Yes, IRMAA affects Medicare Advantage plans. If your modified adjusted gross income crosses certain thresholds, you pay a surcharge on both your Part B and Part D premiums — even if you’re enrolled in a Medicare Advantage plan instead of Original Medicare. The Income-Related Monthly Adjustment Amount was established under the Medicare Modernization Act of 2003 for Part B and expanded by the Affordable Care Act for Part D in 2011. This means Medicare Advantage members face a double surcharge: one for Part B medical coverage and one for Part D prescription drug coverage built into most MA plans.
About 5.1 million Medicare beneficiaries — roughly 7% of all enrollees — paid Part B IRMAA surcharges in 2025. For a married couple at the highest IRMAA tier, the combined surcharge can exceed $13,800 per year in extra premiums on top of their regular plan costs.
Here’s what you’ll learn in this article:
- 💰 How IRMAA surcharges apply to Medicare Advantage plans and why members get billed twice
- 📊 The exact 2025 and 2026 IRMAA income brackets, thresholds, and surcharge amounts
- 🛡️ How to appeal IRMAA using Form SSA-44 when a life-changing event drops your income
- ⚠️ The most common IRMAA mistakes that cost retirees thousands each year
- 📋 Proven income planning strategies to lower your MAGI and reduce your IRMAA bracket
What IRMAA Is and Why Medicare Created It
IRMAA stands for Income-Related Monthly Adjustment Amount. It is a surcharge that higher-income Medicare beneficiaries pay on top of their standard Part B and Part D premiums. The federal government designed IRMAA to shift more of Medicare’s cost to people who can afford to pay a larger share.
Standard Medicare premiums cover only about 25% of Part B costs and roughly 15% of Part D costs. General tax revenues fund the rest. Congress created IRMAA to make the system more balanced so that wealthier retirees contribute more toward the coverage they receive.
The Social Security Administration (SSA) determines your IRMAA each year. SSA pulls your income data from the IRS using your tax return from two years prior. If your income exceeds the threshold, you will receive a letter in the mail notifying you of your higher premium amount.
How IRMAA Hits Medicare Advantage Members Twice
Many people assume IRMAA only affects those on Original Medicare. That is wrong. IRMAA applies to all Medicare beneficiaries, whether you have Original Medicare or a Medicare Advantage plan. The surcharge works on a sliding scale with five income tiers, and crossing a threshold by even $1 triggers the full surcharge for that bracket.
The Part B Surcharge
Every Medicare Advantage member pays a Part B premium. In 2026, the standard Part B premium is $202.90 per month. If your income is above the IRMAA threshold, you pay a surcharge on top of that $202.90. This surcharge is deducted from your Social Security check — or billed to you directly by CMS if you don’t receive Social Security .
The Part D Surcharge
Almost all Medicare Advantage plans include Part D prescription drug coverage. These are called MA-PD plans. If you’re in an MA-PD plan and your income is above the threshold, you also pay a Part D IRMAA surcharge. This surcharge is billed separately by Medicare and paid directly to Medicare — not to your Medicare Advantage plan.
This is the part that catches most people off guard. You could have a $0 premium Medicare Advantage plan and still owe hundreds of dollars each month in IRMAA surcharges for Part B and Part D combined.
2026 IRMAA Income Brackets and Part B Surcharges
The 2026 IRMAA brackets increased by about 3% compared to 2025, while surcharge amounts rose by approximately 9%. Your 2026 IRMAA is based on your 2024 tax return because SSA uses a two-year lookback.
| Individual MAGI | Total Monthly Part B Premium |
|---|---|
| $109,000 or less | $202.90 (standard) |
| $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 |
| Married Filing Jointly MAGI | Total Monthly Part B Premium |
|---|---|
| $218,000 or less | $202.90 (standard) |
| $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 |
The Part B surcharges for 2026 range from $81.20 to $487.00 per month added on top of the $202.90 standard premium. At the highest bracket, a single individual pays $689.90 per month — more than three times the standard premium.
2026 IRMAA Part D Surcharges for Medicare Advantage Drug Plans
Part D IRMAA surcharges are separate from Part B and use the same income brackets. These amounts are added to whatever your MA-PD plan premium already costs.
| Individual MAGI | Monthly Part D Surcharge |
|---|---|
| $109,000 or less | $0.00 |
| $109,001 – $137,000 | $14.50 |
| $137,001 – $171,000 | $37.50 |
| $171,001 – $205,000 | $60.40 |
| $205,001 – $499,999 | $83.30 |
| $500,000 or more | $91.00 |
| Married Filing Jointly MAGI | Monthly Part D Surcharge |
|---|---|
| $218,000 or less | $0.00 |
| $218,001 – $274,000 | $14.50 |
| $274,001 – $342,000 | $37.50 |
| $342,001 – $410,000 | $60.40 |
| $410,001 – $749,999 | $83.30 |
| $750,000 or more | $91.00 |
The Married Filing Separately Penalty
Married couples who file their taxes separately face a much harsher IRMAA structure. The brackets are compressed into just three tiers instead of six, which means you jump to the second-highest surcharge level much faster.
| Married Filing Separately MAGI | Part B Surcharge | Part D Surcharge |
|---|---|---|
| $109,000 or less | $0 | $0 |
| $109,001 – $390,999 | $446.30 | $83.30 |
| $391,000 or more | $487.00 | $91.00 |
A married person filing separately with an income of just $110,000 pays the same Part B surcharge as a single filer making $400,000. This makes filing separately extremely expensive for Medicare purposes unless there is a compelling legal or financial reason to do so.
The Two-Year Lookback Rule That Catches People Off Guard
IRMAA uses your tax return from two years ago to set your current premiums. Your 2026 IRMAA is based on your 2024 MAGI. Your 2025 IRMAA was based on your 2023 MAGI.
SSA uses the two-year lookback because your most recent tax return is the latest data the IRS can provide before the upcoming coverage year begins . Medicare determines IRMAA charges in the fourth quarter of the prior year, so the two-year-old return is the most current one available.
This creates a timing trap. A decision you make today — like selling a rental property or converting a large IRA — won’t affect your Medicare premiums until two years from now. Many retirees are blindsided when a one-time income event in the past creates a surcharge they didn’t expect.
What Counts as Income for IRMAA Purposes
The income figure SSA uses is your Modified Adjusted Gross Income (MAGI). For IRMAA purposes, MAGI is calculated as your Adjusted Gross Income (AGI) from Line 11 of Form 1040 plus any tax-exempt interest income from Line 2a .
