The 2026 IRMAA Brackets

To read it, find your 2024 MAGI in the first two columns, then slide right: the third column is your total 2026 monthly Part B premium (the $202.90 base plus the surcharge), and the fourth is the IRMAA amount added on top of whatever your Part D drug plan charges. Married-filing-separately filers follow a separate, compressed schedule that reaches the top tier at $391,000.

The detail that catches people off guard is that IRMAA is a cliff, not a marginal calculation. Cross a threshold by a single dollar and you owe the full surcharge for that entire tier — for the whole year. A joint filer at $274,001 pays the Tier 2 rate; at $274,000, the Tier 1 rate. That one dollar is worth roughly $3,475 a year for the couple.

Quick Answers to the Top IRMAA Questions

At what income does IRMAA start in 2026?

It begins the moment your 2024 MAGI exceeds $109,000 (single) or $218,000 (married filing jointly). Below those lines you pay only the standard $202.90 Part B premium and your plan’s Part D premium. One dollar above, and the first surcharge tier applies. See the full bracket table above.

Why is my 2026 premium based on 2024 income?

Medicare uses a two-year lookback because the Social Security Administration sets your premium in late 2025, before any more recent return exists. Your 2024 return (filed in 2025) is the most current data the IRS can hand over. More on the lookback mechanics below.

What income counts toward IRMAA?

Essentially everything on your return that flows into adjusted gross income — wages, IRA and 401(k) withdrawals, capital gains, dividends, pensions, the taxable share of Social Security — plus tax-exempt municipal bond interest, which is added back. The full counts-vs-doesn’t-count list is below.

Does Social Security count?

Only the taxable portion. Depending on your other income, up to 85% of your benefits can be taxable, and that taxable amount lands in your MAGI. The part of your Social Security that isn’t taxed does not count toward IRMAA.

Can I avoid or appeal it?

Yes to both. You can manage MAGI in advance with conversions, charitable distributions, and careful timing, and if a life-changing event has lowered your income, you can file Form SSA-44 to have IRMAA recalculated on your current income instead of your 2024 return.

What Is IRMAA, Exactly?

IRMAA is a surcharge that higher-income beneficiaries pay on top of the standard premiums for Medicare Part B (doctor and outpatient services) and Part D (prescription drugs). The Social Security Administration determines it from your tax return and notifies you by mail; the extra amount is typically deducted straight from your Social Security check or billed alongside your premium.

The logic is that the government subsidizes roughly 75% of Part B and Part D costs for most beneficiaries, and IRMAA simply asks higher earners to cover a larger share — 35% up to 85% of program cost across the five tiers, instead of the standard 25%. Fewer than one in ten Medicare beneficiaries pay it.

One point that surprises new enrollees: IRMAA isn’t limited to Original Medicare. If you’re on a Medicare Advantage plan with drug coverage (an MA-PD), the Part B and Part D surcharges still apply — they’re tied to you and your income, not to which flavor of Medicare you chose.

How IRMAA Is Calculated: The Two-Year Lookback

The income figure that drives IRMAA is your MAGI, defined for this purpose as your adjusted gross income plus any tax-exempt interest (chiefly municipal bond interest). For 2026 premiums, Medicare looks at your 2024 MAGI. For 2027 it will use 2025; for 2028, 2026. The pattern never changes: this year’s premium reflects the income from two years ago.

That delay is exactly why one-time events bite so hard. A retiree who sold a rental property, realized a large capital gain, or did a sizable Roth conversion in 2024 may have a perfectly modest income in 2026 — yet still pay a top-tier surcharge, because the premium is anchored to that 2024 spike. The same lag works in your favor on the way down: when a one-time income event rolls off, your IRMAA falls automatically the next year. You are not penalized for life.

Three features are worth fixing in your mind, because they shape every planning decision that follows. IRMAA is a cliff (a dollar over the line triggers the whole tier). It is assessed per person, so a married couple where both are on Medicare can pay it twice. And it recurs every year your lookback income stays above a threshold. Households under 65 face a structurally similar income cliff in the insurance marketplace — see our breakdown of the 2026 ACA subsidy cliff for that parallel.

What Counts as Income for IRMAA (and What Doesn’t)

Because IRMAA keys off MAGI, the planning question is always the same: which dollars land in MAGI and which don’t? The line between the two columns below is where most of the strategy lives.

