Author: Hazel Secco, CFP®, CDFA®
Estimated reading time: 11 minutes
Table of contents
- What Is IRMAA? A Cliff, Not a Ramp
- The Two-Year Lookback: Your 2024 Return Sets Your 2026 Premium
- What Are the 2026 Medicare IRMAA Brackets?
- Do Roth Conversions Trigger IRMAA? Timing Is Everything
- How Do You Appeal IRMAA? Form SSA-44 and Life-Changing Events
- Other MAGI Dials Worth Turning
- What to Do This Week
- Want the full framework?
- Frequently Asked Questions
- Sources
Here is a letter nobody warns you about. You turn 65, enroll in Medicare, and instead of the standard premium, Social Security tells you that you’ll be paying two or three times more because of income you earned two years ago. That surcharge is called IRMAA, and IRMAA 2026 is set by your 2024 tax return. Not your income today. Not your retirement budget. The return you filed for a year when you may have still been working full tilt.
For high-earning women, this is not an edge case. One large RSU vest, one home sale, one well-intentioned Roth conversion at the wrong age: any of those can push your premium up by hundreds of dollars a month, per person, for a full year. And because IRMAA is recalculated every year off that two-year-old return, a string of high-income years can keep the surcharge running indefinitely.
This post covers what IRMAA actually is, the full 2026 brackets for single and married filers, why the two-year lookback ambushes so many retirees, how Roth conversions interact with it, and the one appeal that works, plus the moves that keep your premiums where they belong.
What Is IRMAA? A Cliff, Not a Ramp
IRMAA stands for income-related monthly adjustment amount. It’s a surcharge added on top of your Medicare Part B and Part D premiums when your modified adjusted gross income (MAGI) crosses certain thresholds.
The standard Part B premium for 2026 is $202.90 per month. Cross the first IRMAA threshold and yours becomes $284.10. Keep climbing and it tops out at $689.90, nearly $8,300 a year for Part B alone.
Here’s the part that matters most: IRMAA is a cliff, not a phase-in. Go one dollar over a tier and your entire premium jumps to the next level. There is no proration, no gradual slope.
| 2024 MAGI (single filer) | 2026 Part B premium | Annual Part B cost |
|---|---|---|
| $109,000 | $202.90/month | $2,434.80 |
| $109,001 (one dollar more) | $284.10/month | $3,409.20 |
That single dollar costs $974.40 over the year. This is one of the few places in the tax code where a marginal dollar can cost you nearly a thousand.
Two more things people miss. First, IRMAA is charged per person. If you and your spouse are both on Medicare, you each pay the surcharge, so every number below effectively doubles for a couple.
Second, it follows you regardless of which plan you choose. Switching plans during Medicare open enrollment doesn’t touch it; IRMAA attaches to you, not your plan. If you’re still mapping out your coverage options, start with my overview of Medicare choices in retirement, because IRMAA sits on top of whichever path you pick.
The good news: IRMAA is redetermined every year. A one-time income spike costs you one year of surcharge, not a lifetime. The bad news: if nobody is managing your income year to year, the “one-time” spike has a way of repeating.
The Two-Year Lookback: Your 2024 Return Sets Your 2026 Premium
Social Security determines your 2026 IRMAA using your most recent tax return on file with the IRS, generally the 2025 filing for tax year 2024. That two-year lookback is the mechanism behind almost every IRMAA surprise I see.
MAGI for IRMAA purposes is your adjusted gross income plus tax-exempt interest. Yes, your municipal bond interest counts. So do capital gains from selling a house (above the exclusion), RSU vests, bonuses, IRA withdrawals, and Roth conversions. Almost everything that lands on your return lands in this number.
The ambush works like this. Consider a hypothetical composite: a 63-year-old executive in her final working year.
| Her 2024 income (final working year) | Amount |
|---|---|
| Salary | $250,000 |
| RSU vest | $150,000 |
| Rental property gain | $130,000 |
| Joint MAGI | ~$530,000 |
She retires at 64. At 65, she and her husband enroll in Medicare and each get a Part B premium of $649.20 a month, the fourth IRMAA tier. That’s $446.30 above the standard premium, each. Together: $892.60 a month, or about $10,711 a year, plus Part D surcharges on top.
Their actual retirement income is a fraction of what they earned in 2024. Medicare doesn’t care. The lookback only sees the 2024 return.
The planning implication is simple to state and easy to miss: your Medicare premiums at 65 are set by your income at 63. If you’re 63 or older right now, every income decision you make this year has a Medicare price tag attached.
What Are the 2026 Medicare IRMAA Brackets?
