IRMAA: why higher incomes pay more for Medicare

Last reviewed: September 2026

What IRMAA means

IRMAA stands for Income-Related Monthly Adjustment Amount. It’s an extra amount added to your Part B and Part D premiums if your income is above certain levels.

How it’s calculated

Social Security determines IRMAA using your modified adjusted gross income (MAGI) from your IRS tax return from 2 years earlier — for example, premiums for one year are generally based on the tax return from two years before. For this purpose, MAGI is your adjusted gross income plus any tax-exempt interest income.

The income brackets and dollar amounts are set each year and depend on your tax filing status. Visit Medicare.gov and SSA.gov for the current figures.

It applies to Part D too

The Part D IRMAA applies whether your drug coverage comes from a stand-alone Part D plan or a Medicare Advantage plan. It’s paid to Medicare directly, not to the plan.

IRMAA is reassessed every year, based on your most recent available tax information.

If your income has changed

If your income has gone down because of certain life-changing events — marriage, divorce or annulment, the death of a spouse, work stoppage, a reduction in work hours, loss of income-producing property, loss or reduction of certain pension income, or an employer settlement payment — you can ask Social Security to use more recent income instead. You’ll file Form SSA-44 along with supporting documentation.

Planning ahead

Because of the 2-year lookback, a large one-time income event — selling a business or property, large capital gains, a Roth conversion, or a large retirement account withdrawal — can raise your premiums two years later. If you’re planning something like this, it’s worth coordinating the timing with your tax professional or financial advisor.

I’m not a tax advisor. This guide is general information — please talk with your tax professional about your situation.

How I can help

IRMAA catches a lot of people by surprise. I can help you understand how it works and how it might affect your Medicare costs. Schedule a review to talk through your situation.