What Is IRMAA?
IRMAA is an extra Medicare charge for people with higher income. It can raise your Part B and Part D costs, often based on income from two years ago.
The Simple Answer
IRMAA stands for Income-Related Monthly Adjustment Amount. It is an additional amount some people pay on top of their Medicare Part B and Part D premiums when their income is above certain limits.
IRMAA does not give you better Medicare coverage. It is simply a higher premium based on income.
Plain English: IRMAA is Medicare’s income surcharge. If your income is high enough, you pay more for the same Medicare Part B and Part D coverage.
Which Parts of Medicare Can Have IRMAA?
IRMAA can apply to Medicare Part B and Medicare Part D.
| Medicare Part | Can IRMAA Apply? | What It Means |
|---|---|---|
| Part A | No | IRMAA does not apply to Medicare Part A. |
| Part B | Yes | You may pay more than the standard Part B premium. |
| Part C / Medicare Advantage | Indirectly | IRMAA still applies if you have Part B and/or Part D through a Medicare Advantage plan. |
| Part D | Yes | You may pay an extra Part D amount in addition to your drug plan premium. |
How Is IRMAA Calculated?
Social Security generally uses tax return information from two years ago to decide whether you owe IRMAA.
For example, your 2026 IRMAA is generally based on income reported on your 2024 tax return. Social Security uses information from the IRS to make that decision.
What Income Counts?
IRMAA is usually based on modified adjusted gross income. That can include income such as wages, Social Security benefits, pensions, IRA withdrawals, capital gains, dividends, interest and tax-exempt interest.
Watch this: A one-time income spike can trigger IRMAA. Selling property, taking a large retirement withdrawal or doing a Roth conversion may raise Medicare premiums two years later.
IRMAA Estimate Calculator
Use this simple calculator to estimate whether IRMAA may apply for 2024, 2025 or 2026. This is based on Medicare premium year, filing status and MAGI.
This is an estimate only. IRMAA is determined by Social Security using IRS tax data, usually from two years prior. Part D amounts are added to your plan premium.
Why Did I Get an IRMAA Notice?
If Social Security determines your income is above the IRMAA threshold, they may send a notice explaining that you owe a higher Medicare premium.
The notice should explain which tax year was used and how much extra you are expected to pay.
Can You Appeal IRMAA?
Yes, in some situations you can ask Social Security to lower or remove IRMAA.
You may have a valid reason if your income has gone down because of a life-changing event.
Common Life-Changing Events
- Marriage
- Divorce or annulment
- Death of a spouse
- Work stoppage
- Work reduction
- Loss of income-producing property
- Loss or reduction of pension income
- Employer settlement payment
Social Security uses Form SSA-44 for many IRMAA life-changing event requests.
What Usually Does Not Work as an Appeal?
Not every income spike qualifies for relief.
- A planned Roth conversion
- Capital gains from selling investments
- A large IRA withdrawal
- Higher income from normal business activity
- A one-time income event without a qualifying life-changing event
Blunt truth: “I did not know this would happen” is usually not enough. IRMAA is where tax planning and Medicare planning collide.
How Do You Pay IRMAA?
If you receive Social Security benefits, IRMAA may be deducted from your benefit payment.
If you do not receive Social Security benefits, you may receive a bill from Medicare or need to pay another way.
How to Reduce Future IRMAA Risk
You cannot always avoid IRMAA, but you can plan better when you know how it works.
Planning Questions to Ask
- Will retirement income push me into an IRMAA bracket?
- Will a Roth conversion affect Medicare premiums later?
- Will selling property create a two-year Medicare premium surprise?
- Are required minimum distributions going to raise my income?
- Should I coordinate with a tax professional before taking a large withdrawal?
- Did my income drop because of retirement, reduced work or death of a spouse?
Bottom Line
IRMAA is an extra Medicare charge based on income. It can apply to Medicare Part B and Part D, and it is usually based on your tax return from two years ago.
The big mistake is looking only at today’s Medicare premium and ignoring how retirement income, capital gains, IRA withdrawals or Roth conversions may affect future Medicare costs.
Worried About IRMAA?
If your income changed, or you received an IRMAA notice, it is worth reviewing what triggered it before you assume you are stuck with it.
Contact MichelleThis page is for educational purposes only and is not legal, tax, financial or Medicare advice. IRMAA rules, income brackets and premium amounts can change each year. Always confirm current figures with Medicare, Social Security, your plan, your tax professional or a qualified advisor.