IRMAA 2026 surcharges begin once 2024 MAGI passes $109,000 for single filers or $218,000 married filing jointly. Here are the full 2026 tiers from CMS, including the Part D surcharge that gets layered on top of whatever your drug plan charges. Remember: these are per person, per month.
Single filers (2024 MAGI):
| 2024 MAGI | 2026 Part B premium | 2026 Part D surcharge |
|---|---|---|
| $109,000 or less | $202.90 | $0.00 |
| Above $109,000 up to $137,000 | $284.10 | +$14.50 |
| Above $137,000 up to $171,000 | $405.80 | +$37.50 |
| Above $171,000 up to $205,000 | $527.50 | +$60.40 |
| Above $205,000 and below $500,000 | $649.20 | +$83.30 |
| $500,000 and above | $689.90 | +$91.00 |
Married filing jointly (2024 MAGI):
| 2024 MAGI | 2026 Part B premium | 2026 Part D surcharge |
|---|---|---|
| $218,000 or less | $202.90 | $0.00 |
| Above $218,000 up to $274,000 | $284.10 | +$14.50 |
| Above $274,000 up to $342,000 | $405.80 | +$37.50 |
| Above $342,000 up to $410,000 | $527.50 | +$60.40 |
| Above $410,000 and below $750,000 | $649.20 | +$83.30 |
| $750,000 and above | $689.90 | +$91.00 |
The Part D surcharge is added to your drug plan’s own premium. At the top tier, a married couple both on Medicare pays about $1,156 a month in combined Part B and Part D surcharges (on top of the standard premiums) before a single doctor visit.
Print these tables. If your MAGI in any year lands within a few thousand dollars of a threshold, that’s not a rounding error. That’s a decision point.
Do Roth Conversions Trigger IRMAA? Timing Is Everything
They can, because a Roth conversion adds the converted amount to your MAGI in the year you convert. That makes conversions the most common self-inflicted IRMAA event I see, and also one of the most fixable, because you control the timing and the size.
The age math is the whole game.
| Age when you convert | Effect on Medicare premiums |
|---|---|
| Before 63 | None. Because of the two-year lookback, those returns are out of the window by the time you enroll at 65. |
| 63 or later | The conversion shows up in your premium at 65 or later. |
This is a core reason I tell clients the best conversion years are often the gap between retirement and 63: income is low, brackets are open, and Medicare isn’t watching yet. If you’re weighing this, my breakdown of whether a Roth conversion is right for you covers the bracket math that comes first.
Past 63, don’t abandon conversions. Size them deliberately. IRMAA-aware conversion sizing means filling up to the top of an IRMAA tier the same way you’d fill a tax bracket, and stopping a comfortable margin below the cliff.
A married couple at $330,000 of MAGI has about $12,000 of room in their tier; converting $50,000 would vault them up a level and cost each spouse $121.70 more per month for a year. This tier-filling approach is the same framework I lay out in The Executive Woman’s Tax Playbook, applied to Medicare instead of tax brackets.
And sometimes the right answer is to pay the surcharge anyway. IRMAA lasts one year per high-income return. If a large conversion moves $200,000 out of a pre-tax IRA (shrinking future RMDs, cutting your lifetime tax bill, and reducing the tax hit a surviving spouse would face filing single), a year or two of IRMAA can be cheap by comparison.
That’s not a guess; it’s arithmetic. Run the math, or have someone run it with you. This is exactly the difference between tax preparation and actual tax planning for retirement: one looks backward at what you owe, the other prices every move before you make it.
How Do You Appeal IRMAA? Form SSA-44 and Life-Changing Events
If your income has dropped since the lookback year, you don’t have to accept the surcharge. Social Security lets you request a redetermination using Form SSA-44, the life-changing event form. You’re asking them to use a more recent, lower-income year instead of the one on file.
| Qualifies as a life-changing event | Does not qualify |
|---|---|
| Work stoppage or work reduction (retirement counts) | Sale of your home |
| Marriage, divorce, or annulment | A Roth conversion |
| Death of a spouse | An RSU windfall |
| Loss of income-producing property | A large capital gain |
| Loss of pension income |
The classic case is the one from the example above: you retired at 64, but Medicare priced you off your peak earning year. File the SSA-44, document the retirement, give them your estimated current-year income, and the surcharge can be reduced or removed. This is one of the highest-return pieces of paperwork in retirement: an hour of effort that can recover thousands.
The right-hand column matters just as much. Those are one-time income events, not life-changing events in SSA’s definition. If the income was real, the surcharge stands for that year. The appeal is for changed circumstances, not regretted transactions, which is exactly why the planning has to happen before the income hits the return.
