Yes, IRMAA premiums are charged per person, not per household or per couple. Each Medicare beneficiary who earns above the income threshold pays their own separate IRMAA surcharge on top of the standard Part B and Part D premiums. If both spouses have Medicare, both pay the surcharge individually — even if only one spouse earned most of the income.
The Social Security Administration (SSA) uses your modified adjusted gross income (MAGI) from two years ago to decide whether you owe IRMAA. For 2026, that means SSA looks at your 2024 tax return. About 7% of all Medicare beneficiaries pay IRMAA, but even going $1 over the income threshold triggers the surcharge for the entire year.
Here’s what you’ll learn in this article:
- 💰 How IRMAA is calculated and charged to each person on Medicare — and why your spouse pays too
- 📊 The exact 2025 and 2026 IRMAA income brackets for every filing status, with dollar amounts
- 👫 Three real-world scenarios showing what couples and individuals actually pay
- 📝 How to use Form SSA-44 to appeal your IRMAA after a life-changing event like retirement or divorce
- 🛡️ Proven strategies to lower your income and avoid or reduce IRMAA surcharges before they hit
Why IRMAA Hits Each Person on Medicare — Not Just the Household
IRMAA stands for Income-Related Monthly Adjustment Amount. Congress created it in 2003 under the Medicare Modernization Act to require higher-income beneficiaries to pay more for Medicare. The surcharge applies to every individual enrolled in Medicare Part B or Part D who has income above the threshold.
This is where many couples get blindsided. If you and your spouse both have Medicare and file a joint tax return showing income above $218,000 in 2024, both of you pay the IRMAA surcharge. The SSA determines IRMAA liability for each beneficiary based on the same shared tax return. There is no household cap or discount for married couples.
Think of it this way: Medicare treats each person as an individual beneficiary. Your joint tax return sets the bracket, but each spouse enrolled in Medicare pays their own Part B premium and their own Part D surcharge. One joint return can trigger two IRMAA bills.
The 2026 IRMAA Brackets That Decide What You Pay
The standard Part B premium for 2026 is $202.90 per month. If your MAGI stays at or below $109,000 (single) or $218,000 (married filing jointly), you pay that base amount with zero IRMAA surcharge.
Once your income crosses the threshold, a sliding scale with five income brackets kicks in. The IRMAA surcharges for 2026 range from $81.20 to $487.00 per month for Part B and $14.50 to $91.00 for Part D. These brackets increased about 3% from 2025 due to inflation adjustments.
2026 Part B IRMAA for Single Filers
| 2024 MAGI (Single) | Total Monthly Part B Premium |
|---|---|
| $109,000 or less | $202.90 (no IRMAA) |
| $109,001 – $137,000 | $284.10 |
| $137,001 – $171,000 | $405.80 |
| $171,001 – $205,000 | $527.50 |
| $205,001 – $499,999 | $649.20 |
| $500,000 or more | $689.90 |
2026 Part B IRMAA for Married Filing Jointly
| 2024 MAGI (Joint) | Total Monthly Part B Premium |
|---|---|
| $218,000 or less | $202.90 (no IRMAA) |
| $218,001 – $274,000 | $284.10 |
| $274,001 – $342,000 | $405.80 |
| $342,001 – $410,000 | $527.50 |
| $410,001 – $749,999 | $649.20 |
| $750,000 or more | $689.90 |
2026 Part D IRMAA Surcharges
The Part D surcharge gets added on top of whatever you pay for your prescription drug plan. The Part D IRMAA amounts follow the same income brackets as Part B.
| 2024 MAGI (Single / Joint) | Part D Monthly Surcharge |
|---|---|
| $109,000 / $218,000 or less | $0.00 |
| $109,001–$137,000 / $218,001–$274,000 | $14.50 |
| $137,001–$171,000 / $274,001–$342,000 | $37.50 |
| $171,001–$205,000 / $342,001–$410,000 | $60.40 |
| $205,001–$499,999 / $410,001–$749,999 | $83.30 |
| $500,000+ / $750,000+ | $91.00 |
How 2025 Brackets Compare to 2026
The 2025 IRMAA thresholds started at $106,000 for singles and $212,000 for joint filers. The 2026 brackets rose by about 3%.
| Filing Status | 2025 First Bracket | 2026 First Bracket |
|---|---|---|
| Single | $106,000 | $109,000 |
| Married Filing Jointly | $212,000 | $218,000 |
The standard Part B premium also jumped from $185.00 in 2025 to $202.90 in 2026 — a $17.90 increase. That rise hits everyone on Medicare, not just those paying IRMAA.
