IRMAA, the Medicare Income Surcharge, and How to Get It Lowered

If you got a letter from Social Security saying your Medicare premiums will be higher, you're probably looking at IRMAA.

It stands for Income-Related Monthly Adjustment Amount. Plain English: if your income was above a certain level, you pay extra for Part B and Part D.

The thing that surprises people most? It's based on your income from two years ago. And if your income has since dropped for the right reasons, you can ask Social Security to use a newer year.

The mental model: the rearview mirror

IRMAA looks in the rearview mirror.

For 2026 premiums, Social Security generally used your 2024 tax return. That's the most recent return the IRS has shared with them. So your 2026 surcharge reflects your 2024 life, not your 2026 life.

That's fine if nothing changed. It's a problem if you retired in between.

The analogy: last year's paycheck stub

Imagine applying for a discount and the clerk only accepts your pay stub from two years ago. Back then, you had a full salary. Now you're retired and living on a lot less.

The clerk isn't being mean. That's just the paper they have. Your job is to hand them a newer pay stub and explain why it changed.

That's exactly what Form SSA-44 does.

Who pays IRMAA in 2026?

For 2026, IRMAA generally starts when your modified adjusted gross income (MAGI) from 2024 was:

• More than $109,000 if you filed individually
• More than $218,000 if you filed jointly

Above those levels, there are several brackets. The higher your income, the higher the surcharge. Social Security's Medicare premiums page has the full 2026 table.

The 2027 brackets haven't been published yet. They're usually announced each fall along with the new Part B premium.

A few more things to know:

• It applies to Part B and Part D separately. The Part D surcharge is added on top of your drug plan premium. That's true even if your drug coverage comes through a Medicare Advantage plan or an employer.
• Most people don't pay it. Medicare says about 8% of people with Medicare pay the extra Part D amount.
• It's recalculated every year. A high-income year affects one year of premiums, not forever.

What can push you over (even once)

From what I see, it's often a one-time bump, not regular income:

• A big year at work right before retiring
• Selling a business, a farm, or investments
• Large IRA withdrawals or Roth conversions

Those are real income. If they pushed you over two years ago, IRMAA follows. If you're planning one of these, talk to your tax professional about timing. That part's their lane, not mine.

The fix: Form SSA-44 for a life-changing event

If your income went down because of a specific life event, you can ask Social Security to use a more recent tax year. Social Security lists eight life-changing events:

1. Marriage
2. Divorce or annulment
3. Death of your spouse
4. Work stoppage (like retiring)
5. Work reduction
6. Loss of income-producing property (not your choice, like a disaster)
7. Loss or reduction of pension income
8. Receipt of an employer settlement payment

Retirement is the big one. It counts as a work stoppage.

How to ask: Fill out Form SSA-44 and send it to Social Security with proof. Or call Social Security at 1-800-772-1213 to set up an appointment. You don't have to use the form if you'd rather do it by phone.

What to have ready:

• Proof of the event, like a letter from your employer showing your last day of work
• Your more recent tax return, or your best estimate of this year's income if it's not filed yet

What doesn't count: selling property on purpose, or a stock market drop. The "loss of income-producing property" event is for losses that weren't your choice.

If the income Social Security used is just wrong

That's a different situation. If Social Security used the wrong numbers, or your tax return was amended, contact them about that directly. The SSA-44 is for real changes in your life, not errors.

Things I'd do (and never do)

1. I'd file the SSA-44 right after retiring if my income dropped. Don't wait for the next letter.
2. I'd keep my employer's retirement letter. It's the easiest proof of a work stoppage.
3. I'd loop in my tax person before a big one-time sale. Timing matters two years later.
4. I'd never ignore the IRMAA letter. You still have to pay it to keep your coverage.
5. I'd never drop Part D to dodge the surcharge. That can trigger a separate late penalty later.

Want a second set of eyes on your letter?

We can't do your taxes. But we can help you understand what the letter says and how it fits with your Medicare plan choices.

Call (417) 633-7200 or stop by our Wildwood office near St. Louis, or our Springfield office.

Your rearview mirror shouldn't set your budget forever.

— Matt

Frequently asked questions

What is IRMAA in Medicare?

It's an extra amount added to your Part B and Part D premiums if your income was above certain levels. It's based on your tax return from two years ago.

What income levels trigger IRMAA in 2026?

For 2026, it generally starts above $109,000 in 2024 MAGI for individual filers, or above $218,000 for joint filers. The 2027 levels are announced each fall.

How do I get IRMAA reduced after I retire?

Retirement counts as a work stoppage. You can file Form SSA-44 with Social Security, or call them, and ask them to use a more recent year's income.

Does IRMAA apply to Medicare Advantage?

Yes. You still pay the Part B surcharge, since you keep paying Part B. If your plan includes drug coverage, the Part D surcharge applies too.

Is IRMAA permanent?

No. It's recalculated every year based on your income from two years before.