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DOGE Your Medicare premium in 2026 may have little to do with your health — and everything to do with your 2024 tax return. If your income crossed a certain line two years ago, you’re paying a surcharge called IRMAA on top of your Medicare premiums. Here’s exactly what you’ll pay at every income level, and how to fight it.
IRMAA — the Income-Related Monthly Adjustment Amount — is Medicare’s surcharge for higher earners. It raises your Part B and Part D premiums based on your Modified Adjusted Gross Income (MAGI). For 2026, it kicks in when 2024 MAGI exceeds $109,000 filing single or $218,000 married filing jointly.
The 2026 IRMAA Brackets (Based on 2024 Income)
Medicare uses a two-year lookback: your 2026 premiums are set by the MAGI on your 2024 tax return. These are the official figures CMS released on November 14, 2025.
| 2024 MAGI — Single | 2024 MAGI — Joint | Part B / month | Part D surcharge / month |
|---|---|---|---|
| ≤ $109,000 | ≤ $218,000 | $202.90 | $0 |
| $109,001–$137,000 | $218,001–$274,000 | $284.10 | +$14.50 |
| $137,001–$171,000 | $274,001–$342,000 | $405.80 | +$37.50 |
| $171,001–$205,000 | $342,001–$410,000 | $527.50 | +$60.40 |
| $205,001–$499,999 | $410,001–$749,999 | $649.20 | +$83.30 |
| ≥ $500,000 | ≥ $750,000 | $689.90 | +$91.00 |
The Part B amounts above are your total monthly premium. The Part D surcharge is added on top of whatever your drug plan charges.
Three Things That Surprise People
1. It’s per person. If both spouses are on Medicare and you’re in the top tier, you’re each paying $689.90 + $91.00 — nearly $18,700 a year combined in premiums alone.
2. The cliffs are brutal. IRMAA is tier-based with no phase-in. One dollar over $218,000 in joint MAGI costs a couple on Parts B and D an extra $2,296.80 a year. The year you take a large IRA withdrawal matters as much as the amount.
3. Tax-exempt interest counts. Municipal bond interest is free from income tax, but it is added back when Social Security computes your MAGI for IRMAA. The “muni” shelter doesn’t shelter you here.
What Counts as MAGI for IRMAA
For IRMAA purposes, MAGI is your Adjusted Gross Income (Form 1040, Line 11) plus tax-exempt interest (Line 2a). That’s it — a narrower definition than the MAGI used for ACA credits or Roth IRA limits.
Common IRMAA triggers for retirees: large Roth conversions, selling a business or rental property, big capital-gain realizations, and required minimum distributions stacking on top of Social Security.
How to Lower or Appeal IRMAA
If your income has dropped since 2024 because of a life-changing event — retirement, divorce, death of a spouse, loss of pension income — you can ask Social Security to recalculate using your current income instead. File Form SSA-44 (Medicare Income-Related Monthly Adjustment Amount — Life-Changing Event).
Planning ahead is even better. Strategies that keep MAGI under the thresholds include timing Roth conversions to low-income years, managing capital gains realization across calendar years, and coordinating the year you claim Social Security. Our Roth vs Traditional IRA guide walks through the conversion math, and the Social Security claiming guide covers how benefits interact with your tax picture.
Timing Note: Open Enrollment Is Now
Medicare open enrollment runs October 15 through December 7. IRMAA doesn’t change which plans you can pick, but it’s the one season a year when premium costs are top of mind — and when an appeal or a planning conversation with your advisor pays for itself many times over.
The Bottom Line
IRMAA is one of the few retirement “taxes” you can plan around — but only if you look two years ahead. Know your 2024 MAGI, know your tier, and remember that a single well-timed decision (when to convert, when to sell, when to claim) can save a couple thousands per year in premiums. The brackets are cliffs, not slopes: manage the edge.
Related reading: Roth IRA vs Traditional IRA: Which Is Better in 2026? · Social Security: Should You Claim at 62, 67, or 70? · HSA Triple Tax Advantage
Sources
- CMS 2026 Medicare Parts A & B Premiums and Deductibles fact sheet (Nov 14, 2025), via medicareadvocates.com
- Boldin — Medicare Surcharges (IRMAA)
- FedTools — IRMAA appeal (Form SSA-44)
Not financial advice. Do your own research. Tax and Medicare rules are complex — consider a qualified advisor for your situation.
Frequently Asked Questions
What is the IRMAA income threshold for 2026?
IRMAA starts when your 2024 MAGI exceeds $109,000 filing single or $218,000 married filing jointly. Below those limits you pay the standard Part B premium of $202.90/month with no surcharge.
How can I appeal IRMAA?
If your income dropped since 2024 because of a life-changing event — retirement, divorce, death of a spouse, or loss of pension income — file Form SSA-44 with Social Security to have your surcharge recalculated on your current income.
Is IRMAA charged per person or per household?
Per person. If both spouses are on Medicare, each pays the full surcharge for your MAGI tier — a top-tier couple pays nearly $18,700 a year in premiums combined.
Continue the playbook: The 2026 Retirement Tax Playbook — all five retirement-tax guides in one hub.
