Most people on Medicare pay the standard Part B premium and never think about it again. A minority get a letter from Social Security in late fall saying they will pay considerably more, and the reason is a two-year-old tax return.
That surcharge is called the income-related monthly adjustment amount, or IRMAA. It is not a penalty and it is not tied to your health. It is a straight income test, it hits Part B and Part D separately, and it is one of the few Medicare costs you can actually argue your way out of. Every figure below was pulled on September 6, 2026 from CMS and Social Security.
What IRMAA Is and Who Pays It
IRMAA is an extra amount added on top of the standard premium for people whose modified adjusted gross income exceeds a threshold. For 2026 the standard Part B premium is $202.90 a month and the Part B deductible is $283, per the CMS fact sheet released November 14, 2025 and the companion Federal Register notice published November 19, 2025.
Two things surprise people. First, IRMAA applies to both Part B and Part D. The Part B piece is folded into your Part B premium. The Part D piece is billed separately by Medicare or the Railroad Retirement Board, not by your drug plan, even if an employer or retirement system pays your plan premium for you.
Second, it applies whether you are in Original Medicare or a Medicare Advantage plan, because you still owe the Part B premium either way. Some Medicare Advantage plans pay back part of the Part B premium, but that does not erase an IRMAA surcharge.
Social Security, not CMS, decides who owes it. Social Security gets your tax data from the IRS and applies the table.
The Two-Year Lookback
Your 2026 IRMAA is set from the modified adjusted gross income on the tax return you filed for 2024. Social Security uses the two-year-old return because that is the most recent data the IRS has transmitted. If that return is not available, it falls back to the three-year-old return and adjusts later.
Modified adjusted gross income here means your adjusted gross income plus tax-exempt interest. That is a broader number than taxable income, and it is why municipal bond interest can push someone over a threshold.
The practical consequence is a lag. Someone who retired in 2025 is being billed in 2026 on the income of a year when they were still working full time. The surcharge eventually corrects itself when the lower-income year rolls into the window, but that takes two years unless you act.
The 2026 IRMAA Brackets
These are the 2026 tables. Read the income columns carefully: they are your 2024 modified adjusted gross income, the return SSA received from the IRS, not anything you earned in 2026. The Part B column is the total monthly Part B premium including the surcharge. The Part D column is what gets added to whatever your drug plan charges.
| 2024 MAGI, individual return | 2024 MAGI, joint return | 2026 Part B total premium | 2026 Part D add-on |
|---|---|---|---|
| $109,000 or less | $218,000 or less | $202.90 | $0.00 |
| Above $109,000 up to $137,000 | Above $218,000 up to $274,000 | $284.10 | $14.50 |
| Above $137,000 up to $171,000 | Above $274,000 up to $342,000 | $405.80 | $37.50 |
| Above $171,000 up to $205,000 | Above $342,000 up to $410,000 | $527.50 | $60.40 |
| Above $205,000 and under $500,000 | Above $410,000 and under $750,000 | $649.20 | $83.30 |
| $500,000 or more | $750,000 or more | $689.90 | $91.00 |
Married filing separately gets its own compressed schedule, and it is harsh. If you filed separately for 2024 and lived with your spouse at any time during that year, 2024 MAGI of $109,000 or less means the standard $202.90. Above $109,000 and under $391,000 jumps straight to $649.20 for Part B plus $83.30 for Part D. At $391,000 or more it is $689.90 plus $91.00. There are no intermediate rungs.
These figures match across the CMS fact sheet and SSA POMS HI 01101.020, and the Part D add-ons are restated on Social Security’s own higher-income premiums page.
The Cliff Nobody Warns You About
IRMAA is not a graduated tax. One dollar over a threshold moves you into the entire next bracket.
Take a single filer with 2024 MAGI of $109,000. They pay $202.90 for Part B and no Part D add-on. A filer at $109,001 pays $284.10 plus $14.50, which is $95.70 more per month, or $1,148.40 more over the year, for one extra dollar of income.
For a couple filing jointly, both spouses on Medicare each pay their own surcharge, so the same single dollar over $218,000 costs the household roughly $2,296.80 a year.
At the top, a single filer at $500,000 or more pays $689.90 for Part B plus $91.00 for Part D. That is $578.00 a month above the standard, or $6,936 a year, and again $13,872 for a couple both enrolled.
That cliff structure is exactly why the appeal is worth the paperwork.
The Eight Life-Changing Events Social Security Accepts
SSA policy at POMS HI 01120.005 lists the events that let Social Security make a new initial determination using a more recent year’s income:
- Death of a spouse
- Marriage
- Divorce or annulment
- Work stoppage, including retirement
- Work reduction, such as cutting to part time
- Loss of income-producing property, when the loss was not at your direction
- Loss of employer pension income
- Receipt of a settlement payment from a current or former employer because of bankruptcy or reorganization
The property category is narrower than it sounds. SSA-44 describes it as loss not due to your own sale or transfer: real property in a declared disaster area, livestock or crops lost to natural disaster or disease, arson, or investment property lost to fraud or theft. Selling a rental because you felt like it does not count.
