Most people turning 65 know they will pay a Part B premium. Fewer know that if their income is above certain thresholds, they pay significantly more — and the surcharge kicks in automatically, based on tax returns from two years ago.
This is called IRMAA: Income-Related Monthly Adjustment Amount. Here is how it works.
IRMAA is a surcharge added to your Medicare Part B (and Part D) premiums if your income exceeds certain thresholds. It is calculated based on your Modified Adjusted Gross Income (MAGI) from two years prior. In 2026, Social Security looks at your 2024 tax return to determine whether you owe IRMAA.
| 2024 Individual MAGI | 2024 Joint MAGI | 2026 Part B Monthly Premium |
|---|---|---|
| ≤ $106,000 | ≤ $212,000 | $202.90 (standard) |
| $106,001–$133,000 | $212,001–$266,000 | $289.20 |
| $133,001–$167,000 | $266,001–$334,000 | $375.90 |
| $167,001–$200,000 | $334,001–$400,000 | $462.00 |
| $200,001–$500,000 | $400,001–$750,000 | $547.10 |
| Above $500,000 | Above $750,000 | $591.90 |
Verify current thresholds at Medicare.gov, as these figures are adjusted annually.
The same income tiers also add a surcharge to your Part D premium. The Part D IRMAA is added on top of whatever your plan charges. In 2026, the Part D IRMAA ranges from about $13.70 to $85.80 per month depending on income tier.
Because IRMAA is based on income from two years ago, it can create an unfair situation if your income has dropped significantly — for example, if you retired, had a job loss, got divorced, or a spouse died. In any of these situations, you can request a "life-changing event" appeal with Social Security.
Qualifying life-changing events include:
File Form SSA-44 with Social Security. You will need documentation of the income change. If approved, your premiums are recalculated based on your current (lower) income rather than your two-year-old return.
If you know your income will be high in a given year (say, from a large Roth IRA conversion or a business sale), it is worth understanding that the income will affect your Medicare premiums two years later. This is not necessarily a reason to avoid those transactions — but it is worth factoring in when planning.
A fee-only financial advisor (one who does not earn commissions) can help you model the interaction between your income, IRMAA thresholds, and Medicare costs in retirement.
Reminder: Ready at 65 is not affiliated with Medicare, CMS, the SSA, or any government agency. This article is general educational information, not financial, legal, medical, or insurance advice. Rules, costs, and deadlines change — verify current details at Medicare.gov or by calling 1-800-MEDICARE before making any decision. Full disclaimer →