Married Filing Separately: The Bracket Trap Most Couples Miss
Married couples who file separate tax returns face a much harsher IRMAA structure. The SSA assumes you lived together during the tax year unless you prove otherwise. This means you get only three brackets instead of six, and the surcharges jump fast.
| 2024 MAGI (Married Filing Separately) | Total Monthly Part B Premium |
|---|---|
| $109,000 or less | $202.90 (no IRMAA) |
| $109,001 – $390,999 | $649.20 |
| $391,000 or more | $689.90 |
Notice the gap. There is no middle ground between $109,000 and $391,000. A person filing separately with $110,000 in MAGI pays the same $649.20 per month as someone earning $390,000. That is a Part B surcharge of $446.30 per month — or $5,355.60 per year — for a person barely above the first threshold.
The Part D surcharge follows the same compressed structure: $83.30 per month for income between $109,001 and $390,999, and $91.00 at $391,000 or above.
Filing separately to protect one spouse from IRMAA can backfire. You lose the higher joint-filing income thresholds, and each spouse faces this compressed bracket system on their own individual income. The math often works out worse, not better.
Why Your 2024 Tax Return Controls Your 2026 Premiums
The SSA does not look at your current income to set IRMAA. It uses a two-year lookback. Your 2026 IRMAA is based on the MAGI reported on your 2024 federal tax return. If your 2024 return is not available, SSA will use your 2023 return instead.
Medicare sets the following year’s premiums in the fourth quarter of each year. The 2024 tax return is the most recent data the IRS can provide to SSA by that time. This two-year lag catches many new retirees off guard because their working-year income — which is often much higher — controls their premiums during the first year or two of retirement.
What Counts as MAGI for IRMAA
Your MAGI for IRMAA is not the same as your standard adjusted gross income. The formula adds back certain tax-exempt income to your AGI.
| MAGI Component | Where to Find It |
|---|---|
| Adjusted Gross Income (AGI) | Form 1040, Line 11 |
| Tax-exempt interest income | Form 1040, Line 2a |
MAGI = AGI + Tax-Exempt Interest Income
This means income from municipal bonds and other tax-free sources does count toward IRMAA even though it does not count toward your federal income tax. Many retirees hold municipal bonds thinking they are “tax-free” — and they are for income tax purposes. But that interest still pushes your MAGI higher for IRMAA.
Income Sources That Feed Into Your MAGI
| Income Type | Included in MAGI? |
|---|---|
| Wages and salaries | Yes |
| Social Security benefits (taxable portion) | Yes |
| Traditional IRA/401(k) distributions | Yes |
| Roth conversions | Yes |
| Capital gains | Yes |
| Pension and annuity income | Yes |
| Rental and royalty income | Yes |
| Tax-exempt interest (municipal bonds) | Yes |
| Qualified Roth IRA withdrawals | No |
| HSA withdrawals for medical expenses | No |
| Loan proceeds | No |
Roth IRA conversions increase your MAGI in the year of conversion, but qualified withdrawals from a Roth do not. This distinction is the foundation of the most powerful IRMAA-avoidance strategy.
The $1 Cliff That Can Cost You Over $1,000 a Year
IRMAA brackets work as a cliff, not a gradual phase-in. Go even $1 over a bracket threshold, and you pay the full surcharge for that bracket for the entire year. There is no pro-rated amount.
| Scenario | 2024 MAGI (Joint) | Monthly Part B Premium | Annual Part B Cost |
|---|---|---|---|
| Just below the line | $218,000 | $202.90 | $2,434.80 |
| $1 over the line | $218,001 | $284.10 | $3,409.20 |
That single dollar costs you $974.40 more per year in Part B premiums alone — per person. If both spouses have Medicare, the household penalty is $1,948.80 per year for being $1 over the threshold. Add the Part D surcharge of $14.50 per month per person, and the total annual hit for the couple climbs to $2,296.80.
This cliff effect means MAGI management in the years leading up to and during Medicare is not optional. It is essential.
