Every senior on Medicare should be intimately familiar with IRMAA – the initials that stand for Income Related Monthly Adjustment Amount.

It’s the amount by which your Medicare Part B and Part D premiums increase each year, based on your recent modified adjusted gross income (MAGI). The more you earn while on Medicare, the higher your monthly premiums for the insurance!

It’s not just earnings from work that are counted in the IRMAA adjustment formula. If you take your RMD from retirement accounts, it will boost your income – perhaps into the IRMAA adjustment phase. Or if you convert a traditional IRA to a Roth, it could impact you in the formula, raising your Medicare premiums.
And those premiums really jump when you have more income. The standard Medicare Part B premium for 2026 is $202.90 per month, a $17.90 increase from 2025. For 2026, the IRMAA adjustment brackets increased about 9%.

The IRMAA brackets for 2026 are as follows using modified adjusted gross income for single filers or joint filers:

• Single filer $109,000 or less/ Joint $218,00 or less: No IRMAA surcharge
• Single above $109,001 up to $137,000, or Joint $218,000 to $274,000: $81.20 surcharge
• Single above $137,001 up to $171,000, or Joint $274,001 to $342,000: $202.90 surcharge
• Single above $171,001 up to $205,000 or Joint $342,001 to $410,000: $324.60 surcharge
• Single above $205,001 up to $499,999 or Joint $410,001 to $749,999: $446.30 surcharge
Single above $500,000 or Joint over $750,000: $487 surcharge

(Modified Adjusted Gross Income is your Adjusted Gross Income, plus tax-exempt interest and dividends from muni bonds. Your AGI is your total income from all sources minus certain adjustments such as student loan interest, alimony payments and retirement contributions.)

Important note: There is a two-year look-back period for this income adjustment. So, even if you’ve been retired for a year and your income has dropped, you’ll still pay the higher monthly premiums based on your income before you retired. Your 2026 IRMAA adjustment is based on the income shown in your 2024 tax return.

Nearly 5 million people, roughly 7% of Medicare beneficiaries pay higher monthly Medicare premiums based on their adjusted gross income. Although Medicare is individual, if you file a joint return there is a separate IRMAA calculation.

IRMAA and Income Spikes
If you’re about to retire or are already retired, you’ll want to be careful of one-time spikes in income that could impact your monthly Medicare premiums in two years. For example, if you do a Roth Conversion of your IRA (or a series of annual conversions), that money is not only taxable in the year of the conversion, but it adds to the (MAGI) income considered for the IRMAA adjustment.

Your Roth Conversion will give you years of tax-free future growth of your IRA, without annual RMD withdrawal requirements, but that benefit could be offset by significantly higher Medicare premiums starting in two years. On the other hand, taking the IRMAA penalty for one year means future tax-free Roth withdrawals won’t impact your MAGI in future years, avoiding IRMAA!

Similarly, if you sell the family home which you’ve owned for many years, you’ll be able to exclude $250,000 of capital gains for each owner, or $500,000 if the property is held jointly. But if your home has an even higher gain, it will be subject to capital gains taxes – and the IRMAA adjustment.

Taking a lump sum payout of a pension benefit, which becomes taxable income, could also impact the IRMAA adjustment, at least temporarily. Those are all considerations which should go into your financial planning. Consult your tax advisor!

Appealing IRMAA
Once you’ve been subject to IRMAA, it’s entirely possible that in future years your Medicare B and D premiums will automatically be increased for IRMAA – until they catch up on your lower income years. However, if your income spike was a one-time thing, or if you have recently lost a substantial portion of your income, you can appeal the IRMAA adjustment.

Medicare defines the basic qualification for an IRMAA appeal as: “Life-changing events include marriage, divorce, the death of a spouse, loss of income, and an employer settlement payment.”

While there is a specific form SSA 44, which you use to file an appeal or you can call Social Security (which governs Medicare) at 800-772-1213, many find it helpful to get IRMAA appeal help from private consultants that specialize in these appeals.

One such consultant is www.IRMAA.com where you can pay a small fee to uses their professional services to help get your premiums lowered and get repayment of unjust past IRMAA deductions.

When you consider that your monthly Medicare premium could be higher by more than $500 a month — $6,000 per year — based on IRMAA, you’ll understand why it is so important to factor this adjustment into your financial planning decisions. And that’s The Savage Truth.