IRMAA (Income-Related Monthly Adjustment Amount) is a surcharge on your Medicare Part B and Part D premiums if your income exceeds certain thresholds. It's based on your tax return from two years ago — so your 2024 income determines your 2026 IRMAA.
2026 IRMAA Brackets — Part B
| Single Filer MAGI | Married Filing Jointly MAGI | Monthly Part B Premium | Annual Surcharge |
|---|---|---|---|
| $103,000 or less | $206,000 or less | $185.00 (standard) | $0 |
| $103,001 - $129,000 | $206,001 - $258,000 | $259.00 | $888/yr |
| $129,001 - $161,000 | $258,001 - $322,000 | $370.00 | $2,220/yr |
| $161,001 - $193,000 | $322,001 - $386,000 | $480.90 | $3,551/yr |
| $193,001 - $500,000 | $386,001 - $750,000 | $591.90 | $4,883/yr |
| Above $500,000 | Above $750,000 | $628.90 | $5,327/yr |
*2026 brackets are projected based on CMS inflation adjustments. Actual numbers may vary slightly when officially published.
What Counts as MAGI for IRMAA?
Your Modified Adjusted Gross Income includes:
- Wages, salary, self-employment income
- Social Security benefits (taxable portion)
- IRA and 401(k) withdrawals
- Roth conversions (this is where people get surprised)
- Pension income
- Capital gains
- Rental income
- Tax-exempt interest (municipal bonds)
The Two-Year Look-Back
Medicare uses your tax return from two years prior:
| Medicare Year | Based on Tax Return From |
|---|---|
| 2026 | 2024 |
| 2027 | 2025 |
| 2028 | 2026 |
This means a large Roth conversion or one-time capital gain in 2026 won't hit your Medicare premiums until 2028. Plan accordingly.
How to Avoid or Reduce IRMAA
1. Manage Your Income Carefully
If you're close to a threshold, reducing your income by even $1 can save you $888-$5,327 per person. Consider deferring a Roth conversion or spreading capital gains across two years.
2. Use Roth Withdrawals
Roth IRA withdrawals do NOT count toward MAGI. If you've done conversions in prior years, Roth withdrawals are your IRMAA-free income source.
3. Appeal with a Life-Changing Event
If your income dropped due to retirement, divorce, death of a spouse, or work reduction, you can file SSA-44 to request IRMAA recalculation based on current income.
4. Strategic Roth Conversions Before Medicare
The years before age 65 are the ideal time to do Roth conversions — you get the tax-bracket benefit without any IRMAA consequence. See our Roth conversion strategy guide.
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