What Is IRMAA, and How Do You Plan Around It?

IRMAA is the Income-Related Monthly Adjustment Amount, a surcharge Medicare tacks onto your Part B and Part D premiums when your income crosses certain lines. In 2026 it starts above $109,000 of modified adjusted gross income for a single filer, or $218,000 for a married couple filing jointly. Here's the detail that trips people up: Medicare looks back two years, so your 2026 income sets your 2028 premiums. And it's a cliff, not a slope. One dollar over a threshold prices the whole year at that higher tier.

The video below walks through the same mechanics. The sections after it lay out the 2026 thresholds, the moves that quietly trigger IRMAA, and the appeal that almost nobody knows about.

▶ Video: youtube.com/watch?v=M-DcYeJYcKU, “What is IRMAA and How Do I Avoid It?”

Watch: Patrick Shope on what IRMAA is and how to keep it from surprising you.

What is IRMAA, exactly?

Think of IRMAA like a toll booth that looks two years into your rearview mirror. Every Medicare beneficiary pays a standard premium for Part B and Part D. In 2026 the standard Part B premium is $202.90 a month per person. If your income sits under the first threshold, that's what you pay, and IRMAA never enters the picture.

But if your income clears a threshold, you pay a surcharge on top of those standard premiums. It isn't a penalty for doing something wrong. It's simply Medicare charging higher earners more, using a number from your tax return two years back. That two-year gap is the whole reason IRMAA feels like it comes out of nowhere.

How does the two-year look-back work?

Medicare doesn't use this year's income to set this year's premium. It uses your modified adjusted gross income from two years prior. So the tax return you file for 2026 determines what you pay for Medicare in 2028.

That delay cuts both ways. It means a big income year at 63 can raise your premiums the year you turn 65, before you've even started Medicare. It also means the quiet, low-income years right after you retire can work in your favor if you plan around them. Most people only notice the look-back when the letter from Social Security arrives and the premium has already jumped.

What are the 2026 IRMAA thresholds?

Here are the 2026 income lines and the total monthly Part B premium at each tier. The left number is for single filers, the right for married couples filing jointly.

Source: Centers for Medicare & Medicaid Services (CMS), 2026 Medicare Parts A & B premiums and IRMAA brackets (announced November 2025).

Part D carries its own surcharge on top. In that first tier, the extra runs about $81.20 a month on Part B plus about $14.50 on Part D. For a couple who both cross the line and both carry Parts B and D, that's roughly $2,297 a year in surcharges, triggered by being a dollar over.

Why does $1 over cost so much?

Because IRMAA is a cliff, not a phase-in. With regular income tax, an extra dollar of income is taxed at your bracket rate, so one dollar costs you a few cents. IRMAA doesn't work that way. Cross the line by a single dollar and you pay the full surcharge for that tier for the entire year.

I've seen someone land about $500 over a threshold and pay well over $1,000 in surcharges they could have avoided. That's the part that stings. It wasn't the income that hurt them, it was the last few hundred dollars of it. When you're near an IRMAA line, the last dollar is the most expensive dollar you'll earn all year.

What triggers IRMAA that I might not see coming?

This is where good planning can backfire if you only look at half the picture. Two common moves add to the income Medicare measures, and both can push you over a line by accident.

Roth conversions. Say you're 63 and you convert $75,000 from a traditional IRA to a Roth. That can be a smart move while you're in a lower bracket. But the full $75,000 counts as income the year you do it, and it can push you past the IRMAA threshold, raising your Medicare premiums the year you turn 65. That interaction is one of the disadvantages of a Roth conversion that people forget to price in.

Capital gains. Selling appreciated investments to reset your cost basis can also make sense for tax reasons. But realized gains count toward the income Medicare uses. Sell too much in one year and you've quietly added an IRMAA surcharge to the bill.

Neither of these is a bad strategy. The problem is doing them without checking the Medicare side. If you save $3,000 in future taxes but accidentally add $2,000 in surcharges, your real benefit shrank a lot more than you thought.

How do I avoid IRMAA?

The fix is almost always the same: control the timing and the size of the income you bring in. The years between retirement and your first required minimum distribution are the sweet spot. Your paycheck has stopped, Social Security may not be running at full value yet, and RMDs haven't started, so this is the stretch where your income is the most controllable it will ever be.

A couple we'll call Ron and June, both 62 and newly retired, want to convert $150,000 to a Roth. Do it in one year and they blow past the $218,000 line and trigger the surcharge. Spread it as $50,000 a year for three years, and they can stay under the threshold each time. Same total conversion, completely different Medicare outcome. This same low-income window is what makes the years before 73 so useful for softening future RMDs, which ties into the RMD mistakes worth avoiding before they compound.

Can IRMAA be appealed?

Yes, in certain cases, and hardly anyone knows this. If you've had what Social Security calls a life-changing event, you can ask them to use a more recent year's income instead of the standard two-year look-back. Qualifying events include retirement, the death of a spouse, divorce, or a significant drop in your work and wages.

Here's the catch: your income has to have dropped enough to actually move you into a lower IRMAA bracket. A small reduction that leaves you in the same tier won't help. But if you retired last year and your income fell off a cliff, an appeal can bring immediate relief instead of waiting two years for the normal cycle to catch up. The form exists. It works if you qualify. Most people just never file it.

The one thing to remember about IRMAA

IRMAA isn't some unavoidable tax on doing well. It's a planning variable. It can be managed, it can be minimized, and in the right circumstances it can be appealed. The key is knowing it exists and factoring it in before you lock in a Roth conversion or a big stock sale, not two years later when the letter shows up.

If you want to see exactly where the lines fall, our 2026 numbers sheet lists the IRMAA thresholds, the tax brackets, and the RMD ages on one page, so you can check your moves against them before you make them.

Tax planning and health care planning are connected whether we acknowledge it or not. The people who dodge the IRMAA surprise aren't smarter than everyone else. They just looked at the whole picture before the decision got locked in.

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