Three Scenarios That Show How Per-Person IRMAA Adds Up
Scenario 1: Both Spouses on Medicare, Filing Jointly
Frank and Linda are both 68 and enrolled in Medicare Part B and Part D. They file jointly with a 2024 MAGI of $290,000.
| Detail | Frank | Linda |
|---|---|---|
| Filing status | Married filing jointly | Married filing jointly |
| 2024 MAGI (shared) | $290,000 | $290,000 |
| IRMAA bracket | $274,001–$342,000 | $274,001–$342,000 |
| Monthly Part B premium | $405.80 | $405.80 |
| Monthly Part D surcharge | $37.50 | $37.50 |
| Total monthly IRMAA cost | $443.30 | $443.30 |
Combined household cost: $886.60 per month, or $10,639.20 per year. Frank earns 85% of the household income, but Linda pays the exact same IRMAA. The surcharge does not split based on who earned what.
Scenario 2: Only One Spouse on Medicare
David is 67 and on Medicare. His wife Sarah is 62 and still on employer insurance. They file jointly with a 2024 MAGI of $230,000.
| Detail | David | Sarah |
|---|---|---|
| On Medicare? | Yes | No |
| IRMAA bracket | $218,001–$274,000 | N/A |
| Monthly Part B premium | $284.10 | $0 |
| Monthly Part D surcharge | $14.50 | $0 |
| Annual IRMAA cost | $1,174.80 | $0 |
Only David pays IRMAA because Sarah is not yet on Medicare. But when Sarah turns 65 and enrolls, she will also pay the surcharge based on their joint return — even if she has no personal income. Their annual IRMAA bill will double the day she joins Medicare.
Scenario 3: The Filing-Separately Shock
Robert and Karen have a 2024 joint MAGI of $250,000. Robert earns $200,000 and Karen earns $50,000. Both are on Medicare. They consider filing separately to “protect” Karen from IRMAA.
| Detail | Filing Jointly | Filing Separately |
|---|---|---|
| Robert’s MAGI | $250,000 (shared) | $200,000 |
| Karen’s MAGI | $250,000 (shared) | $50,000 |
| Robert’s Part B | $284.10 | $649.20 |
| Karen’s Part B | $284.10 | $202.90 |
| Combined monthly Part B | $568.20 | $852.10 |
| Combined annual Part B | $6,818.40 | $10,225.20 |
Filing separately saves Karen from IRMAA but pushes Robert into the compressed married-filing-separately brackets. The couple pays $3,406.80 more per year by filing separately. They also lose other tax benefits like the full standard deduction and certain credits.
How Your IRMAA Bill Actually Gets Paid
The SSA handles IRMAA billing in two different ways depending on the Medicare part.
Part B IRMAA gets deducted straight from your monthly Social Security check. If your Social Security benefit is not large enough to cover the full premium, or if you have deferred Social Security benefits, the Centers for Medicare & Medicaid Services (CMS) will send you a separate bill.
Part D IRMAA works differently. You pay your plan premium to your drug plan. But the IRMAA surcharge for Part D must be paid directly to Medicare — not to your insurance company or employer. Medicare sends a separate monthly bill for this amount. You can pay it through your MyMedicare account, bank bill pay, or Medicare Easy Pay.
Even if your employer or retirement system covers your Part D plan premium, you are still responsible for the Part D IRMAA surcharge. This catches many retirees with employer-sponsored drug coverage off guard.
Your Secret Weapon: Form SSA-44 and Life-Changing Events
If your income dropped because of a major life event, you do not have to wait two years for the IRMAA to adjust. The SSA lets you appeal using Form SSA-44, officially called the “Medicare Income-Related Monthly Adjustment Amount — Life-Changing Event” form.
Events That Qualify for an IRMAA Appeal
| Qualifying Event | Example |
|---|---|
| Marriage | You married and your combined income dropped below the threshold |
| Divorce or annulment | Your income decreased after splitting assets |
| Death of a spouse | You lost your spouse’s income |
| Work stoppage | You retired or got laid off |
| Work reduction | You cut from full-time to part-time |
| Loss of income-producing property | A rental property was destroyed or foreclosed |
| Loss of pension income | Your employer pension was terminated |
Step-by-Step: Filing Form SSA-44
Step 1: Obtain Form SSA-44 from the SSA website or your local Social Security office.