Income sources that count toward IRMAA MAGI include:
- Wages, salaries, and self-employment income
- Taxable Social Security benefits
- Distributions from traditional IRAs, 401(k)s, and pensions
- Capital gains from investments or property sales
- Roth conversion amounts (counted as taxable income in the year of conversion)
- Rental and royalty income
- Tax-exempt interest from municipal bonds (this is the key “add-back”)
The tax-exempt interest add-back is what trips up many retirees . People invest in municipal bonds specifically to avoid taxes. But those bond interest payments still count toward IRMAA MAGI, even though they don’t appear on your taxable income. This single line item can push someone over an IRMAA threshold without them realizing it.
The IRMAA Cliff Effect: How $1 Can Cost You Thousands
IRMAA uses cliff-based brackets, not gradual increases. If your income lands just $1 over a bracket threshold, you pay the full surcharge for that entire tier. There is no proration or gradual phase-in.
Here’s a concrete example. A single retiree with a 2024 MAGI of $109,000 pays the standard 2026 Part B premium of $202.90 per month. A single retiree with a MAGI of $109,001 pays $284.10 per month. That single extra dollar of income costs an additional $81.20 per month — or $974.40 per year — in Part B surcharges alone.
When you add the Part D surcharge of $14.50 per month, that $1 over the threshold costs an extra $1,148.40 per year. For a married couple where both spouses are on Medicare, double that figure to $2,296.80 annually.
Three Real-World Scenarios That Show IRMAA’s Impact
Scenario 1: The Retired Couple Blindsided by a Roth Conversion
Mark and Linda are both 68 and enrolled in a Medicare Advantage plan with $0 monthly premium. Their combined retirement income is typically around $200,000 per year from pensions and Social Security — safely below the $218,000 IRMAA threshold for joint filers.
In 2024, their financial advisor recommended converting $80,000 from Mark’s traditional IRA to a Roth IRA. This pushed their 2024 MAGI to $280,000.
| Roth Conversion Decision | IRMAA Consequence |
|---|---|
| 2024 MAGI without conversion: $200,000 | 2026 Part B premium: $202.90/month each (standard) |
| 2024 MAGI with $80K conversion: $280,000 | 2026 Part B premium: $405.80/month each (Tier 3) |
| Additional Part B cost per person | $202.90/month × 12 = $2,434.80/year |
| Additional Part D cost per person | $37.50/month × 12 = $450/year |
| Total extra IRMAA for the couple | $5,769.60 per year |
Mark and Linda will pay nearly $5,770 more in 2026 Medicare premiums because of a single Roth conversion they did in 2024. Had they split the conversion across two or three years — converting $25,000 to $30,000 annually — they could have stayed below the $218,000 threshold and avoided IRMAA entirely .
Scenario 2: The New Retiree Who Didn’t Plan for the Lookback
David retired from his engineering job in January 2025 at age 66. His 2024 salary was $175,000, and he also earned $10,000 in investment income. His 2024 MAGI: $185,000.
David signed up for a Medicare Advantage plan in 2026 expecting to pay only the standard premium. His retirement income is now just $55,000 per year from a pension and Social Security. But SSA doesn’t care about his 2025 or 2026 income — they use his 2024 tax return to calculate 2026 IRMAA.
| David’s Situation | IRMAA Result |
|---|---|
| 2024 income (working year): $185,000 | Falls in Tier 3 ($137,001–$171,000)… wait, $185,000 is in Tier 4 |
| 2026 actual income: $55,000 | Irrelevant for 2026 IRMAA calculation |
| Monthly Part B surcharge | $324.60 |
| Monthly Part D surcharge | $60.40 |
| Total extra monthly IRMAA | $385.00 per month ($4,620/year) |
David’s current income of $55,000 would put him well below the IRMAA threshold. But because of the two-year lookback, he’s stuck paying $4,620 in extra premiums during his first year on Medicare.
David can fix this. Because he retired — a qualifying life-changing event — he can file Form SSA-44 with SSA and request that his IRMAA be recalculated using his current, lower income. If approved, the adjustment usually takes effect within one to two billing cycles.
Scenario 3: The Widow Who Successfully Appealed IRMAA
Patricia is 72 and has been on a Medicare Advantage plan for five years. Her husband Robert passed away in March 2025. When they filed jointly in 2024, their combined MAGI was $250,000, which put them in the second IRMAA bracket.
Patricia’s 2026 IRMAA notice arrived showing she owes $284.10 per month for Part B and an additional $14.50 for Part D — based on that joint 2024 return.
| Patricia’s Appeal | Result |
|---|---|
| Life-changing event | Death of spouse (March 2025) |
| Form filed | SSA-44 |
| 2026 income as a single widow | $78,000 |
| Income threshold for single filer | $109,000 |
| New IRMAA after appeal | $0 — standard premium restored |
Patricia filed Form SSA-44 at her local Social Security office with a copy of Robert’s death certificate and an estimate of her 2025 income. SSA reviewed her case and agreed that her current income fell below the $109,000 threshold. Her IRMAA surcharge was removed, saving her $1,148.40 per year in unnecessary premiums.
How to Appeal IRMAA Using Form SSA-44
Filing Form SSA-44 is not technically an appeal. It is a request for a new initial determination based on a qualifying life-changing event that reduced your income. This is an important distinction because it means the process is faster and simpler than the formal appeals process.
Eight Qualifying Life-Changing Events
The SSA recognizes these specific life-changing events for IRMAA reconsideration:
- Marriage
- Divorce or annulment
- Death of a spouse
- Work stoppage (retirement or job loss)
- Work reduction (cutting back hours or moving to part-time)
- Loss of income-producing property (due to disaster, theft, or circumstances beyond your control)
- Loss or reduction of pension income
- Receipt of an employer settlement payment
The event must have happened after the tax year SSA used for your current IRMAA determination, and it must have caused a significant drop in your income. You cannot use Form SSA-44 simply because you disagree with the surcharge or think it’s unfair.
Step-by-Step Process for Filing SSA-44
Step 1: Get the form. Download Form SSA-44 from SSA’s website or pick one up at your local Social Security office.
Step 2: Identify your life-changing event. Section 1 of the form asks you to select which qualifying event applies and provide the exact date it occurred. Be precise — SSA needs to verify that the event happened and when.
Step 3: Provide income estimates. The form requires you to estimate your MAGI for the year affected by the life-changing event. Gather supporting documents like pension statements, Social Security benefit letters, or a letter from your former employer confirming your retirement date.
Step 4: Attach documentation. Include proof of the life-changing event. For retirement, this could be a letter from your employer. For death of a spouse, a death certificate. For divorce, a copy of the divorce decree. SSA needs evidence that the event actually happened and that it reduced your income.
Step 5: Submit the form. You can submit Form SSA-44 at your local Social Security office or mail it in. Some people also submit it online through SSA.
