Medicare Costs and IRMAA
See how higher income raises your Medicare premiums two years later, and how to plan around the cliffs.
TL;DR
- Pay the standard
partBpremium of $202.90, or more if income is high. - IRMAA sets your surcharge from your
MAGItwo years earlier. - Crossing a
bracketby one dollar triggers the full surcharge.
Medicare Premiums
Part AHospital coverage, free for most who paid Medicare taxes.
$0 for most enrolleesPart BDoctor and outpatient care, with a standard premium.
$202.90/month in 2026Part DDrug coverage, priced by the plan you choose.
Plan premium + any surchargePart B DeductibleYou pay this before Medicare starts sharing costs.
$257 in 2026How IRMAA Works
Income SurchargeHigher earners pay more for Part B and Part D.
Added to the standard premiumTwo-Year LookbackYour premium is set from your MAGI two years back.
2026 premium uses 2024 MAGIAutomaticThe SSA reads your tax return and bills the surcharge.
No form to opt inMedicare MAGIYour AGI plus any tax-exempt interest.
AGI + muni interest2026 Brackets (2024 MAGI)
StandardNo surcharge below the first income line.
<= $109,000 single / $218,000 jointTier 1The first surcharge step above the standard premium.
$284.10 Part B + $14.50 Part DMiddle TiersPremiums climb through several income bands.
$405.80 / $527.50 / $649.20 Part BTop TierThe highest incomes pay the largest surcharge.
$689.90 Part B (over $500k/$750k)Plan Around the Cliffs
Convert Before 63Roth conversions before the lookback window avoid a bump.
Age 63 MAGI sets age-65 premiumGive via QCDA charitable IRA gift meets your RMD without raising MAGI.
QCD keeps RMD out of MAGIStraddle Big SalesSplit a large gain across two years to stay in a tier.
Spread the gain, dodge the cliffAppeal a ChangeUse SSA-44 when a life event lowered your income.
Retired? File SSA-44Tips
- Project your
MAGItwo years ahead of any big taxable event, since a Roth conversion or home sale today sets your premium two years out. - Appeal with
Form SSA-44after a life change like retirement or a spouse's death lowered your income below the look-back year.
Warnings
- IRMAA is a
cliff, not a phase-in, so one dollar over a line can cost a couple more than $2,000 a year. - Tax-free
muniInterestand Roth conversions both count in Medicare MAGI, so 'tax-free' income can still raise your premium.
In Practice
See why the IRMAA cliff makes the last dollar of income so expensive.
You and your spouse are both on Medicare. Your 2024 MAGI lands right at $218,000 versus one dollar over it.
- At $218,000: standard $202.90 each = $405.80 a month.
- At $218,001: tier 1 is $284.10 each = $568.20 a month.
- Monthly jump: $568.20 - $405.80 = $162.40.
- Yearly cost: $162.40 x 12 = about $1,949, plus Part D surcharges.
One dollar over the line costs the couple about $1,949 in Part B.
Near an IRMAA line, managing MAGI by even a little pays off big.
FAQ
IRMAA, the Income-Related Monthly Adjustment Amount, is a surcharge added to Medicare Part B and Part D premiums for higher-income enrollees. The Social Security Administration calculates it automatically from your tax return, so you never sign up for it. It applies whether you have Original Medicare or a Medicare Advantage plan.
The Social Security Administration uses a two-year lookback because that is the most recent return it has when premiums are set. Your 2026 premium is based on your 2024 MAGI. So a single high-income year, like a large Roth conversion, can raise your premium two years later even after your income drops back down.
The standard Part B premium is $202.90 a month. IRMAA starts once 2024 MAGI passes $109,000 single or $218,000 joint, raising Part B to as much as $689.90 and adding a Part D surcharge of $14.50 to $91.00. In the top bracket, a couple can pay roughly $11,700 a year more than the standard premiums.
Yes. File Form SSA-44 if a life-changing event, retirement, divorce, the death of a spouse, or loss of income, cut your income after the lookback year. The SSA will use your current estimate instead of the outdated return. Without an event, you generally cannot appeal a surcharge that reflects your real income.