Two entries deserve a flag. First, the muni interest in the left column genuinely catches people: income that’s free of federal tax is still counted for IRMAA. Second, notice the asymmetry in the Roth line — a Roth conversion raises MAGI in the year you do it, but a qualified Roth withdrawal later is invisible to IRMAA. That single distinction underpins most of the strategies below.

How to Avoid (or Reduce) IRMAA

IRMAA is one of the more controllable costs in retirement, precisely because you can see the brackets in advance and you control much of your own MAGI. The goal isn’t always to dodge IRMAA entirely — sometimes a tier bump is worth it — but to make the decision deliberately rather than discover it on a letter from Social Security. Here are the levers, with the catch attached to each.

Do Roth conversions before Medicare starts

The years between retirement and age 65 are the golden window. Income is often lower, tax brackets are favorable, and crucially, conversions done before you’re on Medicare don’t trigger IRMAA at all. Because of the two-year lookback, age 63 is the last year you can convert without the conversion feeding into a Medicare premium. Our Roth vs. traditional IRA guide walks through how to size those conversions.

Satisfy RMDs with Qualified Charitable Distributions

If you’re charitably inclined and at least 70½, a QCD lets you send money straight from your IRA to a charity. It counts toward your required minimum distribution but never appears in your AGI — so it lowers the very number IRMAA is measured against. A retiree giving $20,000 a year can shave that full amount off MAGI while meeting part or all of an RMD.

Harvest losses to offset gains

Capital gains feed directly into MAGI, so offsetting them matters. Selling underwater positions to bank losses against realized gains can keep a profitable year from pushing you into the next tier. See our guide to tax-loss harvesting for the mechanics and the wash-sale traps.

Sequence and spread your withdrawals

An IRMAA-aware withdrawal plan treats each bracket edge as a line not to cross casually. Sometimes pulling a little more from Roth accounts early — even though they’re traditionally drawn last — lowers MAGI enough to drop a tier. Our overview of retirement income planning covers withdrawal sequencing in depth.

Respect the cliff

Above all, remember what the cliff means in dollars. Because the surcharge jumps in full steps, the last dollar before a threshold is the cheapest dollar of income you’ll earn all year, and the first dollar past it is by far the most expensive. Before any year-end conversion, gain harvest, or discretionary withdrawal, calculate your room to the next tier first.

Already Hit? How to Appeal IRMAA (Form SSA-44)

If your 2024 income was high because you were still working — or because of an event that won’t repeat — and your circumstances have since changed, you may not have to accept the surcharge. The Social Security Administration allows an appeal when a life-changing event has reduced your income. The qualifying events are specific:

• Death of a spouse
• Marriage
• Divorce or annulment
• Work stoppage (such as retirement)
• Work reduction (cutting back hours)
• Loss of income-producing property
• Loss or reduction of certain pension income
• An employer settlement payment

To appeal, file Form SSA-44 (Medicare Income-Related Monthly Adjustment Amount — Life-Changing Event) with the Social Security Administration. You document the event, report a more accurate estimate of your current-year income, and attach supporting evidence — for example, a retirement letter or a death certificate. If approved, Social Security recalculates IRMAA using your reduced income instead of your 2024 return. This is one of the most underused tools in retirement planning; many people simply pay the surcharge without realizing a routine retirement can qualify them to challenge it. You can download the current form and instructions at SSA.gov.

Can You Deduct IRMAA or Medicare Premiums on Taxes?

Sometimes — and the IRMAA portion counts right alongside the base premium. There are two main routes.

If you have self-employment income, the self-employed health insurance deduction can include your Medicare Part B, Part D, and Medicare Advantage premiums (and IRMAA), taken as an above-the-line deduction without having to itemize. For everyone else, Medicare premiums — IRMAA included — are a qualifying medical expense, deductible as part of itemized deductions to the extent your total medical costs exceed 7.5% of your adjusted gross income. Many retirees never clear that floor, so this route helps mainly in years with heavy medical spending.

Separately, retirees 65 and older now have a new lever on taxable income: the $6,000 senior deduction created under the 2025 tax law, available for tax years 2025 through 2028 (per eligible person, so up to $12,000 for a qualifying couple). It phases out above $75,000 of MAGI for singles and $150,000 for joint filers, and it’s available whether or not you itemize. It doesn’t reduce IRMAA directly, but it’s part of the same income-management picture. We cover it in detail in our guide to the new $6,000 senior tax deduction, and rounding up the rest is our checklist of tax deductions you’re probably missing.