Step 6: Wait for the decision. If approved, the adjustment typically takes effect within one to two billing cycles. You may also receive a refund if you already overpaid based on the old income data.
What Happens If Your SSA-44 Is Denied
If SSA denies your request, you can file a formal appeal using Form SSA-561-U2 (Request for Reconsideration). This triggers a full review by a different SSA employee who was not involved in the original decision.
If the reconsideration is also denied, the next level is a hearing before the Office of Medicare Hearings and Appeals (OMHA). After that, you can appeal to the Medicare Appeals Council and ultimately to federal court if necessary. Most cases are resolved at the SSA-44 stage, though, because the qualifying events are straightforward to document.
Income Planning Strategies to Reduce or Avoid IRMAA
The best way to manage IRMAA is to plan your income before you cross a threshold. Once a high-income year hits your tax return, you’re locked into that IRMAA determination two years later.
Strategic Roth Conversions
Converting money from a traditional IRA to a Roth IRA is one of the most powerful tools for reducing future IRMAA exposure . The conversion amount counts as taxable income now, but qualified Roth withdrawals in retirement are tax-free and do not count toward MAGI .
The key is to spread conversions across multiple years rather than doing one large conversion . Converting $30,000 per year over four years keeps your income steady. Converting $120,000 all at once could spike your MAGI into a high IRMAA bracket for that year.
Qualified Charitable Distributions (QCDs)
If you are 70½ or older, you can donate up to $105,000 per year directly from your IRA to a qualified charity . A QCD satisfies your Required Minimum Distribution (RMD) but does not count as taxable income on your return . This directly lowers your MAGI and can keep you below an IRMAA threshold.
Manage Capital Gains Carefully
Selling investments, rental properties, or a business can spike your MAGI and push you into a higher IRMAA bracket. When possible, spread large sales across multiple tax years to avoid a single-year income spike. You can also use tax-loss harvesting — selling investments at a loss to offset gains — to reduce your net capital gains.
Delay or Manage Required Minimum Distributions
The SECURE Act 2.0 raised the age for Required Minimum Distributions (RMDs) to 73 starting in 2023, and it will rise to 75 by 2033. Delaying RMDs can keep your MAGI lower during the early years of Medicare eligibility. If you can live on other income sources like Roth withdrawals or taxable brokerage accounts, postponing RMDs gives your tax-deferred accounts more time to grow while keeping IRMAA at bay.
Balance Withdrawals Across Account Types
Retirees with multiple account types — taxable brokerage, traditional IRA, and Roth IRA — should pull income strategically from each bucket . Use Roth and HSA funds to fill income gaps when your traditional account withdrawals approach an IRMAA threshold . This “bucket strategy” gives you control over how much taxable income appears on your return each year.
IRMAA Mistakes That Cost Retirees Thousands
Mistake 1: Ignoring Municipal Bond Interest
Many retirees invest in municipal bonds for tax-free interest income . But that interest gets added back to your AGI when SSA calculates your IRMAA MAGI . A retiree earning $100,000 in AGI plus $15,000 in municipal bond interest has an IRMAA MAGI of $115,000 — enough to trigger the first IRMAA surcharge bracket.
Mistake 2: Doing a Large Roth Conversion in a Single Year
Converting a $200,000 traditional IRA all at once adds $200,000 to your taxable income that year. This can catapult your MAGI into the fourth or fifth IRMAA tier, creating a surcharge that lasts for an entire year of premiums two years later . Splitting conversions into $30,000–$50,000 annual chunks is almost always the smarter approach.
Mistake 3: Filing Taxes as Married Filing Separately
The IRMAA brackets for married filing separately are punishing. There are only three brackets instead of six, and anyone earning over $109,000 immediately jumps to the second-highest surcharge level. Unless there is a serious legal reason to file separately, married couples on Medicare should almost always file jointly.
Mistake 4: Not Filing Form SSA-44 After Retiring
David’s scenario above is one of the most common IRMAA mistakes. Retirees often assume they are stuck paying the surcharge until their lower-income tax return catches up two years later. But retirement qualifies as a work stoppage — one of the eight life-changing events SSA accepts. Filing SSA-44 can remove the surcharge within weeks.
Mistake 5: Forgetting That Mutual Fund Distributions Count
At the end of every year, many mutual funds distribute capital gains and dividends to shareholders. These distributions are taxable income even if you reinvest them automatically. Retirees near an IRMAA threshold can be pushed over it by a surprise year-end mutual fund distribution they didn’t plan for.
Mistake 6: Not Paying the Part D IRMAA Separately
The Part D IRMAA surcharge is billed by Medicare, not by your Medicare Advantage plan. If your employer or retirement system pays your plan premium, you are still responsible for paying the Part D IRMAA yourself . Failing to pay this separate bill can result in a late payment and potential penalties.
Do’s and Don’ts for Managing IRMAA on Medicare Advantage
Pros and Cons of Medicare Advantage When IRMAA Applies
Key Organizations and Their Roles in IRMAA
Several federal agencies and entities interact in the IRMAA process. Understanding who does what helps you know where to direct questions, payments, and appeals.
The Social Security Administration (SSA) makes the initial IRMAA determination each year by reviewing your IRS income data. SSA sends you the IRMAA determination letter and processes Form SSA-44 requests. If you disagree with your IRMAA, SSA is your first point of contact.
The Centers for Medicare & Medicaid Services (CMS) sets the annual Part B premium and publishes the official IRMAA bracket amounts each fall. CMS also bills you for any unpaid IRMAA if your Social Security check doesn’t cover the full amount .
The Internal Revenue Service (IRS) provides your tax return data to SSA. Your AGI from Line 11 and tax-exempt interest from Line 2a of Form 1040 are the two numbers that determine your IRMAA MAGI . The IRS does not make IRMAA decisions — it only supplies the income data.
The Office of Medicare Hearings and Appeals (OMHA) handles formal IRMAA appeals at the third level if your SSA-44 request and reconsideration are both denied. OMHA hearings involve an Administrative Law Judge who reviews your case independently.
Your Medicare Advantage plan itself has no role in IRMAA. Your plan does not set, collect, or adjust the surcharge. IRMAA is entirely a federal matter between you, SSA, and CMS . If you call your MA plan about IRMAA, they will direct you to SSA.
How IRMAA Payments Work for Medicare Advantage Members
Understanding how IRMAA is collected helps avoid missed payments and penalties.
Part B IRMAA is automatically deducted from your monthly Social Security benefit . If you don’t receive Social Security or your benefit isn’t large enough, CMS sends you a separate bill . You can pay through your MyMedicare.gov account, your bank’s bill pay service, Medicare Easy Pay (automatic deduction), or by mail to the Medicare Premium Collection Center .