Other MAGI Dials Worth Turning
Beyond conversions and appeals, three tools consistently keep MAGI below the cliffs:
- Qualified charitable distributions. At 70½ or later, a QCD sends IRA money directly to charity, satisfies RMDs, and never enters your AGI. It’s the single cleanest IRMAA tool for charitably inclined retirees.
- Tax-loss harvesting. Realized losses offset realized gains dollar for dollar, which can pull a gain-heavy year back under a threshold.
- Charitable timing. Giving appreciated stock instead of selling it means the embedded gain never appears in your MAGI at all.
Stack these in a high-income year and a tier crossing often becomes optional.
What to Do This Week
- Pull your 2024 return and compute your IRMAA MAGI. Adjusted gross income plus tax-exempt interest. That number set your 2026 premium, and your 2025 return will set 2027. Know where you stand against the tables above.
- If you’re 63 or older, project your current-year MAGI before December. Every dollar of income this year is a Medicare pricing input two years out. If you’re within a few thousand dollars of a tier, decide now whether to defer income, harvest losses, or accept the crossing deliberately.
- Size any Roth conversion to a tier, not a hunch. Fill to the top of your current IRMAA tier and stop with a margin, or document why paying a year of surcharge beats decades of RMDs. Either answer is fine; not doing the math is not.
- File Form SSA-44 if your income dropped after a life-changing event. Retired, widowed, divorced, or reduced your hours since the lookback year? Request a redetermination. It’s an hour of paperwork against thousands in premiums.
- Route charitable giving through QCDs or appreciated stock. If you’re 70½ or older and giving cash while taking RMDs, you’re likely paying IRMAA you don’t owe.
Want the full framework?
The tax moves behind this episode (the bracket planning, Roth sequencing, and account-location decisions I walk through with clients) are in my free guide, The Executive Woman’s Tax Playbook. It’s a free PDF you can read in one sitting. Get the playbook here.
Hazel Secco, CFP®, CDFA®, is the founder of Align Financial Solutions, a fee-only fiduciary firm that works with high-earning women and female executives on retirement planning, equity compensation, and tax strategy.
Already past the research phase? Book a free 15-minute Align Call: https://alignfinancialsolutions.com/book-a-call/
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Frequently Asked Questions
What income counts for IRMAA?
IRMAA uses your modified adjusted gross income, which is adjusted gross income plus tax-exempt interest, so even municipal bond interest counts. RSU vests, bonuses, IRA withdrawals, Roth conversions, and home-sale gains above the exclusion all land in the number. For your 2026 premium, Medicare looks at your 2024 tax return because of the two-year lookback.
What are the Medicare IRMAA brackets for 2026?
IRMAA 2026 surcharges begin once 2024 MAGI passes $109,000 for single filers or $218,000 married filing jointly. The standard Part B premium is $202.90 a month; the first tier raises it to $284.10, climbing to $689.90 at the top. Each tier is a cliff, one dollar over triggers the full jump, and the surcharge applies per person.
Can I appeal an IRMAA surcharge?
Yes, if your income dropped because of a life-changing event. File Form SSA-44 and ask Social Security to use a more recent, lower-income year. Work stoppage or reduction, marriage, divorce, death of a spouse, and loss of pension income all qualify. A home sale, Roth conversion, or RSU windfall does not; those surcharges stand for the year.
Do Roth conversions trigger IRMAA?
They can, because the converted amount adds to your MAGI in the conversion year. Conversions completed before you turn 63 never touch your Medicare premiums thanks to the two-year lookback. From 63 on, size conversions to fill your current IRMAA tier and stop below the cliff, or confirm the long-term RMD savings justify a year of surcharge.
Disclaimer: Advisory services are offered through Align Financial Solutions LLC (“AFS”), an Investment Advisor in the State of New Jersey. This article is for educational purposes only and does not constitute personalized tax, legal, investment, or financial planning advice. Rules and figures are current for 2026 and subject to change. All client scenarios are hypothetical composites for illustration and do not represent any specific client outcome. Consult a qualified professional about your specific situation.
Sources
- 2026 Medicare Parts A & B Premiums and Deductibles (CMS): https://www.cms.gov/newsroom/fact-sheets/2026-medicare-parts-b-premiums-deductibles
- Medicare Costs, Part B premium (Medicare.gov): https://www.medicare.gov/basics/costs/medicare-costs
- Medicare Premiums: Rules for Higher-Income Beneficiaries (SSA.gov): https://www.ssa.gov/benefits/medicare/medicare-premiums.html