows the income range and the amounts it used.

What are the 2026 IRMAA brackets?

For 2026, the first IRMAA tier begins when 2024 MAGI is above $109,000 for a single filer or above $218,000 for a joint return, and there are five tiers above the standard premium. The table shows the amounts CMS released on November 14, 2025.

Part D surcharges are added to your drug plan's own premium, which varies by plan. If you are married, lived with your spouse at any time during the tax year, and filed separately, the tiers are different: above $109,000 and under $391,000 the surcharges are $446.30 for Part B and $83.30 for Part D, and at $391,000 or more they are $487.00 and $91.00. Source: CMS 2026 Medicare Parts A and B premiums and Part D income-related amounts, released November 14, 2025, checked October 15, 2026.

The dollar amounts and income limits change every year. As of October 15, 2026, CMS had not yet published 2027 premiums or income tiers, so check the CMS newsroom for them when they are released. Because the thresholds move, it is sensible to leave a cushion below a line instead of aiming at it exactly.

How can I avoid or reduce IRMAA?

Some steps may lower the MAGI that Social Security sees, though each has trade-offs and none fits everyone. Start by finding your number: look at line 11 plus line 2a on your last return, estimate this year's, and compare both with the table above. Because of the two-year lookback, income you control before December 31, 2026 may affect 2028 premiums, so earlier planning gives you more options.

• Spread out large one-time income. A business sale, a large IRA withdrawal, or a large capital gain can lift one year's MAGI into a higher tier. Where the timing is flexible, spreading income over more than one tax year may keep each year lower. The trade-off: delaying income is not always practical, and it may move income into years with higher tax rates.
• Size Roth conversions with the tiers in mind. The IRS says the taxable part of a conversion is included in gross income for the year of the conversion (IRS Publication 590-A, checked October 15, 2026). A large conversion can cross a threshold, and the surcharge arrives two years later. Smaller conversions over several years may stay below a line. The trade-offs: you pay income tax on the converted amount now, Roth withdrawal rules apply, and a conversion that lowers taxes later may still be worth one surcharge year.
• Consider qualified charitable distributions if you give to charity. For 2026, a person age 70½ or older can send up to $111,000 from an IRA directly to an eligible charity, and the amount is excluded from gross income instead of added to it. It can count toward a required minimum distribution. The trade-offs: the money goes to charity, you cannot also deduct that amount, and the rules have eligibility details. Sources: IRS Notice 2025-67 and IRS IRA distribution FAQs, checked October 15, 2026.
• Plan the sale of a home or other assets. The IRS says you may be able to exclude up to $250,000 of gain on the sale of your main home, or $500,000 on a joint return, if you meet the ownership and use tests (IRS Topic 701, checked October 15, 2026). Gain above the exclusion, and gain on other property, counts toward income. Spreading sales over more than one year, or offsetting gains with losses, may help, and each has its own tax rules. Selling only to manage IRMAA could cost more in tax than it saves.
• Know where your withdrawals come from. The IRS says qualified Roth IRA distributions are not included in gross income, while traditional IRA distributions generally are (IRS Publication 590-B, checked October 15, 2026). Having money in more than one type of account may give you room to meet spending needs in a year when income needs to stay lower. The trade-off: that mix is built over many years, and drawing from a Roth account leaves less in it to grow.
• Remember that tax-exempt interest still counts. Social Security adds tax-exempt interest back to adjusted gross income to reach MAGI, so shifting income into tax-exempt interest does not lower the number used for IRMAA.
• Before Medicare starts, look at health savings account contributions. If you are covered by an eligible plan, contributions other than an employer's are generally deductible, which lowers adjusted gross income. The IRS says your contribution limit is zero beginning with the first month you are enrolled in Medicare, including months of retroactive coverage. Source: IRS Publication 969, checked October 15, 2026. The trade-offs: you need an eligible health plan, and contributions made after Medicare begins can be excess contributions.

Avoiding IRMAA is not always the right goal. The surcharge is one cost among several, alongside income tax, the taxation of Social Security benefits, and your spending needs. A move that triggers a surcharge for a year or two may still be reasonable if it lowers lifetime taxes, and a move that avoids it may cost more elsewhere. A retirement tax plan looks at these together, and the order you draw from accounts is part of a retirement income plan.

How do I appeal IRMAA or ask for a lower amount?

There are two routes. If your income has dropped because of a life-changing event, you ask Social Security for a new decision, using Form SSA-44. If you believe Social Security used wrong information, or you disagree with its decision, you file an appeal, called a request for reconsideration. An appeal generally has to be filed within 60 days of receiving the notice. Social Security makes the decision in each case, and no one can promise an outcome.