Part D IRMAA is billed separately from your Part B premium and your MA plan premium. Medicare sends you a monthly bill for this amount. You pay it directly to Medicare — not to your Medicare Advantage insurer . Even if a third party or employer pays your MA plan premium, the Part D IRMAA is still your responsibility .
How IRMAA Interacts With the SECURE Act 2.0
The SECURE Act 2.0, enacted in late 2022, changed the rules for Required Minimum Distributions in ways that directly affect IRMAA planning.
Before 2023, retirees had to start taking RMDs at age 70½. The original SECURE Act in 2019 raised that to 72. SECURE Act 2.0 pushed it to 73 starting in 2023 and will raise it to 75 by 2033.
This delay creates a planning window. If you retire at 65 and don’t need to take RMDs until 73, you have up to eight years where you can draw from Roth accounts or taxable accounts while keeping your traditional IRA untouched. During those years, your MAGI stays lower, which can help you avoid IRMAA entirely during early Medicare enrollment.
The flip side is that delaying RMDs allows your traditional IRA to grow larger. When RMDs finally begin, they could be bigger and potentially push you into a higher IRMAA bracket later. Working with a financial advisor to model both scenarios is critical.
Comparing 2025 and 2026 IRMAA Thresholds
The IRMAA income thresholds are adjusted for inflation annually based on the Consumer Price Index for Urban Consumers (CPI-U). The top bracket ($500,000 single / $750,000 joint) is currently frozen and cannot be indexed for inflation until 2028.
| 2025 Single Threshold | 2026 Single Threshold |
|---|---|
| $106,000 | $109,000 |
| $133,500 | $137,000 |
| $167,000 | $171,000 |
| $200,000 | $205,000 |
| $500,000 (frozen) | $500,000 (frozen) |
The 2025-to-2026 increase of about 3% in the lower brackets means some retirees whose income stayed the same may drop out of an IRMAA bracket they were in the prior year. If your MAGI was $107,000 in both 2023 and 2024, you would have paid IRMAA in 2025 (threshold: $106,000) but not in 2026 (threshold: $109,000). Checking the updated thresholds every year is essential.
How IRMAA Affects Your Total Medicare Advantage Costs
Many people focus only on their MA plan’s premium and forget about the federal costs layered on top. Here’s a breakdown of what a Medicare Advantage member at the third IRMAA tier (single filer, MAGI $137,001–$171,000) pays each month in 2026:
| Cost Component | Monthly Amount |
|---|---|
| MA plan premium (example: $0 plan) | $0 |
| Standard Part B premium | $202.90 |
| Part B IRMAA surcharge (Tier 3) | $202.90 |
| Part D IRMAA surcharge (Tier 3) | $37.50 |
| Total monthly cost | $443.30 |
That same person on a $0-premium MA plan without IRMAA would pay only $202.90 per month. IRMAA more than doubles their Medicare costs. Over a full year, the difference is $2,884.80 — money that goes entirely to the federal government, not to your plan’s benefits.
FAQs
Does IRMAA apply to Medicare Advantage plans?
Yes. IRMAA surcharges apply to both Part B and Part D premiums, which Medicare Advantage members pay on top of their plan premium.
Can I avoid IRMAA by switching from Original Medicare to Medicare Advantage?
No. IRMAA is based on your income, not the type of Medicare plan you choose. It applies equally to both.
Does my Medicare Advantage plan collect the IRMAA payment?
No. Part B IRMAA comes from your Social Security check. Part D IRMAA is billed separately by Medicare .
Is the Part D IRMAA surcharge included in my MA plan premium?
No. The Part D surcharge is paid directly to Medicare, not to your plan, even if your MA plan includes drug coverage.
Can I appeal IRMAA if I just retired?
Yes. Retirement counts as a “work stoppage” life-changing event. File Form SSA-44 with SSA to request a recalculation.
Does selling my house trigger IRMAA?
Yes. Capital gains from a home sale increase your MAGI, which can push you into a higher IRMAA bracket two years later.
Does Roth IRA income count toward IRMAA?
No. Qualified Roth withdrawals are not included in your MAGI. However, Roth conversions do count as taxable income in the conversion year .
Does tax-exempt municipal bond interest affect IRMAA?
Yes. Tax-exempt interest is added back to your AGI when calculating the IRMAA-specific MAGI .
How long does an SSA-44 appeal take?
Typically one to two billing cycles. If approved, adjustments apply to future premiums and you may receive a refund for overpayments.
Does IRMAA count toward my MA plan’s out-of-pocket maximum?
No. IRMAA surcharges are federal premium charges and do not count toward your Medicare Advantage plan’s annual spending limit.
Can both spouses be charged IRMAA?
Yes. Each spouse on Medicare is assessed IRMAA individually based on the couple’s joint tax return, so both pay the surcharge.
Is IRMAA a one-time charge or ongoing?
Ongoing. SSA recalculates IRMAA every year based on your tax return from two years prior. If your income drops, your surcharge can decrease or disappear.
Can I deduct IRMAA surcharges on my taxes?
Yes. IRMAA surcharges are considered Medicare premiums and may be deductible as a medical expense if your total medical costs exceed 7.5% of your AGI.
What happens if I don’t pay the Part D IRMAA bill?
Late fees accrue. Medicare can also disenroll you from Part D coverage if the surcharge remains unpaid for an extended period .
Does IRMAA affect Medicare Part A premiums?
No. There is no income-related surcharge for Medicare Part A, even for the small percentage of people who pay a Part A premium.
Prepared using Claude Opus 4.6 Thinking
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Yes, IRMAA affects Medicare Advantage plans. If your modified adjusted gross income crosses certain thresholds, you pay a surcharge on both your Part B and Part D premiums — even if you’re enrolled in a Medicare Advantage plan instead of Original Medicare. The Income-Related Monthly Adjustment Amount was established under the Medicare Modernization Act of 2003 for Part B and expanded by the Affordable Care Act for Part D in 2011. This means Medicare Advantage members face a double surcharge: one for Part B medical coverage and one for Part D prescription drug coverage built into most MA plans.
About 5.1 million Medicare beneficiaries — roughly 7% of all enrollees — paid Part B IRMAA surcharges in 2025. For a married couple at the highest IRMAA tier, the combined surcharge can exceed $13,800 per year in extra premiums on top of their regular plan costs.
Here’s what you’ll learn in this article:
- 💰 How IRMAA surcharges apply to Medicare Advantage plans and why members get billed twice
- 📊 The exact 2025 and 2026 IRMAA income brackets, thresholds, and surcharge amounts
- 🛡️ How to appeal IRMAA using Form SSA-44 when a life-changing event drops your income
- ⚠️ The most common IRMAA mistakes that cost retirees thousands each year
- 📋 Proven income planning strategies to lower your MAGI and reduce your IRMAA bracket
What IRMAA Is and Why Medicare Created It
IRMAA stands for Income-Related Monthly Adjustment Amount. It is a surcharge that higher-income Medicare beneficiaries pay on top of their standard Part B and Part D premiums. The federal government designed IRMAA to shift more of Medicare’s cost to people who can afford to pay a larger share.