Step 2: Identify which life-changing event you experienced and the date it happened. Write in your estimated income for the current year. Break it down by source — wages, investments, pensions, self-employment.
Step 3: Gather supporting documents. You need proof that the event happened and proof of your reduced income. Examples include a letter from your former employer, a death certificate, a divorce decree, or a tax return showing lower income.
Step 4: Submit the form and documents to your local SSA office. You can do this in person, by mail, or by fax. The SSA processes most appeals within 30 to 60 days.
Step 5: If approved, the adjustment applies to future premiums within one to two billing cycles. You may receive a refund for overpaid premiums if you have already been paying the higher amount.
What to Include on Form SSA-44
| Form Section | What You Provide |
|---|---|
| Life-changing event type | Which qualifying event occurred |
| Date of event | When the event happened |
| Income estimate | Projected current-year income by source |
| Explanation | How the event reduced your income |
Be as accurate as possible with your income estimates. The SSA will compare your projections against your actual tax return later. If your estimate is too low, you could owe back premiums.
Mistakes That Cost Medicare Beneficiaries Thousands
Mistake #1: Ignoring the two-year lookback. Many new retirees assume Medicare will use their current retirement income. It does not. Your 2024 working-year income sets your 2026 premiums. If you retired in 2025, you need to file Form SSA-44 to get your premiums adjusted.
Mistake #2: Forgetting municipal bond interest counts. Tax-exempt interest from municipal bonds is added back to your AGI when calculating MAGI for IRMAA. A retiree holding $2 million in muni bonds generating $60,000 in interest could push themselves into a higher bracket without realizing it.
Mistake #3: Doing a large Roth conversion without planning. Converting $300,000 from a traditional IRA to a Roth in a single year spikes your MAGI in that year. Two years later, that spike sets your IRMAA bracket. Spreading conversions over multiple smaller years prevents a single large jump.
Mistake #4: Assuming filing separately will save money. As Scenario 3 showed, the compressed brackets for married-filing-separately status often cost more than filing jointly. Always run the math on both options before choosing.
Mistake #5: Selling a home or business without IRMAA planning. A one-time capital gain from a home sale or business sale gets included in your MAGI. Two years later, it triggers IRMAA — even though the income was a one-time event. You can appeal this, but only if it qualifies as a life-changing event.
Mistake #6: Not checking your IRMAA notice. The SSA mails an IRMAA determination letter each year. Some beneficiaries ignore it and miss errors. If the SSA used the wrong tax year or wrong filing status, you have 60 days to request a reconsideration.
Mistake #7: Thinking only the higher earner pays. Both spouses on Medicare pay the surcharge. It does not matter that one spouse earned 90% of the income. Both get the same bill.
Do’s and Don’ts of Managing IRMAA Premiums
Do’s
- Do check your MAGI every year in October or November, before the SSA sets next year’s premiums
- Do convert traditional IRA funds to a Roth in smaller amounts spread over several years to avoid bracket spikes
- Do use Qualified Charitable Distributions (QCDs) from your IRA after age 70½ to satisfy RMDs without increasing MAGI
- Do file Form SSA-44 immediately after a qualifying life-changing event — you do not have to wait until tax season
- Do run the numbers on both joint and separate filing to see which option produces the lowest total household cost
- Do consider tax-loss harvesting in your brokerage accounts to offset capital gains that inflate MAGI
Don’ts
- Don’t assume your current income controls your current-year premiums — it is always a two-year lag
- Don’t ignore the Part D IRMAA bill — it is separate from your drug plan premium and must be paid directly to Medicare
- Don’t do a large one-time Roth conversion without calculating the IRMAA impact two years later
- Don’t hold excessive municipal bonds without understanding they inflate your IRMAA-specific MAGI
- Don’t file married-filing-separately without comparing the compressed IRMAA brackets to joint filing
- Don’t miss the 60-day window to appeal an incorrect IRMAA determination letter
The Trade-Offs of Paying Higher IRMAA Premiums
| Pros | Cons |
|---|---|
| Higher income means more retirement spending power | IRMAA surcharges reduce that spending power by up to $16,557.60/year per couple |
| Roth conversions raise MAGI now but eliminate future IRMAA exposure | Conversion-year IRMAA spike can cost thousands in the short term |
| Filing jointly preserves standard deduction and tax credits | Joint filing exposes both spouses to IRMAA on shared income |
| Medicare benefits stay identical regardless of premium tier | You receive the same Part B and Part D coverage whether you pay $202.90 or $689.90 |
| Paying IRMAA means you had a high-income year — a good problem | The surcharge is non-deductible and does not count toward out-of-pocket limits |
| QCDs and Roth strategies can reduce future IRMAA | These strategies require years of advance planning |
The biggest frustration with IRMAA is that you get no additional benefits for paying more. A person paying $689.90 per month receives the exact same Medicare Part B coverage as someone paying $202.90. The surcharge is a premium adjustment, not a co-pay or deductible — it does not count toward your Medicare out-of-pocket maximum.
