What is IRMAA? It is the Income-Related Monthly Adjustment Amount — the extra charge the government adds to your Medicare Part B and Part D premiums when your income is above a set line. Most retirees never pay it. But if your income crosses the threshold, the surcharge lands automatically, and at the top tier it can add $578 a month to what you pay for Medicare: $487 on Part B and $91 on Part D in 2026.
That is real money — $6,936 a year, per person. And because the charge applies to each enrolled spouse separately, a couple in the top tier pays nearly $13,872 a year extra between them. The good news is that IRMAA is not permanent, and it is not a penalty. It is a surcharge tied to your income, and in some situations you can appeal it. For the full projected 2027 bracket table, see our IRMAA brackets 2027 guide: https://northchecknews.com/irmaa-brackets-2027/
How IRMAA works: the two-year lookback
Social Security decides your IRMAA from your tax return from two years earlier. Your 2026 premiums are based on your 2024 tax return, and your 2027 premiums will be based on your 2025 return. The income figure used is your modified adjusted gross income, or MAGI — your adjusted gross income plus any tax-exempt interest.
That two-year lag catches people off guard. A Roth conversion or a big capital gain in 2025 will not show up in your Medicare bill until 2027, when it is already too late to undo. By the same token, if your income has dropped since the tax year Social Security used, you may be paying a surcharge on income you no longer earn — and that is exactly the situation the appeal process exists for.
The 2026 IRMAA table (confirmed by CMS)
These are the confirmed 2026 figures, published by CMS on November 14, 2025. The standard Part B premium in 2026 is $202.90 a month.
- $109,000 or less (single) / $218,000 or less (joint): Part B $202.90 a month, Part D add-on $0
- $109,001 to $137,000 / $218,001 to $274,000: Part B $284.10, Part D +$14.50
- $137,001 to $171,000 / $274,001 to $342,000: Part B $405.80, Part D +$37.50
- $171,001 to $205,000 / $342,001 to $410,000: Part B $527.50, Part D +$60.40
- $205,001 to under $500,000 / $410,001 to under $750,000: Part B $649.20, Part D +$83.30
- $500,000 or more / $750,000 or more: Part B $689.90, Part D +$91.00
Married filing separately has compressed tiers, with the surcharge starting at much lower income. The Part D surcharge is added on top of whatever your drug plan already charges.
What changes in 2027 — every figure projected
CMS has not announced the official 2027 Part B premium or IRMAA brackets as of today, November 12, 2026. Last year the announcement came on November 14, so it could land any day. Until then, every 2027 figure is a projection — do not present any of them as final.
The 2026 Medicare Trustees Report projects the standard Part B premium at $209.50 a month in 2027, up $6.60 from $202.90. The first IRMAA threshold is projected at about $112,000 for a single filer and about $224,000 for a couple filing jointly, based on your 2025 tax return. The full projected tier-by-tier table is in our IRMAA brackets 2027 post: https://northchecknews.com/irmaa-brackets-2027/ — and our Medicare Part B 2027 costs post explains why $209.50 is still only a projection: https://northchecknews.com/medicare-2027-costs-part-b-premium-still-not-final-here-is-what-is-actually-set/
One warning: your 2025 income is already locked in. Anything you earned, sold, or converted in 2025 will set your 2027 premiums. Moves you make in 2026 affect 2028, not 2027.
The cliff: one dollar can cost you $1,148
IRMAA works in steps, not a smooth slope. Cross a threshold by one dollar and you pay the full surcharge for that tier, for all 12 months. A couple with joint MAGI of $218,000 pays no IRMAA at all in 2026. At $218,001, each enrolled spouse pays an extra $95.70 a month — $1,148.40 a year per person, $2,296.80 for the couple. That is why retirees who sit close to a line plan their withdrawals and conversions carefully, and why a one-off gain in a single year can be so expensive.
How to appeal IRMAA: Form SSA-44
If your income has dropped since the tax year Social Security used, you can ask for a new decision. File Form SSA-44, the Medicare Income-Related Monthly Adjustment Amount — Life-Changing Event form, with proof of the event and your lower income. The qualifying life-changing events are marriage, divorce or annulment, death of your spouse, work reduction, work stoppage (including retirement), loss of income-producing property, loss of pension income, and an employer settlement payment.
Social Security usually decides within about 30 to 90 days. If the appeal succeeds, the surcharge is reduced or removed, and any excess premiums already paid are refunded. You can also ask for a new determination if the tax information Social Security used was wrong — for example, if you filed an amended return.
Can you lower IRMAA next year?
A few planning levers exist, as general information only: timing Roth conversions so they do not all land in one year, spreading capital gains across years, and qualified charitable distributions from an IRA after age 70 and a half, which do not count in adjusted gross income. None of this is personal financial advice — the rules are individual, and a tax professional can run your numbers. What matters most is knowing the two-year lag exists, so a decision you make this year does not surprise you two years from now.
IRMAA hits a small slice of retirees — roughly 1 in 14 Medicare beneficiaries pay it — but for those it hits, it is one of the biggest line items in a retirement budget. Know your MAGI, know the two-year lag, and know that a life-changing event gives you a route to appeal. And remember that your January 2027 Social Security check already reflects the 3.6% COLA, with the projected Part B rise taken out of it: https://northchecknews.com/january-2027-social-security-check-cola-medicare-part-b/ — the COLA itself is confirmed here: https://northchecknews.com/social-security-cola-2027/
FAQ: What is IRMAA?
What does IRMAA stand for?
IRMAA stands for Income-Related Monthly Adjustment Amount — the income-based surcharge added to Medicare Part B and Part D premiums when your modified adjusted gross income is above the threshold.
Does IRMAA apply to Medicare Advantage?
Yes. If you have a Medicare Advantage plan with drug coverage, the Part B IRMAA still applies, and the Part D IRMAA applies to the drug portion. The surcharge is billed separately by Social Security, not by your plan, and it is usually deducted from your Social Security payment.
Will IRMAA go away if my income drops?
It resets every year, based on your tax return from two years earlier, so a lower income eventually flows through on its own. If the drop followed a life-changing event such as retirement, file Form SSA-44 for a faster review instead of waiting for the two-year cycle.
How do I know if I am paying IRMAA?
Social Security sends a letter (an Initial IRMAA Determination) before the year starts. The amount also shows in your my Social Security account, and the premium is usually deducted from your monthly Social Security payment.
Can I appeal IRMAA if I retired?
Yes — retirement, or work stoppage, is one of the eight qualifying life-changing events on Form SSA-44. File the form with proof of your retirement and your reduced income, and Social Security will review your surcharge.
Sources
- CMS, “2026 Medicare Parts A & B Premiums and Deductibles” fact sheet, November 14, 2025 (CMS-8091-N)
- Social Security Administration, Program Operations Manual System (POMS) HI 01101.010 and HI 01101.020
- 2026 Medicare Trustees Report (June 9, 2026) — 2027 projections
- Social Security Administration, Form SSA-44 (Medicare Income-Related Monthly Adjustment Amount — Life-Changing Event)