Standard Medicare premiums cover only about 25% of Part B costs and roughly 15% of Part D costs. General tax revenues fund the rest. Congress created IRMAA to make the system more balanced so that wealthier retirees contribute more toward the coverage they receive.
The Social Security Administration (SSA) determines your IRMAA each year. SSA pulls your income data from the IRS using your tax return from two years prior. If your income exceeds the threshold, you will receive a letter in the mail notifying you of your higher premium amount.
How IRMAA Hits Medicare Advantage Members Twice
Many people assume IRMAA only affects those on Original Medicare. That is wrong. IRMAA applies to all Medicare beneficiaries, whether you have Original Medicare or a Medicare Advantage plan. The surcharge works on a sliding scale with five income tiers, and crossing a threshold by even $1 triggers the full surcharge for that bracket.
The Part B Surcharge
Every Medicare Advantage member pays a Part B premium. In 2026, the standard Part B premium is $202.90 per month. If your income is above the IRMAA threshold, you pay a surcharge on top of that $202.90. This surcharge is deducted from your Social Security check — or billed to you directly by CMS if you don’t receive Social Security.
The Part D Surcharge
Almost all Medicare Advantage plans include Part D prescription drug coverage. These are called MA-PD plans. If you’re in an MA-PD plan and your income is above the threshold, you also pay a Part D IRMAA surcharge. This surcharge is billed separately by Medicare and paid directly to Medicare — not to your Medicare Advantage plan.
This is the part that catches most people off guard. You could have a $0 premium Medicare Advantage plan and still owe hundreds of dollars each month in IRMAA surcharges for Part B and Part D combined.
2026 IRMAA Income Brackets and Part B Surcharges
The 2026 IRMAA brackets increased by about 3% compared to 2025, while surcharge amounts rose by approximately 9%. Your 2026 IRMAA is based on your 2024 tax return because SSA uses a two-year lookback.
| Individual MAGI | Total Monthly Part B Premium |
|---|---|
| $109,000 or less | $202.90 (standard) |
| $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 |
| Married Filing Jointly MAGI | Total Monthly Part B Premium |
|---|---|
| $218,000 or less | $202.90 (standard) |
| $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 |
The Part B surcharges for 2026 range from $81.20 to $487.00 per month added on top of the $202.90 standard premium. At the highest bracket, a single individual pays $689.90 per month — more than three times the standard premium.
2026 IRMAA Part D Surcharges for Medicare Advantage Drug Plans
Part D IRMAA surcharges are separate from Part B and use the same income brackets. These amounts are added to whatever your MA-PD plan premium already costs.
| Individual MAGI | Monthly Part D Surcharge |
|---|---|
| $109,000 or less | $0.00 |
| $109,001 – $137,000 | $14.50 |
| $137,001 – $171,000 | $37.50 |
| $171,001 – $205,000 | $60.40 |
| $205,001 – $499,999 | $83.30 |
| $500,000 or more | $91.00 |
| Married Filing Jointly MAGI | Monthly Part D Surcharge |
|---|---|
| $218,000 or less | $0.00 |
| $218,001 – $274,000 | $14.50 |
| $274,001 – $342,000 | $37.50 |
| $342,001 – $410,000 | $60.40 |
| $410,001 – $749,999 | $83.30 |
| $750,000 or more | $91.00 |
The Married Filing Separately Penalty
Married couples who file their taxes separately face a much harsher IRMAA structure. The brackets are compressed into just three tiers instead of six, which means you jump to the second-highest surcharge level much faster.
| Married Filing Separately MAGI | Part B Surcharge | Part D Surcharge |
|---|---|---|
| $109,000 or less | $0 | $0 |
| $109,001 – $390,999 | $446.30 | $83.30 |
| $391,000 or more | $487.00 | $91.00 |
A married person filing separately with an income of just $110,000 pays the same Part B surcharge as a single filer making $400,000. This makes filing separately extremely expensive for Medicare purposes unless there is a compelling legal or financial reason to do so.
The Two-Year Lookback Rule That Catches People Off Guard
IRMAA uses your tax return from two years ago to set your current premiums. Your 2026 IRMAA is based on your 2024 MAGI. Your 2025 IRMAA was based on your 2023 MAGI.
SSA uses the two-year lookback because your most recent tax return is the latest data the IRS can provide before the upcoming coverage year begins. Medicare determines IRMAA charges in the fourth quarter of the prior year, so the two-year-old return is the most current one available.
This creates a timing trap. A decision you make today — like selling a rental property or converting a large IRA — won’t affect your Medicare premiums until two years from now. Many retirees are blindsided when a one-time income event in the past creates a surcharge they didn’t expect.
What Counts as Income for IRMAA Purposes
The income figure SSA uses is your Modified Adjusted Gross Income (MAGI). For IRMAA purposes, MAGI is calculated as your Adjusted Gross Income (AGI) from Line 11 of Form 1040 plus any tax-exempt interest income from Line 2a.
Income sources that count toward IRMAA MAGI include:
- Wages, salaries, and self-employment income
- Taxable Social Security benefits
- Distributions from traditional IRAs, 401(k)s, and pensions
- Capital gains from investments or property sales
- Roth conversion amounts (counted as taxable income in the year of conversion)
- Rental and royalty income
- Tax-exempt interest from municipal bonds (this is the key “add-back”)
The tax-exempt interest add-back is what trips up many retirees. People invest in municipal bonds specifically to avoid taxes. But those bond interest payments still count toward IRMAA MAGI, even though they don’t appear on your taxable income. This single line item can push someone over an IRMAA threshold without them realizing it.
The IRMAA Cliff Effect: How $1 Can Cost You Thousands
IRMAA uses cliff-based brackets, not gradual increases. If your income lands just $1 over a bracket threshold, you pay the full surcharge for that entire tier. There is no proration or gradual phase-in.
Here’s a concrete example. A single retiree with a 2024 MAGI of $109,000 pays the standard 2026 Part B premium of $202.90 per month. A single retiree with a MAGI of $109,001 pays $284.10 per month. That single extra dollar of income costs an additional $81.20 per month — or $974.40 per year — in Part B surcharges alone.
When you add the Part D surcharge of $14.50 per month, that $1 over the threshold costs an extra $1,148.40 per year. For a married couple where both spouses are on Medicare, double that figure to $2,296.80 annually.
