IRMAA (Income-Related Monthly Adjustment Amount) is a surcharge that higher-income Medicare beneficiaries pay on top of the standard Medicare Part B and Part D premiums. It’s triggered when your modified adjusted gross income (MAGI) from two years earlier exceeds certain thresholds — which, for 2026, are based on your 2024 tax return. CMS
Understanding IRMAA — and planning your income to stay below the thresholds — can significantly reduce your Medicare costs in retirement. This is especially important for retirees with $500,000–$5 million in investable assets. Strong income planning — including Roth conversions and thoughtful distribution sequencing — can help manage or even avoid IRMAA surcharges. This makes Roth conversion timing an essential part of income sequencing planning, especially if you are between ages 55 and 70. Because Medicare premiums are driven by income decisions, avoiding IRMAA often requires proactive retirement income planning, not last-minute fixes.
What IRMAA Is and Why It Matters
IRMAA is an additional charge on Medicare Part B (medical insurance) and Part D (prescription drug) monthly premiums that only applies if your income exceeds certain limits. The surcharge is based on MAGI — which includes taxable income plus tax-exempt interest — from your tax return two years prior. CMS
- For 2026 premiums, the SSA will use your 2024 tax return information.
- Even a small bump in income (like a large Roth conversion or capital gain) can move you into a higher IRMAA tier.
- IRMAA applies whether you’re on Original Medicare or a Medicare Advantage plan with drug coverage.
Because IRMAA is driven by income decisions made years earlier, avoiding these surcharges often requires proactive tax planning for retirees, not last-minute adjustments.
2026 IRMAA Brackets and Premiums (Based on 2024 Income)
Below is how IRMAA affects your total Medicare Part B and Part D premiums in 2026.
Medicare Part B + IRMAA Premiums — 2026
| MAGI Threshold (Individual) | MAGI Threshold (Married Filing Jointly) | Total Monthly Part B Premium | Part D IRMAA |
|---|---|---|---|
| ≤ $109,000 | ≤ $218,000 | $202.90 | $0 + your plan premium |
| > $109,000–$137,000 | > $218,000–$274,000 | $284.10 | $14.50 |
| > $137,000–$171,000 | > $274,000–$342,000 | $405.80 | $37.50 |
| > $171,000–$205,000 | > $342,000–$410,000 | $527.50 | $60.40 |
| > $205,000–$500,000 | > $410,000–$750,000 | $649.20 | $83.30 |
| ≥ $500,000 | ≥ $750,000 | $689.90 | $91.00 |
| Source: Centers for Medicare & Medicaid Services and SSA rules |
How to read this:
- If your income is $109,000 or less (single) or $218,000 or less (joint), you pay the standard Part B premium and no IRMAA surcharge. CMS
- As income increases, both Part B and Part D surcharges rise across five tiers.
How IRMAA Is Calculated
Your IRMAA is based on your Modified Adjusted Gross Income (MAGI) from your tax return filed in 2025 (the 2024 return).
MAGI includes:
- Adjusted Gross Income (AGI), including your taxable Social Security benefits
- Tax-exempt interest
- Other modifications mandated by IRS rules
If your income changes — due to retirement, separation, divorce, or a large one-time event — you can appeal IRMAA using SSA Form SSA-44 with supporting documentation. Social Security
Why Roth Conversions Matter for IRMAA
Roth IRA withdrawals and qualified Roth conversions do not count toward MAGI once the Roth is established and withdrawals are qualified. Because IRMAA is based on MAGI, a well-timed Roth conversion strategy can potentially lower your IRMAA tier in future years.
Here’s how:
- Converting traditional IRA funds to a Roth IRA increases MAGI in the conversion year, which could temporarily increase your IRMAA.
- However, because Roth balances grow tax-free and qualified Roth withdrawals do not count as income, planning conversions years before Medicare eligibility can reduce MAGI at critical IRMAA calculation periods.
- A staged Roth conversion strategy — spreading conversions over several years — can help avoid pushing income into higher IRMAA brackets.
This makes Roth conversion timing an essential part of income sequencing planning, especially if you are between ages 55 and 70.
Practical Tips to Reduce or Avoid IRMAA
1. Spread Income Over Time
Rather than taking large withdrawals or one-time gains in a single year, spread income over multiple years to avoid crossing IRMAA thresholds.
2. Consider Timing of Roth Conversions
Doing conversions in years with lower baseline income reduces MAGI and IRMAA risk. Internal planning tools can model this within broader strategies such as Roth Conversions After 60.
3. Use Qualified Charitable Distributions (QCDs)
If you are eligible for QCDs after age 70½ (even before RMDs start), these distributions count toward RMD requirements but do not count as income for IRMAA. (See: Using QCDs in Retirement Planning)
4. Appeal for Life-Changing Events
If your income decreased due to retirement, loss of spouse, or disability, you may submit SSA Form SSA-44 to appeal IRMAA. Social Security
Example: IRMAA Cost Impact (2026)
Suppose:
- You are married filing jointly with a MAGI of $300,000 in 2024
- In 2026 you would pay a Part B premium of $405.80/month and a Part D surcharge of $37.50/month, adding up to $443.30+ monthly, instead of the base $202.90.
That’s an extra ~$240/month just because of IRMAA — over $2,800 extra annually. CMS
This makes income planning before 65 highly impactful. IRMAA is one of the most commonly overlooked costs in retirement income planning.
Internal Links That Help You Plan Around IRMAA
For detailed strategies that tie into IRMAA planning, check out:
- Roth Conversions After 60 — When They Make Sense
- Using the ACA to Retire Early (health coverage timing and income planning)
- Can You Reduce Required Minimum Distributions? (RMD timing and income sequencing)
- Questions to Ask a Financial Advisor (And My Answers)
This topic is often part of a broader retirement or tax planning conversation. If you’d like help applying these ideas to your own situation, you can request an introductory conversation here.
Frequently Asked Questions
What income determines IRMAA for 2026?
Your 2024 tax return MAGI determines your Medicare IRMAA status for 2026.
Does IRMAA affect only Part B?
No — IRMAA also adds a surcharge to Medicare Part D prescription drug premiums.
Can I appeal an IRMAA surcharge?
Yes — if your income dropped due to a qualifying life event, you can submit Form SSA-44 to request a reduction. Social Security
