How to Avoid IRMAA
— or Appeal It When You Retire

Medicare's income surcharge is a cliff, not a slope, and it's priced off your income from two years ago. Both facts are exploitable — in your favor.

By Alex Merritt · Updated July 31, 2026 · 2026 figures from official CMS/SSA announcements (full reference table)

What IRMAA Actually Is

IRMAA — the Income-Related Monthly Adjustment Amount — is a surcharge added to your Medicare Part B and Part D premiums when your income crosses certain thresholds. In 2026, the standard Part B premium is $202.90/month; IRMAA can more than triple it.

Three properties make it nastier than a tax bracket:

  • It's a cliff. Tax brackets tax the marginal dollar; IRMAA tiers reprice every month of premiums. One dollar over the first threshold costs a single filer about $1,148 for the year.
  • It looks back two years. Your 2026 premiums are set by your 2024 MAGI. Decisions you make at 63 price your premiums at 65.
  • It's per person. Couples where both spouses are on Medicare pay the surcharge twice, off the same joint MAGI.

The 2026 IRMAA Tiers

Based on 2024 MAGI (AGI plus tax-exempt interest). Surcharges shown are per person, per month, on top of the standard premium:

MAGI — Single MAGI — Married Joint Part B + Part D + Extra per year
Up to $109,000 Up to $218,000 — — —
$109,000 – $137,000 $218,000 – $274,000 $81.20 $14.50 $1,148
$137,000 – $171,000 $274,000 – $342,000 $202.90 $37.50 $2,885
$171,000 – $205,000 $342,000 – $410,000 $324.60 $60.40 $4,620
$205,000 – $500,000 $410,000 – $750,000 $446.30 $83.30 $6,355
Over $500,000 Over $750,000 $487.00 $91.00 $6,936

(Married filing separately has its own harsher schedule — see the full reference table. Remember: a couple pays each figure twice.)

The Trap Most New Retirees Walk Into: Dana

Dana is single, retired in mid-2026 at 64, and enrolls in Medicare at 65. Dana's premium won't be based on retirement income — it's based on 2024, Dana's last full year of salary: $160,000 of MAGI.

That lands in tier 3 of the table: an extra $240.40 per month — about $2,885 a year in surcharges — priced off a paycheck that no longer exists, while Dana actually lives on around $40,000.

Here's the rule almost nobody uses: retirement is a qualifying "life-changing event." SSA form SSA-44 exists precisely for this. Dana files it — checking "work stoppage," attaching evidence of retirement, and estimating 2027 income of $40,000 — and SSA re-figures the premium from the estimate instead of the stale return. Under the first threshold of $109,000, the surcharge drops to zero: $2,885/year saved with one form.

The eight qualifying life-changing events (SSA-44):

  1. Work stoppage (retirement)
  2. Work reduction
  3. Marriage
  4. Divorce or annulment
  5. Death of a spouse
  6. Loss of income-producing property (disaster, etc.)
  7. Loss or reduction of pension income
  8. Employer settlement payment

A big Roth conversion or home sale is not on the list — those surcharges stand (but only for one year, and the planning section below is how you manage them).

Check any income scenario against the tiers — Dana's is pre-loaded:

Open the IRMAA Optimizer

Avoiding IRMAA on Purpose: The Planning Moves

For income you control — conversions, gain harvesting, withdrawals — IRMAA is a design constraint, not a surprise. The moves, roughly in order of leverage:

  1. Front-load big income before age 63. The lookback means income through the year you turn 62 never touches your age-65 premiums. Do the heavy Roth conversions and gain harvesting early — the whole argument of our sweet spot guide.
  2. Size conversions to the tier, not just the tax bracket. From 63 on, every conversion plan should be checked against the tier table above — the IRMAA Optimizer shows your headroom to the next cliff.
  3. Bunch, don't hover. Because tiers reprice a whole year, crossing one deliberately once (one big conversion year) usually beats skimming just over it two years running. One year of surcharge, then done.
  4. Use QCDs from 70½. Qualified charitable distributions satisfy RMDs without entering AGI at all — the cleanest IRMAA reducer available once RMDs begin.
  5. Watch the stealth income. Municipal bond interest counts toward IRMAA MAGI despite being federally tax-free. Home-sale gains above the $250k/$500k exclusion count. Mutual-fund capital-gain distributions count. None of them feel like "income" until the letter arrives.
  6. Shrink future forced income. RMDs are the engine that pushes retirees into IRMAA tiers permanently. Everything that reduces the traditional balance early — see the conversion ladder guide — is IRMAA planning too.

If You're Already Being Charged

  • Life-changing event? File SSA-44 (or call/visit SSA) with your income estimate and evidence. You can use an estimate for the current year — or the next one, if the event's income effect lands there.
  • SSA used the wrong data? If you amended your return or the IRS record is simply outdated, that's not an SSA-44 case — contact SSA with the corrected/amended return and ask them to update the determination.
  • Neither? Then the surcharge is real but temporary: it re-sets every year from the new lookback return. A one-time income spike costs one year of surcharges, not a lifetime.

Frequently Asked Questions

Is IRMAA permanent once I'm hit with it?

No. IRMAA is redetermined every single year from the latest tax return the IRS supplies — normally two years back. One high-income year (a Roth conversion, a home sale) means one year of surcharges; when the lookback year's income drops back below the thresholds, the surcharge disappears automatically. No appeal needed for that.

Do both spouses pay the surcharge?

Yes, if both are enrolled in Medicare. The tiers are based on your joint MAGI, but each spouse pays their own surcharge on their own Part B and Part D premiums — so every dollar figure in the table doubles for a couple.

Does selling my house trigger IRMAA?

It can. The taxable gain above the primary-residence exclusion ($250,000 single / $500,000 married filing jointly) lands in your AGI, and two years later it can push you over an IRMAA tier. A big enough gain is a classic one-year IRMAA spike — worth checking the tier table before choosing which year to close.

I just retired — do I really have to pay surcharges based on my old salary?

Usually not, and this is the most under-used rule in Medicare. Retirement counts as a "work stoppage" — a qualifying life-changing event. File form SSA-44 with an estimate of your actual income this year, and SSA will re-figure your premium using that estimate instead of your final working years.

What income counts toward IRMAA?

Your MAGI for IRMAA is adjusted gross income plus tax-exempt interest (plus a few rare add-backs, like excluded foreign earned income). The tax-exempt part surprises people: municipal bond interest — invisible on your federal tax bill — counts fully toward the IRMAA thresholds. Roth conversions, capital gains, RMDs, and pension income all count too; qualified Roth withdrawals do not.

How will I even know IRMAA applies to me?

The Social Security Administration mails an initial determination notice — typically in late fall — telling you next year's premium and which tax year it was based on. Read it: it states the income figures used and explains your reconsideration rights. If the events or numbers are wrong or outdated, that letter is your cue to respond.

Plan Around the Cliffs

IRMAA Optimizer →

Your distance to the next tier, for any income scenario.

 Conversion Modeler →

Size conversions against brackets and cliffs, year by year.

 RMD Forecaster →

The forced income that decides your permanent IRMAA tier.

 IRMAA Reference Table →

Every tier, every filing status, kept current.

Sources & Further Reading

For educational purposes only; not financial advice. Rules and figures change — confirm current details with the primary sources above.

💡 Near a tier?

Check any income scenario against this year's IRMAA cliffs.

IRMAA Optimizer →