If your Medicare premiums are higher than the standard amount, IRMAA may be the reason.
IRMAA stands for Income-Related Monthly Adjustment Amount. It is an extra charge added to Medicare Part B and Part D for people with higher incomes. A lot of people do not realize this exists until they see a much bigger premium than they expected.
The good news is that IRMAA is understandable once you know the rules. Here is what it is, who pays it, and when you may be able to do something about it.
What Is IRMAA in Medicare?
IRMAA is a surcharge Medicare adds for higher-income beneficiaries.
It applies to:
- Medicare Part B
- Medicare Part D
It does not replace your normal premium. It gets added on top of it.
So if you are paying IRMAA, you are paying:
- the standard Part B premium
- plus an income-based Part B surcharge
- plus your Part D premium
- plus an income-based Part D surcharge
That is why people are often shocked when their Medicare costs are much higher than a friend’s, even though both people are on Medicare.
Why Are My Medicare Premiums Higher Than Other People’s?
Because Medicare looks at income.
Social Security uses your modified adjusted gross income, or MAGI, from two years earlier to determine whether you owe IRMAA. That means your 2026 Medicare premiums are based on your 2024 tax return.
This 2-year lookback rule is one of the biggest reasons IRMAA catches people off guard. A person may have earned a high income while working, retired later, and then wonder why Medicare is still charging them as if they are in their old income bracket.
Who Pays IRMAA in 2026?
In 2026, IRMAA starts if your 2024 income was above:
- $109,000 for an individual filer
- $218,000 for a married couple filing jointly
If your income was above those levels, you may owe higher Part B and Part D premiums in 2026.
For many retirees in the Kansas City metro, IRMAA becomes a real issue after high-earning working years, large capital gains, Roth conversions, or required minimum distributions later in retirement.
How Much More Does IRMAA Add to Medicare?
It depends on your income bracket.
The standard Part B premium in 2026 is $202.90 per month. If you are subject to IRMAA, your Part B premium can rise significantly above that amount. Part D surcharges are also added separately on top of your prescription drug plan premium.
If you want to see the actual numbers for your income level, the easiest move is to use the 2026 IRMAA Calculator. It shows your bracket, your monthly Part B and Part D surcharges, and the annual impact.
Does IRMAA Apply to Medicare Advantage?
Yes and no.
IRMAA does not directly increase the premium charged by your Medicare Advantage plan itself. But it does still apply to:
- your Medicare Part B premium
- any Part D coverage inside your Advantage plan, if applicable
So if you have a $0-premium Medicare Advantage plan, you can still be paying a much higher overall Medicare bill because of IRMAA.
Does IRMAA Apply to Medigap?
Not directly.
IRMAA does not change your Medigap premium. But if you have Original Medicare with a Medicare Supplement, IRMAA can still raise your overall cost because it increases your Part B premium and may increase your Part D costs too.
If you want a broader look at what Medicare can cost, this article pairs well with IRMAA planning: Medicare costs in 2026
What Income Counts for IRMAA?
IRMAA is based on modified adjusted gross income, not just wages.
That can include:
- taxable income from work
- IRA distributions
- pension income
- capital gains
- Roth conversion income
- tax-exempt interest that gets added back for Medicare purposes
That last one surprises a lot of people. Some retirees assume municipal bond income is invisible here because it is tax-exempt for federal income tax purposes. It is not invisible to Medicare.
What Triggers IRMAA Most Often?
The most common triggers I see are:
- still having high earned income two years earlier
- retiring after a strong final working year
- large Roth conversions
- capital gains from selling appreciated assets
- required minimum distributions
- a surviving spouse moving from married filing jointly to single thresholds
That last one can be especially painful. A widow or widower may have roughly the same income as before but much lower IRMAA thresholds because of the filing-status change.
Can You Appeal IRMAA?
Sometimes, yes.
If your income dropped because of a qualifying life-changing event, you may be able to ask Social Security to recalculate your IRMAA. Common qualifying events include:
- retirement
- reduced work hours
- marriage
- divorce
- death of a spouse
- loss of income-producing property
- loss of pension income
If that sounds like your situation, the next article to read is here: How to appeal IRMAA in Missouri
What Form Do You Use to Appeal IRMAA?
The form is SSA-44.
That is the Social Security form used to report a life-changing event and request a new IRMAA determination based on more current income. If you recently retired and your current income is much lower than it was two years ago, this can save you a meaningful amount of money.
How Do I Know If I Am Paying IRMAA?
The easiest clue is your Medicare premium.
If your Part B premium is higher than the standard amount, IRMAA is likely the reason. Social Security should also send you a notice explaining the surcharge.
If you want to verify it quickly, use the IRMAA Calculator. It is a fast way to compare your income to the 2026 thresholds and estimate the annual impact.
What Should Higher-Income Medicare Beneficiaries Watch For?
If you are near an IRMAA threshold, even small planning decisions can matter.
That is because IRMAA works like a cliff. Going one dollar over a bracket can trigger the full surcharge for that tier. This is one reason Roth conversions, capital gains, and retirement account withdrawals should be coordinated carefully.
That does not mean you should never make those moves. It just means Medicare should be part of the planning conversation.
Should You Plan for IRMAA Before You Turn 65?
Yes, especially if you expect retirement income, investment income, or distributions to keep you near the thresholds.
This matters even before Medicare starts because the income history follows you into your premium calculations later. If you are approaching Medicare and want a broader preparation checklist, start here: What do you need to do before turning 65? Medicare checklist
Frequently Asked Questions
Is IRMAA only for rich people?
IRMAA is aimed at higher-income Medicare beneficiaries, but plenty of people hit it for reasons that do not feel “rich” in real life. A one-time Roth conversion, sale of appreciated assets, or strong final working year can be enough to trigger it.
Does IRMAA last forever?
Not necessarily. IRMAA is recalculated each year based on the applicable tax-return data. If your income drops later, your future IRMAA can drop too. And if the drop is tied to a qualifying life event, you may be able to appeal sooner.
Does IRMAA affect both spouses?
IRMAA is applied per person, but filing status matters. If both spouses are on Medicare and you file jointly, each spouse can owe IRMAA based on the household income level.
Can IRMAA affect me if I have a $0 Medicare Advantage plan?
Yes. Even with a $0 Medicare Advantage premium, you still pay Part B, and IRMAA can increase that amount. Part D-related surcharges can apply too.