Medicare Premiums & IRMAA Brackets
Income-related monthly adjustment amounts for Medicare Part B and Part D premiums
Key Numbers
Part B Standard
$202.90/mo
IRMAA Starts
$109K (Single)
Lookback
2-Year Lag
Max Surcharge
$487/mo (Part B)
IRMAA (Income-Related Monthly Adjustment Amount) is a surcharge on Medicare Part B and Part D premiums for higher-income beneficiaries. About 8% of enrollees pay IRMAA. Your 2026 surcharge is based on your 2024 tax return (2-year lookback).
How IRMAA Works
Two-Year Lookback: SSA uses your MAGI from 2 years prior. Your 2024 return determines your 2026 premiums.
Based on MAGI: Modified Adjusted Gross Income = AGI + tax-exempt interest (includes wages, pensions, RMDs, Roth conversions, capital gains, muni bond interest).
Cliff Effect: IRMAA is not progressive — exceeding a threshold by $1 triggers the full surcharge for that tier.
Annual Redetermination: Recalculated each year. If income drops, surcharge can decrease (with 2-year lag).
Cliff example: A married couple with MAGI of $218,001 vs. $218,000 pays an extra ~$2,000/year combined in Part B alone.
What Counts Toward MAGI?
Included
Wages, pensions, IRA/401(k) distributions, RMDs, Roth conversions, capital gains, dividends, interest, tax-exempt interest (munis), rental income, taxable Social Security
Not Included
Qualified Roth withdrawals, qualified HSA withdrawals, return of basis, life insurance proceeds, gifts, inheritances, reverse mortgage proceeds
Part B Premiums & IRMAA
2026 standard Part B premium: $202.90/month (up from $185.00 in 2025). Deductible: $283/year.
2026 Part B IRMAA Brackets
| Single Filer | Married Filing Jointly | Monthly | Surcharge | Extra/Year |
|---|---|---|---|---|
| ≤ $109,000 | ≤ $218,000 | $202.90 | $0 | — |
| $109,001 – $138,000 | $218,001 – $276,000 | $284.10 | +$81.20 | +$974 |
| $138,001 – $174,000 | $276,001 – $348,000 | $405.70 | +$202.80 | +$2,434 |
| $174,001 – $220,000 | $348,001 – $440,000 | $527.30 | +$324.40 | +$3,893 |
| $220,001 – $500,000 | $440,001 – $750,000 | $648.90 | +$446.00 | +$5,352 |
| > $500,000 | > $750,000 | $689.90 | +$487.00 | +$5,844 |
Married Filing Separately (Living with Spouse)
| MAGI (MFS with Spouse) | Monthly Part B |
|---|---|
| ≤ $109,000 | $202.90 |
| $109,001 – $391,000 | $648.90 |
| > $391,000 | $689.90 |
MFS scale jumps directly from standard to Tier 4 — filing separately while living together is very expensive for Medicare purposes.
Part D Surcharges
Part D base premium varies by plan (~$46.50/month avg in 2026). IRMAA surcharges are added on top. Unlike Part B, Part D IRMAA is billed separately by Medicare, not your plan.
2026 Part D IRMAA Surcharges
| Single Filer | Married Filing Jointly | Part D Surcharge | Extra/Year |
|---|---|---|---|
| ≤ $109,000 | ≤ $218,000 | $0 | — |
| $109,001 – $138,000 | $218,001 – $276,000 | +$14.50 | +$174 |
| $138,001 – $174,000 | $276,001 – $348,000 | +$37.40 | +$449 |
| $174,001 – $220,000 | $348,001 – $440,000 | +$60.30 | +$724 |
| $220,001 – $500,000 | $440,001 – $750,000 | +$83.20 | +$998 |
| > $500,000 | > $750,000 | +$91.00 | +$1,092 |
Combined Annual IRMAA (Part B + D)
| Tier | Part B Extra | Part D Extra | Per Person | Couple* |
|---|---|---|---|---|
| Standard | $0 | $0 | $0 | $0 |
| Tier 1 | $974 | $174 | $1,148 | $2,296 |
| Tier 2 | $2,434 | $449 | $2,883 | $5,766 |
| Tier 3 | $3,893 | $724 | $4,617 | $9,234 |
| Tier 4 | $5,352 | $998 | $6,350 | $12,700 |
| Tier 5 | $5,844 | $1,092 | $6,936 | $13,872 |
*Couple assumes both spouses on Medicare with Part B + D.
IRMAA Reduction Strategies
Because IRMAA uses a 2-year lookback, income planning must start before age 63 to affect premiums at Medicare enrollment (age 65).
| Strategy | How It Helps | Timing |
|---|---|---|
| Roth Conversions | Qualified Roth withdrawals don't count toward MAGI | Before age 63 |
| Capital Gains Timing | Spread large sales across years; harvest losses to offset gains | Near thresholds |
| QCDs (Age 70½+) | IRA donations to charity satisfy RMDs without increasing MAGI | Age 70½+ |
| Muni Bond Review | Tax-exempt interest is excluded from AGI but included in MAGI | Ongoing |
| HSA Contributions | Reduce MAGI while still working with HSA-eligible plan | Pre-Medicare |
Appeal via Form SSA-44
If your income dropped due to a qualifying life event, request that SSA use a more recent year's income. File Form SSA-44 within 60 days of your IRMAA notice.
Qualifying Events
Marriage, divorce, death of spouse, work stoppage/reduction, loss of income-producing property, loss of pension, employer settlement
What You'll Need
Completed Form SSA-44, documentation of the event, estimate of current year's MAGI, supporting tax documents
Tax note: IRMAA surcharges are Medicare premiums and may be deductible as medical expenses on Schedule A if total medical costs exceed 7.5% of AGI.
This content is for educational and informational purposes only and does not constitute financial, tax, or legal advice. Consult a qualified professional for guidance tailored to your situation.