Three Real-World Scenarios That Show IRMAA’s Impact
Scenario 1: The Retired Couple Blindsided by a Roth Conversion
Mark and Linda are both 68 and enrolled in a Medicare Advantage plan with $0 monthly premium. Their combined retirement income is typically around $200,000 per year from pensions and Social Security — safely below the $218,000 IRMAA threshold for joint filers.
In 2024, their financial advisor recommended converting $80,000 from Mark’s traditional IRA to a Roth IRA. This pushed their 2024 MAGI to $280,000.
| Roth Conversion Decision | IRMAA Consequence |
|---|---|
| 2024 MAGI without conversion: $200,000 | 2026 Part B premium: $202.90/month each (standard) |
| 2024 MAGI with $80K conversion: $280,000 | 2026 Part B premium: $405.80/month each (Tier 3) |
| Additional Part B cost per person | $202.90/month × 12 = $2,434.80/year |
| Additional Part D cost per person | $37.50/month × 12 = $450/year |
| Total extra IRMAA for the couple | $5,769.60 per year |
Mark and Linda will pay nearly $5,770 more in 2026 Medicare premiums because of a single Roth conversion they did in 2024. Had they split the conversion across two or three years — converting $25,000 to $30,000 annually — they could have stayed below the $218,000 threshold and avoided IRMAA entirely.
Scenario 2: The New Retiree Who Didn’t Plan for the Lookback
David retired from his engineering job in January 2025 at age 66. His 2024 salary was $175,000, and he also earned $10,000 in investment income. His 2024 MAGI: $185,000.
David signed up for a Medicare Advantage plan in 2026 expecting to pay only the standard premium. His retirement income is now just $55,000 per year from a pension and Social Security. But SSA doesn’t care about his 2025 or 2026 income — they use his 2024 tax return to calculate 2026 IRMAA.
| David’s Situation | IRMAA Result |
|---|---|
| 2024 income (working year): $185,000 | Falls in Tier 3 ($137,001–$171,000)… wait, $185,000 is in Tier 4 |
| 2026 actual income: $55,000 | Irrelevant for 2026 IRMAA calculation |
| Monthly Part B surcharge | $324.60 |
| Monthly Part D surcharge | $60.40 |
| Total extra monthly IRMAA | $385.00 per month ($4,620/year) |
David’s current income of $55,000 would put him well below the IRMAA threshold. But because of the two-year lookback, he’s stuck paying $4,620 in extra premiums during his first year on Medicare.
David can fix this. Because he retired — a qualifying life-changing event — he can file Form SSA-44 with SSA and request that his IRMAA be recalculated using his current, lower income. If approved, the adjustment usually takes effect within one to two billing cycles.
Scenario 3: The Widow Who Successfully Appealed IRMAA
Patricia is 72 and has been on a Medicare Advantage plan for five years. Her husband Robert passed away in March 2025. When they filed jointly in 2024, their combined MAGI was $250,000, which put them in the second IRMAA bracket.
Patricia’s 2026 IRMAA notice arrived showing she owes $284.10 per month for Part B and an additional $14.50 for Part D — based on that joint 2024 return.
| Patricia’s Appeal | Result |
|---|---|
| Life-changing event | Death of spouse (March 2025) |
| Form filed | SSA-44 |
| 2026 income as a single widow | $78,000 |
| Income threshold for single filer | $109,000 |
| New IRMAA after appeal | $0 — standard premium restored |
Patricia filed Form SSA-44 at her local Social Security office with a copy of Robert’s death certificate and an estimate of her 2025 income. SSA reviewed her case and agreed that her current income fell below the $109,000 threshold. Her IRMAA surcharge was removed, saving her $1,148.40 per year in unnecessary premiums.
How to Appeal IRMAA Using Form SSA-44
Filing Form SSA-44 is not technically an appeal. It is a request for a new initial determination based on a qualifying life-changing event that reduced your income. This is an important distinction because it means the process is faster and simpler than the formal appeals process.
Eight Qualifying Life-Changing Events
The SSA recognizes these specific life-changing events for IRMAA reconsideration:
- Marriage
- Divorce or annulment
- Death of a spouse
- Work stoppage (retirement or job loss)
- Work reduction (cutting back hours or moving to part-time)
- Loss of income-producing property (due to disaster, theft, or circumstances beyond your control)
- Loss or reduction of pension income
- Receipt of an employer settlement payment
The event must have happened after the tax year SSA used for your current IRMAA determination, and it must have caused a significant drop in your income. You cannot use Form SSA-44 simply because you disagree with the surcharge or think it’s unfair.
Step-by-Step Process for Filing SSA-44
Step 1: Get the form. Download Form SSA-44 from SSA’s website or pick one up at your local Social Security office.
Step 2: Identify your life-changing event. Section 1 of the form asks you to select which qualifying event applies and provide the exact date it occurred. Be precise — SSA needs to verify that the event happened and when.
Step 3: Provide income estimates. The form requires you to estimate your MAGI for the year affected by the life-changing event. Gather supporting documents like pension statements, Social Security benefit letters, or a letter from your former employer confirming your retirement date.
Step 4: Attach documentation. Include proof of the life-changing event. For retirement, this could be a letter from your employer. For death of a spouse, a death certificate. For divorce, a copy of the divorce decree. SSA needs evidence that the event actually happened and that it reduced your income.
Step 5: Submit the form. You can submit Form SSA-44 at your local Social Security office or mail it in. Some people also submit it online through SSA.
Step 6: Wait for the decision. If approved, the adjustment typically takes effect within one to two billing cycles. You may also receive a refund if you already overpaid based on the old income data.
What Happens If Your SSA-44 Is Denied
If SSA denies your request, you can file a formal appeal using Form SSA-561-U2 (Request for Reconsideration). This triggers a full review by a different SSA employee who was not involved in the original decision.
If the reconsideration is also denied, the next level is a hearing before the Office of Medicare Hearings and Appeals (OMHA). After that, you can appeal to the Medicare Appeals Council and ultimately to federal court if necessary. Most cases are resolved at the SSA-44 stage, though, because the qualifying events are straightforward to document.
Income Planning Strategies to Reduce or Avoid IRMAA
The best way to manage IRMAA is to plan your income before you cross a threshold. Once a high-income year hits your tax return, you’re locked into that IRMAA determination two years later.
Strategic Roth Conversions
Converting money from a traditional IRA to a Roth IRA is one of the most powerful tools for reducing future IRMAA exposure. The conversion amount counts as taxable income now, but qualified Roth withdrawals in retirement are tax-free and do not count toward MAGI.
The key is to spread conversions across multiple years rather than doing one large conversion. Converting $30,000 per year over four years keeps your income steady. Converting $120,000 all at once could spike your MAGI into a high IRMAA bracket for that year.