Which life-changing events qualify?

Social Security may make a new decision about your surcharge if your income went down because of one of these events. You do not need to file an appeal for this route.

• You married or divorced, or your spouse died
• You or your spouse stopped working or reduced your work hours
• You or your spouse lost income-producing property because of a disaster or other event beyond your control
• You or your spouse experienced a scheduled cessation, termination, or reorganization of an employer's pension plan
• You or your spouse received a settlement from an employer or former employer because of the employer's closure, bankruptcy, or reorganization

A one-time Roth conversion, stock sale, or capital gain does not appear on this list, so this route may not be available for them. Source: SSA, Medicare premiums and your income, checked October 15, 2026.

Steps to request a lower amount

1. Read the notice. It shows the tax year, the income range, and the surcharge Social Security used. Check the filing status and the income figures first.
2. Pick the route. Income dropped because of a listed event: ask for a new decision. Facts or tax data are wrong, or you disagree with the decision: appeal.
3. Gather proof. For a life-changing event, Social Security asks for documents that verify the event and the drop in income, such as a death certificate or a letter from your employer about your retirement. If you filed a federal return for the year in question, you also need a signed copy of it. For incorrect IRS data, an amended return with the IRS's acceptance letter or an IRS transcript is acceptable proof.
4. File the request. For a life-changing event, sign in to your Social Security account and upload Form SSA-44, or fax or mail it with your evidence to a Social Security office, or call 1-800-772-1213. If you filed an amended return, call and say you want to lower your IRMAA. For an appeal, file online or complete a Request for Reconsideration (Form SSA-561-U2).
5. Mind the deadlines. Social Security presumes you received a notice 5 days after its date, and the 60 days start the next day. If you miss the window, you may ask for more time in writing and explain why. For an event in the last three months of a calendar year, Social Security says it needs the request for a new decision by March 31 of the following year.
6. Follow up. If Social Security lowers the amount and you are owed money, its notice says a refund should arrive within 30 days. If it has not, call 1-800-772-1213.

If you disagree with the income the IRS reported, the correction has to be made with the IRS, and then you show Social Security the proof. If the Part D surcharge is wrong because you have no drug coverage, call CMS at 1-800-MEDICARE, because CMS supplies that information. Sources: SSA Medicare Annual Verification Notices FAQ, SSA, Request to lower an IRMAA, and SSA, Your Right to Question the Decision, checked October 15, 2026.

When should I plan for IRMAA, and what else should I weigh?

A sensible time to start is about two years before Medicare begins, because the income on those returns can set your first premiums. If you retire before 65, the lower-income years may create room to plan conversions or withdrawals, and the health coverage you choose in those years is part of the same picture. See our guide to financial planning for early retirement. Once you are on Medicare, review your income each fall, since a year with an unusual event can show up in premiums two years later.

IRMAA is separate from the Part B late-enrollment penalty, and both can apply to the same person. Our article on the Medicare enrollment deadline explains that penalty. Your Social Security claiming age also matters, because benefits that become taxable raise adjusted gross income. The whole picture lives in your retirement plan, and the cost of building one is on our pricing page.

What questions should I ask any advisor or tax professional about IRMAA?

Bring these to any advisor or tax preparer you work with, including us.

1. Which IRMAA tier did my last tax return put me in, and how close am I to the next threshold?
2. What do you expect my MAGI to be this year and next, and which premiums would that set two years from now?
3. Which of my planned moves, such as Roth conversions, withdrawals, asset sales, or charitable gifts, would raise or lower MAGI?
4. What would a surcharge cost me in dollars each year, compared with what the move could save in taxes?
5. Do I have a life-changing event that qualifies for Form SSA-44, and what documents would I need?
6. If my notice looks wrong, what should we check before the 60-day deadline?
7. Who prepares my tax return, and how will that person and my advisor coordinate on timing?
8. How do you get paid, and would any of your recommendations earn you a commission? Our guide to what retirement planners cost explains the questions to ask.

Maryland Financial Advocates and LPL Financial do not provide legal advice or tax services. Please consult your legal advisor or tax advisor regarding your specific situation.

Traditional IRA account owners have considerations to make before performing a Roth IRA conversion. These primarily include income tax consequences on the converted amount in the year of conversion, withdrawal limitations from a Roth IRA, and income limitations for future contributions to a Roth IRA. In addition, if you are required to take a required minimum distribution (RMD) in the year you convert, you must do so before converting to a Roth IRA.

This material is for general information and educational purposes only and is not intended to provide specific advice or recommendations for any individual. Investing involves risk including the loss of principal.