How to Avoid IRMAA: The Hidden Medicare Surcharge
The IRMAA income tiers
IRMAA kicks in the moment your income crosses a threshold — even by one dollar. These are the approximate 2026 brackets, based on your Modified Adjusted Gross Income (MAGI) from two years prior:
| MAGI — single filer | MAGI — married filing jointly | Approx. added surcharge/mo (per person) |
|---|---|---|
| Up to ~$109,000 | Up to ~$218,000 | $0 — standard premium |
| ~$109,000–$137,000 | ~$218,000–$274,000 | ~$85 |
| ~$137,000–$171,000 | ~$274,000–$342,000 | ~$213 |
| ~$171,000–$205,000 | ~$342,000–$410,000 | ~$341 |
| ~$205,000–$500,000 | ~$410,000–$750,000 | ~$469 |
| $500,000+ | $750,000+ | ~$512 |
Figures are illustrative for 2026 and combine the Part B and Part D adjustments per person; married couples can pay these amounts each. Thresholds are indexed and change yearly — confirm current numbers before acting.
The 2-year lookback surprise
Here's what catches most new retirees off guard: IRMAA doesn't look at what you earn today. It looks at your tax return from two years ago. So your 2026 Medicare premiums are set by your 2024 income — often your last big working year, or the year you sold a house, took a large IRA withdrawal, or did a Roth conversion. You can be fully retired on a modest income and still get hit with a surcharge because of a one-time spike two years back. Planning ahead matters precisely because the damage is already "baked in" by the time the bill arrives.
The SSA-44 appeal
If your income has dropped because of a life-changing event, you don't have to accept the surcharge. File Form SSA-44 with the Social Security Administration and check the event that applies — work stoppage (retirement), work reduction, marriage, divorce, or death of a spouse. Retiring counts. Attach proof of the change, and Social Security can recalculate your IRMAA based on your current, lower income instead of the two-year-old return. Many retirees who pay in their first Medicare year could have appealed and didn't.
Managing your MAGI before Medicare
Because IRMAA is a series of cliffs, going even slightly over a threshold triggers the full surcharge — so the goal is to keep your MAGI just under the next line. A few common strategies: do Roth conversions in your 60s, before you're on Medicare, so the taxable income lands in years that don't affect your premiums; use Qualified Charitable Distributions (QCDs) to give directly from your IRA, which lowers your AGI dollar-for-dollar; and spread large capital gains across multiple tax years instead of realizing them all at once. Remember that tax-exempt municipal-bond interest still counts toward MAGI — a common blind spot.
See if you're headed for an IRMAA surcharge
Enter your income sources and filing status — our free IRMAA calculator shows which bracket you're in and how much a Roth conversion or capital gain could cost you.
Check my IRMAA risk →Frequently asked questions
What income counts toward IRMAA?
IRMAA is based on your Modified Adjusted Gross Income (MAGI) — your adjusted gross income plus any tax-exempt interest. That includes Social Security, pensions, IRA and 401(k) withdrawals, Roth conversions, capital gains, dividends, and even municipal-bond interest. It uses the return from two years prior.
How do I appeal IRMAA after I retire?
File Form SSA-44 with the Social Security Administration and check the life-changing event that applies — such as work stoppage, work reduction, marriage, divorce, or death of a spouse. Retiring counts as work stoppage. Attach proof, and Social Security can recalculate based on your new, lower income.
Does going one dollar over a threshold really matter?
Yes. IRMAA is a cliff, not a gradual phase-in. Crossing a bracket by even one dollar triggers the full surcharge for that tier — for the whole year. That's why keeping your MAGI just under the next line, through timing and Roth planning, can be worth hundreds of dollars a month.
The Retirement Literacy Foundation is a 501(c)(3) non-profit. This guide is general financial education, not individualized investment, tax, or insurance advice. Figures are illustrative and change with income thresholds and your personal situation. Consider speaking with a licensed professional before making decisions.