Qualified Charitable Distributions (QCDs)
If you are 70½ or older, you can donate up to $105,000 per year directly from your IRA to a qualified charity. A QCD satisfies your Required Minimum Distribution (RMD) but does not count as taxable income on your return. This directly lowers your MAGI and can keep you below an IRMAA threshold.
Manage Capital Gains Carefully
Selling investments, rental properties, or a business can spike your MAGI and push you into a higher IRMAA bracket. When possible, spread large sales across multiple tax years to avoid a single-year income spike. You can also use tax-loss harvesting — selling investments at a loss to offset gains — to reduce your net capital gains.
Delay or Manage Required Minimum Distributions
The SECURE Act 2.0 raised the age for Required Minimum Distributions (RMDs) to 73 starting in 2023, and it will rise to 75 by 2033. Delaying RMDs can keep your MAGI lower during the early years of Medicare eligibility. If you can live on other income sources like Roth withdrawals or taxable brokerage accounts, postponing RMDs gives your tax-deferred accounts more time to grow while keeping IRMAA at bay.
Balance Withdrawals Across Account Types
Retirees with multiple account types — taxable brokerage, traditional IRA, and Roth IRA — should pull income strategically from each bucket. Use Roth and HSA funds to fill income gaps when your traditional account withdrawals approach an IRMAA threshold. This “bucket strategy” gives you control over how much taxable income appears on your return each year.
IRMAA Mistakes That Cost Retirees Thousands
Mistake 1: Ignoring Municipal Bond Interest
Many retirees invest in municipal bonds for tax-free interest income. But that interest gets added back to your AGI when SSA calculates your IRMAA MAGI. A retiree earning $100,000 in AGI plus $15,000 in municipal bond interest has an IRMAA MAGI of $115,000 — enough to trigger the first IRMAA surcharge bracket.
Mistake 2: Doing a Large Roth Conversion in a Single Year
Converting a $200,000 traditional IRA all at once adds $200,000 to your taxable income that year. This can catapult your MAGI into the fourth or fifth IRMAA tier, creating a surcharge that lasts for an entire year of premiums two years later. Splitting conversions into $30,000–$50,000 annual chunks is almost always the smarter approach.
Mistake 3: Filing Taxes as Married Filing Separately
The IRMAA brackets for married filing separately are punishing. There are only three brackets instead of six, and anyone earning over $109,000 immediately jumps to the second-highest surcharge level. Unless there is a serious legal reason to file separately, married couples on Medicare should almost always file jointly.
Mistake 4: Not Filing Form SSA-44 After Retiring
David’s scenario above is one of the most common IRMAA mistakes. Retirees often assume they are stuck paying the surcharge until their lower-income tax return catches up two years later. But retirement qualifies as a work stoppage — one of the eight life-changing events SSA accepts. Filing SSA-44 can remove the surcharge within weeks.
Mistake 5: Forgetting That Mutual Fund Distributions Count
At the end of every year, many mutual funds distribute capital gains and dividends to shareholders. These distributions are taxable income even if you reinvest them automatically. Retirees near an IRMAA threshold can be pushed over it by a surprise year-end mutual fund distribution they didn’t plan for.
Mistake 6: Not Paying the Part D IRMAA Separately
The Part D IRMAA surcharge is billed by Medicare, not by your Medicare Advantage plan. If your employer or retirement system pays your plan premium, you are still responsible for paying the Part D IRMAA yourself. Failing to pay this separate bill can result in a late payment and potential penalties.
Do’s and Don’ts for Managing IRMAA on Medicare Advantage
| Do | Why |
|---|---|
| Check your MAGI two years ahead | Your 2024 income determines your 2026 IRMAA — plan withdrawals and income events around the brackets |
| File Form SSA-44 after a qualifying event | Retirement, divorce, or death of a spouse can eliminate your surcharge within one to two billing cycles |
| Spread Roth conversions over multiple years | Smaller annual conversions keep your MAGI below IRMAA cliffs instead of spiking it in one year |
| Use QCDs for charitable giving after age 70½ | QCDs reduce your taxable RMD income without adding to your MAGI |
| Review your mutual fund holdings in November | Year-end capital gain distributions can push you over a threshold unexpectedly |
| Don’t | Why |
|---|---|
| Don’t file as married filing separately unless legally necessary | You lose most bracket protections and jump to near-maximum surcharges at $109,001 |
| Don’t ignore your IRMAA determination letter | Failing to respond or appeal means you accept the surcharge for the full year |
| Don’t assume a $0 premium MA plan means $0 total cost | You still owe the Part B premium plus any IRMAA surcharges on both Part B and Part D |
| Don’t wait two years for your lower income to “catch up” | File SSA-44 immediately after a life-changing event — don’t overpay while waiting |
| Don’t forget that tax-exempt interest counts for IRMAA | Municipal bond interest is added back to your AGI for the IRMAA MAGI calculation |
Pros and Cons of Medicare Advantage When IRMAA Applies
| Pro | Con |
|---|---|
| Many MA plans have $0 plan premiums, which offsets some IRMAA sting | You still pay the full Part B premium and IRMAA surcharges regardless of plan premium |
| MA plans often bundle Part D drug coverage, dental, vision, and hearing | The bundled Part D means you pay both Part B and Part D IRMAA surcharges |
| MA plans cap your annual out-of-pocket spending (MOOP) | IRMAA surcharges do not count toward your plan’s out-of-pocket maximum |
| MA plans may offer supplemental benefits like gym memberships and transportation | These extra benefits do not reduce or offset IRMAA costs |
| Some MA plans offer rebates that lower Part D premiums | The Part D IRMAA surcharge is paid to Medicare, not the plan, so rebates don’t apply to it |
Key Organizations and Their Roles in IRMAA
Several federal agencies and entities interact in the IRMAA process. Understanding who does what helps you know where to direct questions, payments, and appeals.
The Social Security Administration (SSA) makes the initial IRMAA determination each year by reviewing your IRS income data. SSA sends you the IRMAA determination letter and processes Form SSA-44 requests. If you disagree with your IRMAA, SSA is your first point of contact.
The Centers for Medicare & Medicaid Services (CMS) sets the annual Part B premium and publishes the official IRMAA bracket amounts each fall. CMS also bills you for any unpaid IRMAA if your Social Security check doesn’t cover the full amount.
The Internal Revenue Service (IRS) provides your tax return data to SSA. Your AGI from Line 11 and tax-exempt interest from Line 2a of Form 1040 are the two numbers that determine your IRMAA MAGI. The IRS does not make IRMAA decisions — it only supplies the income data.