Smart Strategies to Reduce or Avoid IRMAA
The Roth Conversion Ladder
The most powerful long-term strategy is to convert traditional IRA funds to a Roth IRA before you start Medicare or during low-income years in early retirement. Roth conversions increase your MAGI in the year of conversion. But once the money is in the Roth, qualified withdrawals are tax-free and do not count toward MAGI.
| Strategy | IRMAA Impact |
|---|---|
| Convert $50,000/year over 6 years before Medicare | Small annual MAGI increase, stays below IRMAA thresholds |
| Convert $300,000 in one year | Huge MAGI spike triggers high IRMAA bracket two years later |
Spreading conversions across several lower-income years keeps you in the lowest possible IRMAA bracket while building a tax-free Roth balance for later.
Qualified Charitable Distributions (QCDs)
If you are 70½ or older, you can direct up to $105,000 per year (2024 limit) from your traditional IRA straight to a qualified charity. This satisfies your Required Minimum Distribution without adding that amount to your AGI. A $100,000 QCD could keep you below an IRMAA threshold that a $100,000 normal RMD would push you over.
Manage Capital Gains and Investment Income
Large capital gains in a single year inflate your MAGI. Selling a stock position worth $200,000 in gains will raise your IRMAA bracket two years later. Consider spreading sales over multiple tax years. You can also harvest tax losses in your brokerage accounts to offset gains.
Time Your Income Around the Brackets
If your MAGI is close to a bracket threshold, even small adjustments matter. Deferring a freelance payment, delaying a pension start date, or timing the sale of property can keep you just below the line. Given the cliff effect, keeping your MAGI $1 under a threshold saves you hundreds or thousands of dollars per year.
Use HSA Funds for Medical Expenses
Health Savings Account withdrawals used for qualified medical expenses are not included in MAGI. If you built up HSA savings during working years, using those funds for medical bills in retirement keeps your MAGI lower than if you pulled from a traditional IRA.
Key Entities and How They Interact
Understanding which agencies and rules control IRMAA helps you know where to go when problems arise.
| Entity | Role in IRMAA |
|---|---|
| Social Security Administration (SSA) | Determines your IRMAA bracket, sends your determination letter, processes Form SSA-44 appeals |
| Internal Revenue Service (IRS) | Shares your tax return data (MAGI, filing status) with SSA |
| Centers for Medicare & Medicaid Services (CMS) | Sets the standard Part B premium, bills you for unpaid IRMAA balances |
| Your Medicare Part D Plan | Collects your plan premium only — the Part D IRMAA surcharge goes to Medicare directly |
The SSA receives your tax data from the IRS automatically. You do not need to send anything unless you are filing an appeal. If the IRS sends incorrect data — for example, using the wrong tax year — you need to contact SSA directly to correct it.
How the Two-Year Lookback Creates Real-World Timing Problems
A common timing problem hits people who retire at 65. During their last working year, they earn a full salary. Two years later, that salary-year income determines their Medicare premium — even though they now live on a fraction of that income.
Example: Maria retires in December 2024 after earning $180,000 that year. In 2026, her IRMAA is based on that $180,000 MAGI. Her 2026 Part B premium is $405.80 per month instead of $202.90. She is now living on $45,000 in Social Security and pension income. Maria can file Form SSA-44 citing “work stoppage” as her life-changing event and request that SSA use her current reduced income instead.
Without the appeal, Maria would pay an extra $2,434.80 in Part B premiums during 2026 for income she no longer earns. The SSA-44 form exists for exactly this situation.
