Question 1

What is Medicare IRMAA and who has to pay it?

Accepted Answer

IRMAA (Income-Related Monthly Adjustment Amount) is a surcharge added to Medicare Part B and Part D premiums for higher-income beneficiaries. In 2025, IRMAA kicks in for individuals with Modified Adjusted Gross Income above $106,000 and married couples filing jointly above $212,000. About 7% of Medicare beneficiaries pay IRMAA surcharges.

Question 2

How does the Medicare IRMAA 2-year lookback work?

Accepted Answer

Medicare uses your tax return from two years prior to determine your IRMAA bracket. For 2025 premiums, your 2023 MAGI is used. For 2026, it's your 2024 MAGI. This means a financial event like a large Roth conversion or capital gain won't affect your Medicare premiums until two years later. Planning conversions and asset sales with this delay in mind is essential.

Question 3

How can I reduce or avoid IRMAA surcharges?

Accepted Answer

Strategies include timing Roth conversions to stay below IRMAA thresholds, spreading capital gains across multiple years, using Qualified Charitable Distributions (QCDs) from IRAs instead of standard withdrawals, and filing Form SSA-44 to request a lower bracket if you've had a qualifying life-changing event like retirement or loss of a spouse.

Question 4

What are the current IRMAA income brackets?

Accepted Answer

IRMAA has five surcharge tiers above the standard premium. For 2025, the first tier starts at $106,000 for Single filers and $212,000 for Married Filing Jointly, with the highest tier at $500,000/$750,000. Unlike tax brackets, IRMAA tiers are cliff-based — exceeding a threshold by even one dollar puts you in the higher surcharge tier for the entire year.

Question 5

Does a Roth conversion affect my Medicare premiums?

Accepted Answer

Yes. Roth conversion amounts are included in your Modified Adjusted Gross Income (MAGI), which is the figure Medicare uses to determine IRMAA. A large conversion can push you into a higher premium tier two years later due to the lookback rule. Use this calculator to find how much conversion room you have before crossing the next IRMAA bracket.

Income Range	Part B	Part B IRMAA	Part D IRMAA
$0 – $218,000← You	$202.90	$0.00	$0.00
$218,000 – $274,000	$284.10	+$81.20	+$14.50
$274,000 – $342,000	$405.80	+$202.90	+$37.50
$342,000 – $410,000	$527.50	+$324.60	+$60.40
$410,000 – $750,000	$649.20	+$446.30	+$83.30
Above $750,000	$689.90	+$487.00	+$91.00

Will You Owe Medicare IRMAA Surcharges?

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IRMAA Brackets — Married Filing Jointly, 2026

Income & Filing

Coverage Details

IRMAA Brackets — Married Filing Jointly, 2026

2026 IRMAA Income Thresholds

Annual Cost Summary

Common IRMAA Strategies

IRMAA Appeal: Life-Changing Events (Form SSA-44)

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