The Office of Medicare Hearings and Appeals (OMHA) handles formal IRMAA appeals at the third level if your SSA-44 request and reconsideration are both denied. OMHA hearings involve an Administrative Law Judge who reviews your case independently.
Your Medicare Advantage plan itself has no role in IRMAA. Your plan does not set, collect, or adjust the surcharge. IRMAA is entirely a federal matter between you, SSA, and CMS. If you call your MA plan about IRMAA, they will direct you to SSA.
How IRMAA Payments Work for Medicare Advantage Members
Understanding how IRMAA is collected helps avoid missed payments and penalties.
Part B IRMAA is automatically deducted from your monthly Social Security benefit. If you don’t receive Social Security or your benefit isn’t large enough, CMS sends you a separate bill. You can pay through your MyMedicare.gov account, your bank’s bill pay service, Medicare Easy Pay (automatic deduction), or by mail to the Medicare Premium Collection Center.
Part D IRMAA is billed separately from your Part B premium and your MA plan premium. Medicare sends you a monthly bill for this amount. You pay it directly to Medicare — not to your Medicare Advantage insurer. Even if a third party or employer pays your MA plan premium, the Part D IRMAA is still your responsibility.
How IRMAA Interacts With the SECURE Act 2.0
The SECURE Act 2.0, enacted in late 2022, changed the rules for Required Minimum Distributions in ways that directly affect IRMAA planning.
Before 2023, retirees had to start taking RMDs at age 70½. The original SECURE Act in 2019 raised that to 72. SECURE Act 2.0 pushed it to 73 starting in 2023 and will raise it to 75 by 2033.
This delay creates a planning window. If you retire at 65 and don’t need to take RMDs until 73, you have up to eight years where you can draw from Roth accounts or taxable accounts while keeping your traditional IRA untouched. During those years, your MAGI stays lower, which can help you avoid IRMAA entirely during early Medicare enrollment.
The flip side is that delaying RMDs allows your traditional IRA to grow larger. When RMDs finally begin, they could be bigger and potentially push you into a higher IRMAA bracket later. Working with a financial advisor to model both scenarios is critical.
Comparing 2025 and 2026 IRMAA Thresholds
The IRMAA income thresholds are adjusted for inflation annually based on the Consumer Price Index for Urban Consumers (CPI-U). The top bracket ($500,000 single / $750,000 joint) is currently frozen and cannot be indexed for inflation until 2028.
| 2025 Single Threshold | 2026 Single Threshold |
|---|---|
| $106,000 | $109,000 |
| $133,500 | $137,000 |
| $167,000 | $171,000 |
| $200,000 | $205,000 |
| $500,000 (frozen) | $500,000 (frozen) |
The 2025-to-2026 increase of about 3% in the lower brackets means some retirees whose income stayed the same may drop out of an IRMAA bracket they were in the prior year. If your MAGI was $107,000 in both 2023 and 2024, you would have paid IRMAA in 2025 (threshold: $106,000) but not in 2026 (threshold: $109,000). Checking the updated thresholds every year is essential.
How IRMAA Affects Your Total Medicare Advantage Costs
Many people focus only on their MA plan’s premium and forget about the federal costs layered on top. Here’s a breakdown of what a Medicare Advantage member at the third IRMAA tier (single filer, MAGI $137,001–$171,000) pays each month in 2026:
| Cost Component | Monthly Amount |
|---|---|
| MA plan premium (example: $0 plan) | $0 |
| Standard Part B premium | $202.90 |
| Part B IRMAA surcharge (Tier 3) | $202.90 |
| Part D IRMAA surcharge (Tier 3) | $37.50 |
| Total monthly cost | $443.30 |
That same person on a $0-premium MA plan without IRMAA would pay only $202.90 per month. IRMAA more than doubles their Medicare costs. Over a full year, the difference is $2,884.80 — money that goes entirely to the federal government, not to your plan’s benefits.
FAQs
Does IRMAA apply to Medicare Advantage plans?
Yes. IRMAA surcharges apply to both Part B and Part D premiums, which Medicare Advantage members pay on top of their plan premium.
Can I avoid IRMAA by switching from Original Medicare to Medicare Advantage?
No. IRMAA is based on your income, not the type of Medicare plan you choose. It applies equally to both.
Does my Medicare Advantage plan collect the IRMAA payment?
No. Part B IRMAA comes from your Social Security check. Part D IRMAA is billed separately by Medicare.
Is the Part D IRMAA surcharge included in my MA plan premium?
No. The Part D surcharge is paid directly to Medicare, not to your plan, even if your MA plan includes drug coverage.
Can I appeal IRMAA if I just retired?
Yes. Retirement counts as a “work stoppage” life-changing event. File Form SSA-44 with SSA to request a recalculation.
Does selling my house trigger IRMAA?
Yes. Capital gains from a home sale increase your MAGI, which can push you into a higher IRMAA bracket two years later.
Does Roth IRA income count toward IRMAA?
No. Qualified Roth withdrawals are not included in your MAGI. However, Roth conversions do count as taxable income in the conversion year.
Does tax-exempt municipal bond interest affect IRMAA?
Yes. Tax-exempt interest is added back to your AGI when calculating the IRMAA-specific MAGI.
How long does an SSA-44 appeal take?
Typically one to two billing cycles. If approved, adjustments apply to future premiums and you may receive a refund for overpayments.
Does IRMAA count toward my MA plan’s out-of-pocket maximum?
No. IRMAA surcharges are federal premium charges and do not count toward your Medicare Advantage plan’s annual spending limit.
Can both spouses be charged IRMAA?
Yes. Each spouse on Medicare is assessed IRMAA individually based on the couple’s joint tax return, so both pay the surcharge.
Is IRMAA a one-time charge or ongoing?
Ongoing. SSA recalculates IRMAA every year based on your tax return from two years prior. If your income drops, your surcharge can decrease or disappear.
Can I deduct IRMAA surcharges on my taxes?
Yes. IRMAA surcharges are considered Medicare premiums and may be deductible as a medical expense if your total medical costs exceed 7.5% of your AGI.
What happens if I don’t pay the Part D IRMAA bill?
Late fees accrue. Medicare can also disenroll you from Part D coverage if the surcharge remains unpaid for an extended period.
Does IRMAA affect Medicare Part A premiums?
No. There is no income-related surcharge for Medicare Part A, even for the small percentage of people who pay a Part A premium.
Related reading
- How Income Affects Medicare Part B (IRMAA)? (w/Examples) + FAQs
- 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
- What Is Medicare Part B IRMAA? (w/Examples) + FAQs
- Are IRMAA Premiums Per Person? (w/Examples) + FAQs
- Is Nationwide Long-Term Care Insurance Worth It? (w/Examples) + FAQs