How to Avoid IRMAA: The Hidden Medicare Surcharge
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The IRMAA income tiers
IRMAA kicks in the moment your income crosses a threshold, even by one dollar. These are the official 2026 brackets (set by CMS), based on your Modified Adjusted Gross Income (MAGI) from two years prior:
| MAGI (single filer) | MAGI (married filing jointly) | Added Part B + Part D surcharge/mo (per person, 2026) |
|---|---|---|
| Up to $109,000 | Up to $218,000 | $0 (standard Part B premium $202.90) |
| Over $109,000 to $137,000 | Over $218,000 to $274,000 | $95.70 ($81.20 B + $14.50 D) |
| Over $137,000 to $171,000 | Over $274,000 to $342,000 | $240.40 ($202.90 B + $37.50 D) |
| Over $171,000 to $205,000 | Over $342,000 to $410,000 | $385.00 ($324.60 B + $60.40 D) |
| Over $205,000 to under $500,000 | Over $410,000 to under $750,000 | $529.60 ($446.30 B + $83.30 D) |
| $500,000 or more | $750,000 or more | $578.00 ($487.00 B + $91.00 D) |
Full 2026 Part B and Part D tables: 2026 Medicare premiums and IRMAA brackets. A step-by-step list for staying under the cliffs: the IRMAA avoidance checklist.
Figures are the official 2026 amounts and combine the Part B and Part D adjustments per person; married couples can pay these amounts each. Thresholds are indexed and change yearly, so confirm current numbers before acting.
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2027 numbers: the projected 2027 IRMAA brackets start above $112,000 single and $224,000 joint on 2025 income, with a table of what $1 over each line costs.
The 2-year lookback surprise
What catches most new retirees off guard is that 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. That is 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 because the cost 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. Many people miss that one.
Retiring before 65? The same MAGI also decides your ACA Marketplace subsidy, and since 2026 that has a cliff of its own: the ACA subsidy cliff for early retirees.
These numbers change every year
The IRMAA brackets, the standard deduction and the senior deduction are all adjusted annually, and the 2027 figures are published late in 2026. The one exception is the Social Security taxation thresholds, which have not moved since 1983 and are not expected to.
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| Provisional income | $0 |
| Which tier you land in | n/a |
| Share of benefit taxed | 0% |
We will email you a written copy showing how the math worked, what would change your tier, and the thresholds for next year. Free, and you can keep it or forward it to whoever does your taxes.
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See if you're headed for an IRMAA surcharge
Enter your income sources and filing status, and 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), which is 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, and it applies 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.
Want to run these numbers for your own situation?
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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.
Hans Goldstein
Founder & Executive Director · Retirement Literacy Foundation, a 501(c)(3) non-profit
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