The IRMAA Trap
Why your Medicare premium just doubled. And what you can do about it.
Did Your Premium Just Double?
If your Medicare Part B premium jumped from $200 to $400 or more, you're not alone. It's called IRMAA, and it catches thousands of retirees off guard every year.
This guide explains what IRMAA is, why it happened, and what you can do about it. Written in plain English by the advisors who take these calls every week.
- 2026 IRMAA bracket tables (Part B and Part D)
- The 2-year lookback rule everyone gets wrong
- Real scenarios that trigger surcharges
- How to appeal with form SSA-44
- 6 strategies to plan ahead
What You'll Learn
The 2026 IRMAA Brackets
Complete Part B and Part D surcharge tables by income. Know exactly where you stand and what each bracket costs per month and per year.
The 2-Year Lookback
Why your 2024 tax return determines your 2026 premium. The #1 source of confusion, explained simply.
What Triggers IRMAA
Home sales, Roth conversions, inherited annuities, your last year of working. Real scenarios from real clients.
How to Appeal and Plan Ahead
The SSA-44 form most people don't know exists. Plus 6 strategies to manage your income and avoid the surcharge.
Get the Full Guide
The complete IRMAA guide with 2026 bracket tables, appeal instructions, and planning strategies. No email required. No strings attached.
12 pages. Takes about 10 minutes to read.
Quick Answers
What is IRMAA?
IRMAA (the Income-Related Monthly Adjustment Amount) is an extra charge on Medicare Part B and Part D premiums for people with higher incomes. Social Security generally uses your tax return from two years earlier, so 2026 premiums depend on 2024 income. In 2026 it starts above $109,000 on an individual return and $218,000 on a joint return.
Key facts for 2026
- The standard Medicare Part B premium is $202.90 a month in 2026. Source: CMS
- With IRMAA, Part B costs $284.10 to $689.90 a month for each person in 2026. Source: Medicare.gov
- Part D IRMAA adds $14.50 to $91.00 a month on top of your drug plan premium in 2026. Source: Medicare.gov
- IRMAA is based on modified adjusted gross income: your adjusted gross income plus tax-exempt interest. Source: Social Security
- If a life-changing event such as retiring lowered your income, you can ask Social Security to use a more recent year, with Form SSA-44. Source: Social Security
IRMAA Questions, Answered
How is IRMAA figured, and what is the two-year lookback?
Social Security uses your modified adjusted gross income, which is your adjusted gross income plus any tax-exempt interest, from the most recent tax return the IRS can provide. That is generally two years back, so 2026 premiums use 2024 returns and 2027 premiums will generally use 2025 returns. Your filing status decides which income lines apply. Social Security will tell you if you have to pay the higher premium.
What are the 2026 IRMAA brackets for Part B?
On an individual return, income of $109,000 or less pays the standard $202.90 a month. Above that, Part B is $284.10 up to $137,000, $405.80 up to $171,000, $527.50 up to $205,000, $649.20 below $500,000, and $689.90 at $500,000 or more. On a joint return the lines are $218,000, $274,000, $342,000, $410,000 and $750,000, and each spouse with Part B pays the amount. Married couples filing separately have their own table.
What income counts toward IRMAA? Can a Roth conversion or a home sale trigger it?
Yes, both can. IRMAA counts modified adjusted gross income, so anything that raises your adjusted gross income can push you over a line, including traditional IRA withdrawals, a Roth conversion and capital gains. On a home sale, only the gain above the exclusion counts: up to $250,000 of gain can be excluded, or up to $500,000 on a joint return, if you qualify. Because of the lookback, a big income year at 63 can raise your premiums at 65.
How do I ask Social Security to lower IRMAA after I retire?
If a life-changing event lowered your income, you can ask Social Security for a new decision based on a more recent year. Stopping or cutting back work counts, and so do marriage, divorce or annulment, the death of a spouse, losing income-producing property, losing employer pension income, and certain employer settlement payments. Use Form SSA-44 or contact Social Security, and include proof of the event and your income, or an estimate of it. This is a new decision, not an appeal.
Does IRMAA apply if I have a Medicare Advantage plan?
Yes. Medicare Advantage members must keep Part B and keep paying the Part B premium, so the Part B surcharge applies the same way. If your Medicare Advantage plan includes drug coverage, the Part D surcharge applies too, on top of any plan premium. The surcharge depends on your income, not on the plan you choose, and Social Security generally takes it from your monthly benefit.
My spouse died. Can that lower my IRMAA?
It can. The death of a spouse is one of the life-changing events Social Security accepts. Your premium may still reflect a joint tax return from two years ago, when your household income was higher. You can ask Social Security to use a more recent year that shows your income now, with Form SSA-44 or by contacting your local office. Once you file as a single person, the lower lines for an individual return apply.
Sources
- CMS: 2026 Medicare Parts A and B Premiums and Deductibles
- Medicare.gov: Medicare costs, with the 2026 Part B and Part D income tables
- Social Security POMS HI 01101.010: Modified Adjusted Gross Income
- Social Security POMS HI 01120.001: New decisions after a life-changing event
- IRS Publication 590-A: Roth conversions count as income
General education, not tax or legal advice. Medicare amounts are for 2026 and change each year.
The full guide goes deeper. Get the guide above.
Keep going
More on Medicare and health costs
The Roth Conversion PlaybookWhen converting an IRA to a Roth can make sense, and the tax and Medicare costs to weigh.
Your Home, Your LegacySelling the paid-off house in retirement: the tax, the Medicare echo, and how the home passes on.
- Listen The Whole Chart, a podcast series
- How we help Medicare planning
- Annual Enrollment Period Your plan letter came: what to do before December 7