What IRMAA adds to your premium
Most people on Medicare pay one standard Part B premium. A smaller group pays more, because their income was above a set level, and the extra charge is called IRMAA, short for income-related monthly adjustment amount. The Centers for Medicare & Medicaid Services (CMS) says it affects roughly 8 percent of people with Part B. This guide explains how the charge is worked out, why a decision you make this year can change your premium two years from now, and where the cliffs are.
The standard Part B premium for 2026 is $202.90 a month, with a $283 deductible. If your income is above the first line, the Social Security Administration (SSA) adds a Part B surcharge, and a separate Part D surcharge applies to Medicare prescription drug coverage. The SSA says the Part D adjustment is paid to Medicare rather than your drug plan, and it is deducted from your Social Security benefit or billed to you. That means a Medicare Advantage or standalone drug plan with a low premium can still come with an IRMAA bill.
Which income counts
Medicare uses modified adjusted gross income, or MAGI. For IRMAA, the SSA defines it as your adjusted gross income plus tax-exempt interest. So municipal bond interest counts even though it is not taxed. Required minimum distributions, capital gains, the taxable part of Social Security and taxable Roth conversions are all inside adjusted gross income, so they count too. Qualified Roth distributions are not part of adjusted gross income.
Why the lookback matters
The SSA uses an old tax return. For 2026 premiums it generally uses the return you filed in 2025, which is your 2024 return, and if that is not yet available it may use 2023. The pattern is a two-year lookback: income in 2024 sets 2026 premiums, income in 2025 sets 2027 premiums, and income in 2026 sets 2028 premiums.
| Income earned in | Sets premiums for |
|---|---|
| 2024 | 2026 |
| 2025 | 2027 |
| 2026 | 2028 |
This is the part that surprises people. A large Roth conversion or the sale of a business in 2026 does not touch your 2026 premium. It raises your 2028 premium.
The 2026 brackets
CMS announced these figures on 14 November 2025. Each bracket adds a fixed amount to the standard premium. Nothing is prorated inside a bracket.
| Single, head of household or qualifying surviving spouse | Married filing jointly | Part B surcharge | Part D surcharge |
|---|---|---|---|
| $109,000 or less | $218,000 or less | $0.00 | $0.00 |
| $109,001 to $137,000 | $218,001 to $274,000 | $81.20 | $14.50 |
| $137,001 to $171,000 | $274,001 to $342,000 | $202.90 | $37.50 |
| $171,001 to $205,000 | $342,001 to $410,000 | $324.60 | $60.40 |
| $205,001 to $499,999 | $410,001 to $749,999 | $446.30 | $83.30 |
| $500,000 or more | $750,000 or more | $487.00 | $91.00 |
Married couples who file separately and lived together at any time during the year use a shorter table. At $109,000 or less there is no surcharge, from $109,001 to $390,999 the Part B surcharge is $446.30 and the Part D surcharge is $83.30, and at $391,000 or more they are $487.00 and $91.00. The SSA’s page does not say which table applies to people who filed separately but lived apart all year, and the calculator treats them as single filers, so confirm that with the SSA if it applies to you. For couples who file jointly, each spouse on Medicare pays the amounts shown, so a household with two people on Medicare pays double.
The cliff, in dollars
IRMAA works in steps, so one dollar can change a bill. A single filer with MAGI of $109,000 pays no surcharge. At $109,001 the same person pays $81.20 for Part B and $14.50 for Part D each month, which is $95.70, or $1,148.40 over a year. Nothing about the extra dollar is special. It is simply the first dollar of the next bracket.
Here is a second example. A married couple filing jointly has MAGI of $270,000, and both spouses are on Medicare. They are in the second bracket and pay $2,296.80 a year in IRMAA between them. A $10,000 Roth conversion would raise MAGI to $280,000, which is above the $274,000 line and in the third bracket, where the household pays $5,769.60. The conversion adds $3,472.80 a year in Medicare charges, on top of the income tax on the conversion. If the conversion had been $4,000, MAGI would be exactly $274,000 and the couple would stay in the second bracket.
IRMAA calculatorEnter your income to see your bracket, your headroom and what the next step would cost.Using the what-if
The calculator has a what-if box for extra income. Enter your expected MAGI, add the amount of a conversion or gain, and compare. The result shows how many brackets you would cross and the yearly cost for you or your household. Two cautions apply. First, the calculator uses the 2026 table for the what-if because that is the latest published table. CMS usually adjusts the thresholds each year, so a plan for 2028 premiums is an approximation. Second, the what-if shows only the Medicare charge. A conversion or gain also creates income tax, which is not part of the tool.
Ways people lower the income Medicare sees
These are widely discussed examples of tax planning and not advice for your situation. Roth conversions can be timed so that each year stays under a line. A sale of an appreciated asset can be spread over several years where that is practical. Contributions to an HSA or a deductible retirement plan lower adjusted gross income, and qualified charitable distributions from an IRA are generally excluded from it. Moving money into municipal bonds does not help, because tax-exempt interest is added back.
Required minimum distributions are part of adjusted gross income, so the RMD calculator can help you see how much income your accounts will force. For the same reason, the taxable share of your benefits matters, and the Social Security taxable benefits calculator shows how it changes with your other income.
When the SSA will use a more recent year
If your income dropped because of a specific event, you can ask the SSA to use a more recent year. The events the SSA lists are marriage, divorce or annulment, the death of a spouse, stopping or reducing work, loss of income-producing property because of a disaster or other event, loss or reduction of pension income, and a settlement payment from an employer’s closure, bankruptcy or reorganization. You ask on Form SSA-44. If you disagree with a decision, the SSA’s appeal form is SSA-561-U2, and if you amended your return the SSA expects proof that the IRS acknowledged the amendment.
What to watch for in 2027
CMS has not announced the 2027 premiums and brackets. The 2026 figures were announced on 14 November 2025, so the 2027 figures are expected around mid-November 2026. When they arrive, check three things: the new standard Part B premium, whether each threshold moved, and whether the surcharge amounts changed. The calculator will be updated with the published tables and the date they were checked.
What this guide cannot tell you
IRMAA is decided by the SSA from its own data, and the calculator is an estimate. It does not know your deductions, your plan’s premiums or any adjustment the SSA has already made. People on Medicaid or a Medicare Savings Program, first-year enrollees and people with special filing situations should confirm with the SSA or Medicare.
Common questions
Does IRMAA apply to Medicare Advantage plans?
Is IRMAA paid to my insurance company?
Do Roth withdrawals count toward IRMAA?
What if my income was higher two years ago than it is now?
Sources
Reviewed on 18 Oct 2026 against the published sources below. Laws and prices change, so check the current position before you rely on a figure.
- Centers for Medicare & Medicaid Services: 2026 Medicare Parts A & B premiums and deductibles fact sheet (14 November 2025)
- Social Security Administration: Medicare premiums, rules for higher-income beneficiaries
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This guide is general information, not legal, financial or religious advice. Figures are estimates worked out from the sources above and may differ from what applies to you. See the disclaimer. Found a mistake? Tell us.