Medicare Part B & Part D Premiums in 2026

The standard Part B premium for 2026 is $202.90 a month, up from $185.00 in 2025, with an annual Part B deductible of $283. That standard premium is what the roughly 90% of beneficiaries below the IRMAA thresholds pay. Everyone else pays it plus their surcharge.

The standalone Part D premium varies by plan — it averages around $34.50 a month in 2026 — and IRMAA, when it applies, is added on top of whatever your specific drug plan charges. As income climbs the five tiers, the total Part B premium rises from $202.90 all the way to $689.90, and the Part D surcharge from $14.50 to $91.00. For the exact figure at your income, return to the bracket table at the top.

Common IRMAA Mistakes Retirees Make

• Ignoring the two-year lookback. Planning around this year’s income when the premium is set by income from two years ago.
• A surprise Roth conversion near a bracket edge. Converting a round number without checking how close it lands to the next threshold.
• Forgetting that muni interest counts. Assuming tax-free bond income is also IRMAA-free. It isn’t — it’s added back.
• Not appealing after retirement. Paying a surcharge based on full working-year income instead of filing Form SSA-44.
• Treating IRMAA as marginal. Assuming only the dollars over the line are surcharged, when in fact the whole tier applies.
• Overlooking the per-person doubling. A couple where both are on Medicare can owe the surcharge twice.

Frequently Asked Questions

At what income do Medicare premiums go up in 2026?

Once your 2024 MAGI exceeds $109,000 (single) or $218,000 (married filing jointly), the first IRMAA surcharge applies and your total Part B premium rises from $202.90 to $284.10 a month, with a Part D surcharge added as well.

Does Social Security income count toward IRMAA?

Yes — the taxable portion does. Depending on your other income, up to 85% of your Social Security benefits can be taxable, and that taxable amount is part of the MAGI used to set your premium. The untaxed portion does not count.

Do capital gains count as income for IRMAA?

Yes. Realized capital gains, including capital-gain distributions from mutual funds, flow into your AGI and therefore your MAGI. A large gain — from selling a property or rebalancing a portfolio — is one of the most common reasons people are surprised by a surcharge two years later.

Do 401(k) and IRA withdrawals count toward IRMAA?

Taxable withdrawals from traditional 401(k)s and IRAs — including required minimum distributions — count in full. Qualified withdrawals from Roth accounts do not, which is why pre-Medicare Roth conversions are such a useful planning tool.

How do I avoid IRMAA when selling my house?

Use the home-sale exclusion: up to $250,000 of gain for a single filer or $500,000 for a married couple is excluded from income if you meet the ownership and use tests. Only gain above that exclusion counts toward MAGI, so avoid stacking a home sale in the same year as large withdrawals or conversions.

Is IRMAA based on this year’s income or a prior year?

A prior year. Your 2026 surcharge is based on your 2024 MAGI — a two-year lookback — because that’s the most recent return Social Security can access when premiums are set in late 2025.

Can I deduct Medicare Part B premiums on my taxes?

Possibly. If you’re self-employed, Medicare premiums (including IRMAA) can be claimed under the self-employed health insurance deduction. Otherwise they count as an itemized medical expense, deductible only to the extent your total medical costs exceed 7.5% of your AGI.

How much is Medicare if you make $500,000 a year?

A single filer with 2024 MAGI of $500,000 or more falls in the top tier: a total Part B premium of $689.90 a month plus a $91.00 Part D surcharge. For a married couple filing jointly, the top tier starts at $750,000, and each spouse on Medicare pays those amounts.

Can I appeal IRMAA after I retire?

Yes. Retirement counts as a “work stoppage,” a qualifying life-changing event. File Form SSA-44 with the Social Security Administration, document the event, and provide an estimate of your reduced current income; if approved, your surcharge is recalculated on that lower figure.

Does IRMAA apply every year?

It’s re-evaluated annually. You pay a surcharge in any year your two-years-prior MAGI was above a threshold. If a one-time event pushed you over, the surcharge falls away automatically once your income drops back down — you are not locked into it for life.