IRMAA: The Medicare Surcharge That Looks Back Two Years
IRMAA — the Income-Related Monthly Adjustment Amount — is the surcharge higher-income households pay on top of standard Medicare premiums. It catches people by surprise for one reason: it's based on your tax return from two years ago.
How is IRMAA calculated?
Social Security looks at your Modified Adjusted Gross Income (MAGI) from two years prior — for 2026 premiums, that's your 2024 return. Cross a threshold by even one dollar and your entire surcharge tier applies. For 2026, IRMAA generally begins above $109,000 of MAGI for an individual filer (source: SSA.gov), with higher tiers above that.
Why does IRMAA blindside retirees?
Because the income that triggers it often isn't salary — it's a Roth conversion, a large capital gain from selling a home or business, or a big IRA withdrawal. The transaction happens once; the surcharge shows up two years later on every month's Medicare premium.
Can IRMAA be appealed?
Yes — if your income dropped because of a life-changing event such as retirement, divorce, or death of a spouse, you can file form SSA-44 to ask Social Security to use your more recent, lower income instead. A one-time capital gain generally does not qualify, which is why the planning has to happen before the transaction, not after the letter arrives.
How do advisors use IRMAA planning?
Roth conversion timing, gain harvesting across tax years, and charitable strategies (like QCDs) are the levers. This is where Medicare planning and retirement income planning are the same conversation — and why SkyWell works alongside financial advisors, not around them.
Frequently asked questions
Does IRMAA apply to Part D too?
Yes. IRMAA adds a surcharge to both Part B and Part D premiums, each with its own schedule.
Is IRMAA permanent?
No — it's recalculated every year from your MAGI two years back. High-income one year, surcharge two years later; income drops, the surcharge drops off.
Where can I estimate my IRMAA?
Use our IRMAA calculator to estimate your total 2026 monthly Medicare premium from your filing status and income bracket.
Questions about your own situation?
Free consultation with Virginia — direct response within one business day.