What Happens When One Spouse Dies
The death of a spouse creates two IRMAA complications. First, the surviving spouse loses income (such as one Social Security check or a pension). Second, the surviving spouse’s filing status changes from married-filing-jointly to single the following year — and the single brackets have lower income thresholds.
Example: Tom and Helen filed jointly in 2024 with a MAGI of $250,000. Their 2026 bracket as a couple is $218,001–$274,000 (Part B premium of $284.10 each). Tom dies in March 2026. Helen files as single in 2026 with a MAGI of $140,000. For 2028, her single-filer bracket is $137,001–$171,000, and her Part B premium rises to $405.80. Helen went from a lower joint bracket to a higher single bracket despite having less income.
Helen can file Form SSA-44 citing “death of spouse” to request an immediate adjustment based on her reduced income. She should not wait for the two-year lookback to catch up.
The Inflation Adjustment That Shifts Brackets Every Year
The first four IRMAA brackets are adjusted for inflation each year. The adjustment is based on the average Consumer Price Index for Urban Consumers (CPI-U) over the 12 months ending in August, compared to the prior 12-month average. This means rising inflation pushes the brackets higher, which can work in your favor by allowing you to earn more before crossing a threshold.
The fifth and highest bracket ($500,000 single / $750,000 joint) is frozen by law and cannot be adjusted for inflation until 2028 at the earliest. This means that bracket will not move regardless of how much prices rise. Over time, more beneficiaries will be pushed into this top bracket as their nominal income grows but the threshold stays fixed.
| Bracket | Inflation-Adjusted? |
|---|---|
| Brackets 1 through 4 | Yes — updated annually using CPI-U |
| Bracket 5 ($500,000 / $750,000) | No — frozen until at least 2028 |
FAQs
Is IRMAA charged per person or per couple?
Yes, IRMAA is charged per person. Each Medicare beneficiary pays their own surcharge based on the household’s MAGI from two years prior.
Do both spouses pay IRMAA if only one earns income?
Yes, both spouses enrolled in Medicare pay the surcharge. Filing jointly means both share the same MAGI bracket, regardless of who earned the money.
Can I appeal my IRMAA if I just retired?
Yes, retirement counts as a “work stoppage” life-changing event. File Form SSA-44 with the SSA to request a premium adjustment based on your current lower income.
Does Roth IRA income count toward IRMAA?
No, qualified Roth IRA withdrawals do not count toward MAGI. Roth conversions, however, are included in MAGI during the year of conversion.
Is the IRMAA surcharge tax-deductible?
No, IRMAA surcharges are not deductible as a medical expense on your federal tax return. They are treated as a premium adjustment, not a medical cost.
Does IRMAA apply to Medicare Advantage plans?
Yes, IRMAA applies to all Medicare beneficiaries enrolled in Part B, including those on Medicare Advantage. The surcharge goes to Medicare, not your MA plan.
Can I avoid IRMAA by filing married filing separately?
No, in most cases filing separately increases total IRMAA costs. The compressed brackets penalize the higher-earning spouse with surcharges jumping immediately to the fourth tier.
How long does an IRMAA appeal take?
Yes, you can expect a decision. The SSA processes most IRMAA appeals within 30 to 60 days. Approved adjustments apply within one to two billing cycles.
Does selling my home trigger IRMAA?
Yes, capital gains from a home sale are included in MAGI. If gains exceed the exclusion ($250,000 single / $500,000 joint), the excess raises your IRMAA bracket two years later.
Do I get better Medicare benefits for paying IRMAA?
No, IRMAA provides zero additional benefits. You receive the same Part B and Part D coverage whether you pay the base premium or the highest surcharge amount.
Related reading
- Do High Earners Pay More for Medicare? (w/Examples) + FAQs
- Are IRMAA Surcharges Permanent? (w/Examples) + FAQs
- Does IRMAA Apply to Medicare Part D? (w/Examples) + FAQs
- Does IRMAA Affect Medicare Advantage Plans? (w/Examples) + FAQs
- Are IRMAA Payments Tax Deductible? (w/Examples) + FAQs
- What Is Medicare Part B IRMAA? (w/Examples) + FAQs
- Is Nationwide Long-Term Care Insurance Worth It? (w/Examples) + FAQs