IRMAA Explained: Higher Medicare Premiums for Higher Incomes

If your income is above a certain level, you pay more than the standard premium for Medicare Part B and for Medicare drug coverage. The extra charge is called the income-related monthly adjustment amount, or IRMAA. The Social Security Administration (SSA) decides who owes it, using tax information it gets from the IRS.

IRMAA surprises people because it is based on income from two years earlier, and because a single high-income year, such as the year you sell a property, can trigger it. CMS's 2026 fact sheet says these adjustments affect roughly 8% of people with Part B. Here is how it works for 2026, and how to ask for a new decision if your income has dropped.

This is an independent guide and general information, not tax, financial or legal advice, and it is not affiliated with Medicare, CMS or SSA. For your own numbers, talk with SSA, a licensed tax professional, or your State Health Insurance Assistance Program (SHIP).

What income counts, and from which year

SSA uses your modified adjusted gross income (MAGI). SSA's operations manual (POMS HI 01101.010) defines it as your adjusted gross income plus tax-exempt interest income, both taken from your federal Form 1040.

The year matters. SSA uses the most recent tax return the IRS provides, which is generally from two years before the premium year. SSA's premiums page says that 2026 adjustments generally use a tax return filed in 2025 for tax year 2024, and sometimes tax year 2023 if that is all the IRS has. If SSA used 2023 data and you filed a 2024 return or did not need to file one, SSA asks you to contact it so it can update its records.

The same two-year lookback means the income you report on this year's return can affect your premiums two years from now. If you are planning a large one-time income event, such as a property sale or an IRA conversion, it is worth discussing the timing with a tax professional who knows your situation.

If SSA decides you owe IRMAA, it sends you a letter showing your premium amounts and the reason for its decision.

The 2026 brackets

Most people with Part B pay a standard premium that covers about 25% of the program's cost, according to SSA, with the government paying the rest. SSA's 2026 tables show higher-income beneficiaries paying 35%, 50%, 65%, 80% or 85% of the cost, depending on their bracket.

For 2026, CMS's fact sheet lists these total monthly Part B premiums and Part D adjustments, by MAGI, for people who file individual or joint returns:

• Individual MAGI of $109,000 or less, or joint MAGI of $218,000 or less: 2026 Part B premium of $202.90 and no Part D adjustment, per CMS.
• Individual above $109,000 up to $137,000, or joint above $218,000 up to $274,000: 2026 Part B premium of $284.10 and a Part D adjustment of $14.50, per CMS.
• Individual above $137,000 up to $171,000, or joint above $274,000 up to $342,000: 2026 Part B premium of $405.80 and a Part D adjustment of $37.50, per CMS.
• Individual above $171,000 up to $205,000, or joint above $342,000 up to $410,000: 2026 Part B premium of $527.50 and a Part D adjustment of $60.40, per CMS.
• Individual above $205,000 and under $500,000, or joint above $410,000 and under $750,000: 2026 Part B premium of $649.20 and a Part D adjustment of $83.30, per CMS.
• Individual $500,000 or more, or joint $750,000 or more: 2026 Part B premium of $689.90 and a Part D adjustment of $91.00, per CMS.

Married people who lived with their spouse at any time during the year but filed separate returns have a shorter scale. For 2026, CMS lists a Part B premium of $649.20 for MAGI above $109,000 and below $391,000, and $689.90 at $391,000 or more, with Part D adjustments of $83.30 and $91.00.

Notice how the brackets work: they are steps, not a gradual phase-in. A MAGI just over a threshold puts you into the full amount for the next tier. The thresholds themselves have risen over time; SSA's manual shows the individual threshold at $103,000 for 2024, $106,000 for 2025 and $109,000 for 2026.

How the drug-coverage adjustment is paid

The Part D adjustment is added to your drug plan's premium. Per SSA, it is tied to the base beneficiary premium, not your own plan's premium, so the adjustment doesn't depend on which plan you pick.

SSA says it deducts the drug-coverage adjustment from your monthly Social Security payments regardless of how you usually pay your plan premium. If the amount is more than your monthly payment, or you don't get monthly payments, you get a separate bill from another federal agency, such as CMS or the Railroad Retirement Board.

If you have only Part B or only drug coverage, you pay an adjustment only on the coverage you have. If SSA says you owe a drug-coverage adjustment but you don't have Medicare drug coverage, SSA directs you to call 1-800-MEDICARE (1-800-633-4227) to correct it.

If your income has gone down: life-changing events

If your income dropped after one of certain events, you can ask SSA for a new decision based on a more recent year. SSA's operations manual (POMS HI 01120.005) lists eight qualifying life-changing events:

1. Death of a spouse.
2. Marriage.
3. Divorce or annulment.
4. Work reduction.
5. Work stoppage.
6. Loss of income-producing property because of a disaster or another event beyond your control.
7. Loss of an employer pension because of a scheduled end, termination or reorganization of the plan.
8. A settlement payment from a current or former employer because of its closure, bankruptcy or reorganization.

The list is exclusive. The same manual section says ordinary loss of dividend income, higher medical or living expenses, loss of child support or alimony, and the voluntary sale of income-producing property are not life-changing events. Neither is a one-time spike in income, such as capital gains from selling property, lottery winnings or an IRA conversion.

To report an event, you can use Form SSA-44 (Medicare Income-Related Monthly Adjustment Amount, Life-Changing Event). SSA asks for documentation of the event and of the lower income, such as a death certificate or a letter from your employer about your retirement, plus a signed copy of your tax return for the year in question if you filed one. If you haven't filed yet, you give an estimate.

Other ways to correct an IRMAA decision

• Amended return: if you amended a tax return in a way that changes your MAGI, SSA asks for a copy of the amended return and the IRS acknowledgment receipt.
• Wrong IRS data: if you disagree with the MAGI the IRS reported, SSA says you must correct it with the IRS.
• Appeal: if you disagree with SSA's decision itself, you can appeal online, in writing with a Request for Reconsideration (Form SSA-561-U2), or through your local Social Security office. SSA notes that you don't need to appeal if you're asking for a new decision because a life-changing event lowered your income.

Requests and appeals go to SSA directly; its toll-free number is 1-800-772-1213 (TTY 1-800-325-0778). Be wary of anyone who contacts you claiming to be from Social Security or Medicare and asks for payment by gift card, wire transfer, cryptocurrency or a payment app. The Federal Trade Commission says no government agency will demand payment that way.

Key takeaways

• IRMAA is an extra charge on Part B and Medicare drug coverage premiums for people whose MAGI is above set thresholds.
• For 2026, SSA generally uses 2024 tax returns; for 2026, CMS lists the first threshold at $109,000 for individual filers and $218,000 for joint filers.
• The brackets are steps: going just over a threshold moves you into the full next tier.
• Eight life-changing events, including retirement and a spouse's death, let you ask SSA to use more recent income via Form SSA-44.
• One-time income spikes such as capital gains or IRA conversions don't qualify, so plan large income events with a tax professional.

Sources

• Centers for Medicare & Medicaid Services, 2026 Medicare Parts A & B Premiums and Deductibles; 2026 Medicare Part D Income-Related Monthly Adjustment Amounts (November 14, 2025)
• Social Security Administration, Premiums: Rules for Higher-Income Beneficiaries
• Social Security Administration, POMS HI 01101.010: Modified Adjusted Gross Income (MAGI) (December 2, 2025)
• Social Security Administration, POMS HI 01120.005: Life Changing Events
• Federal Trade Commission, How To Avoid a Government Impersonation Scam