For most Medicare beneficiaries, the 2026 Part B premium is $202.90 per month. But for about 8% of Medicare enrollees — including many people who consider themselves middle-income retirees — the monthly cost is between $284 and $689.90. The difference comes from four letters most people have never heard until they get the bill: IRMAA.
What IRMAA Is
IRMAA stands for Income-Related Monthly Adjustment Amount. It’s a surcharge added to your Medicare Part B and Part D premiums if your Modified Adjusted Gross Income (MAGI) exceeds certain thresholds. The 2026 surcharges are based on your 2024 tax return — what the SSA calls the “two-year lookback.”
The 2026 IRMAA Brackets
For 2026, the IRMAA thresholds and corresponding Part B premiums are:
| 2024 MAGI (Individual) | 2024 MAGI (Married Joint) | Monthly Part B | IRMAA Added |
|---|---|---|---|
| ≤ $109,000 | ≤ $218,000 | $202.90 | $0 |
| $109,001–$137,000 | $218,001–$274,000 | $284.10 | +$81.20 |
| $137,001–$171,000 | $274,001–$342,000 | $405.80 | +$202.90 |
| $171,001–$206,000 | $342,001–$412,000 | $527.50 | +$324.60 |
| $206,001–$500,000 | $412,001–$750,000 | $649.20 | +$446.30 |
| Above $500,000 | Above $750,000 | $689.90 | +$487.00 |
What Counts Toward IRMAA MAGI
IRMAA MAGI includes virtually all income: wages, self-employment income, pension and IRA distributions, Required Minimum Distributions, capital gains, taxable interest and dividends, rental income, and the taxable portion of Social Security. It also includes Roth conversions — a critical planning consideration.
What does NOT count toward IRMAA MAGI: qualified Roth IRA and Roth 401(k) distributions. This is one of the most powerful reasons to build Roth assets before retirement — every dollar in Roth is a dollar that will never push you into an IRMAA bracket.
Why IRMAA Surprises So Many Retirees
The surprise comes from the two-year lookback. A large capital gain from selling a business or investment property in 2024 shows up in your 2026 Medicare costs. A significant Roth conversion in 2024 appears in your 2026 premium. By the time the bill arrives, the income event that caused it may be two years in the past.
For many retirees, the trigger isn’t a one-time event — it’s growing RMDs. As traditional IRA balances compound over time, the mandatory withdrawals grow larger each year, pushing more retirees over IRMAA thresholds as they age.
Five Strategies to Manage IRMAA
1. Roth conversions before RMDs begin
Every dollar moved from a traditional IRA to Roth before age 73 is a dollar that will never generate a mandatory taxable distribution. Strategic conversions over 5–10 years can dramatically reduce future RMDs and their IRMAA impact — even if the conversions themselves temporarily trigger IRMAA in the conversion years.
2. Qualified Charitable Distributions (QCDs)
If you are 70½ or older, you can donate up to $105,000 directly from your IRA to a qualified charity. The QCD satisfies your RMD but is excluded from taxable income — and therefore excluded from IRMAA MAGI. If you give to charity anyway, this is one of the most powerful tax strategies available to retirees.
3. Capital gains timing
If you’re planning to sell appreciated assets, timing the sale to keep MAGI below an IRMAA cliff can save thousands in Medicare premiums. Spreading sales across multiple years is often more advantageous than a single large gain event.
4. Appeal IRMAA for life-changing events
If your income has significantly decreased since the lookback year due to retirement, divorce, death of a spouse, or loss of income, you can appeal your IRMAA determination using SSA Form SSA-44. The SSA will consider your current income instead of the lookback year income.
5. Tax-efficient income sequencing
Drawing from Roth accounts, HSA accounts, or other tax-excluded sources strategically can keep MAGI below IRMAA thresholds even when total spending is high. Sequencing which accounts you draw from and when is a core component of a complete retirement income strategy.