How to Avoid IRMAA: The Hidden Medicare Surcharge
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By Hans Goldstein, EA, founder, Retirement Literacy Foundation · Updated
Admitted to practice before the IRS.
Reviewed by Hans Goldstein, EA · Nonprofit education, nothing sold
What are the 2026 IRMAA income brackets?
IRMAA kicks in the moment your income crosses a threshold, even by one dollar. These are the official 2026 brackets (CMS fact sheet, November 14, 2025), based on your Modified Adjusted Gross Income (MAGI) from two years prior, which for 2026 is your 2024 return:
| 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. On a joint return each spouse on Medicare pays them. The lines are indexed and change each year. CMS has not announced the 2027 amounts yet; it usually does in mid-November.
A worked example: one Roth conversion, two ways
A married couple, both on Medicare, expects $200,000 of MAGI in 2026. They want to move $30,000 from a traditional IRA to a Roth.
| Convert all $30,000 in 2026 | Convert $18,000 in 2026 and $12,000 in 2027 | |
|---|---|---|
| MAGI | $230,000 in 2026 | $218,000 in 2026, $212,000 in 2027 |
| Against the $218,000 joint line | $12,000 over | At or under the line both years |
| Extra Medicare premiums two years later | $95.70 a month each, $2,296.80 for the couple for the year | $0 |
Same $30,000 converted. Splitting it across two tax years avoids about $2,297 of premiums. This uses the 2026 line and 2026 amounts (CMS, 2026). The lines for 2028 and 2029 will be set later and are usually a little higher, so check the current table before you act.
What to do next
- Find your MAGI. It is line 11 plus line 2a of your Form 1040. Your 2024 return sets 2026 premiums and your 2025 return sets 2027.
- See which bracket it lands in. Use the free IRMAA calculator.
- Before December 31, add up any planned conversion, sale or large withdrawal and compare the total with the line above you. This year's income sets your premium two years from now.
- If your income has dropped because you retired, cut back work, lost a spouse or divorced, ask Social Security to use a newer year. See how to appeal with Form SSA-44.
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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.
Why does IRMAA use your income from two years ago?
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.
How do you appeal IRMAA with Form SSA-44?
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.
How do you manage your MAGI before Medicare starts?
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 before the year you turn 63, so the taxable income lands in years Medicare never looks at (Medicare at 65 uses the return from the year you turned 63); after age 70½, use Qualified Charitable Distributions (QCDs) to give directly from your IRA (up to $111,000 per person in 2026, IRS Notice 2025-67), which keeps that money out of your AGI; 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% |
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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 →Sources: CMS, 2026 Medicare Parts A and B premiums and deductibles (November 14, 2025); Social Security, premium rules for higher-income beneficiaries; Form SSA-44; IRS Publication 590-B (QCDs). Checked October 10, 2026. Education only, not tax advice.
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 the taxable part of 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?
The Retirement Literacy Foundation runs free retirement classes across Southern California on Social Security timing, taxes in retirement, and how to turn savings into income. No products are sold at our classes.
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, EA
Founder & Executive Director · Retirement Literacy Foundation, a 501(c)(3) non-profit
Admitted to practice before the IRS
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