What documentation Social Security wants
The SSA-44 instructions pair each event with specific evidence:
- Work stoppage or reduction: a signed statement from your employer, pay stubs, or documents showing transfer of your business. In the absence of that proof, SSA will accept your signed statement on the form under penalty of perjury.
- Loss of income-producing property: an insurance adjuster’s statement of loss or a letter from a state or federal agency about the uncompensated loss. For investment fraud, SSA also wants proof of conviction for the theft.
- Loss of pension income: a letter from the pension fund administrator explaining the reduction or termination.
- Employer settlement payment: a letter from the employer stating the settlement terms and how they affect you.
You also supply the newer income figure. That can be a filed tax return for the more recent year, or an estimate of the current or next year if the reduction is ongoing or expected.
What Is Not a Life-Changing Event
SSA is explicit that the list is exclusive. The following do not qualify, no matter how much they cut your cash flow:
- Ordinary loss of dividend income
- Higher medical or living expenses
- Loss of child support or alimony
- Voluntary sale or transfer of income-producing property
And on the other side, SSA treats one-time income spikes as non-qualifying events. Capital gains from selling property, Roth IRA conversions, cashing in bonds, and lottery or casino winnings all count as non-qualifying. A big Roth conversion in 2024 that triggers a 2026 surcharge is the single most common rejected request. There is no relief for it. The surcharge simply drops away in 2027 when the 2025 return takes over, assuming your income returned to normal.
Form SSA-44 Versus a Formal Appeal
These are two different tracks, and people conflate them constantly.
A new initial determination is what SSA-44 requests. You are not saying Social Security got the math wrong. You are saying the underlying facts changed, and asking them to use different data. SSA’s own guidance in POMS HI 01120.001 says that when a beneficiary alleges a life-changing event, staff should treat it as a request for a new initial determination and should not take an appeal request unless the beneficiary insists. The form is SSA-44, revised December 2025, and Social Security accepts it online through your account, by fax, by mail, or in person at a field office.
A formal appeal is a reconsideration of the determination itself. Per POMS HI 01140.001, you must request it within 60 days of receiving the IRMAA determination notice, and SSA presumes receipt five days after the notice date. If reconsideration goes against you, the next level is an administrative law judge at the HHS Office of Medicare Hearings and Appeals (OMHA), then the Medicare Appeals Council, then federal district court.
SSA’s own note is worth repeating: in most situations a new initial determination gets you the same result as an appeal, so the appeal is usually unnecessary. You are allowed to file both at once.
The Amended or Corrected Return Path
If your 2024 return was simply wrong, that is a third and separate route. POMS HI 01120.045 lets SSA use an amended return in place of the data the IRS transmitted, provided you supply either an IRS receipt letter with your copy of the amended return, or an IRS transcript.
There is a deadline. The request must be made within three calendar years following the close of the tax year the amended return covers, unless you can show good cause for filing late. Note also that SSA will not impose IRMAA based on an amended return alone if the electronic IRS data does not show a surcharge is owed, so this path only runs in your favor.
If the Surcharge Stands
IRMAA has no hardship waiver and no sliding scale below the first threshold. If you owe it and none of the eight events apply, the money is due. What you can still control is everything downstream of the premium.
- The Medicare Prescription Payment Plan spreads out-of-pocket drug costs across the calendar year at no interest, though it does not touch the IRMAA surcharge itself.
- Medicare Easy Pay automates the separate Part D IRMAA bill, which is the one people most often let lapse because it does not come from their drug plan.
- Manufacturer and foundation programs listed in our guide to prescription assistance programs are means-tested on income, and the high income that triggered IRMAA usually rules them out. Check the specific program rather than assuming.
- If the surcharge lands in a year you also have large provider bills, the tactics in medical bill assistance programs and hospital charity care operate on a completely separate income test.
At the low end of the income scale, the picture inverts entirely: Medicare Savings Programs pay the Part B premium outright, and Extra Help covers most Part D costs. People who retire early and have a low-income year before Medicare starts should also read our guide to health insurance for early retirees, because the income planning that lowers IRMAA two years later starts there.
Separately, if you delayed enrolling in Part B or Part D, an IRMAA surcharge can sit on top of a late enrollment penalty. They are unrelated charges and both can apply at once.
When the 2027 Numbers Arrive
As of September 6, 2026, no 2027 IRMAA brackets exist. CMS publishes the following year’s Part B premium, deductible and IRMAA tables in a fact sheet each November, and the 2027 figures will be set from 2025 tax returns. Any 2027 bracket table circulating now is a projection made by a consultant or an actuary, not a published federal figure. Treat it as an estimate and check the CMS fact sheet in November before relying on it.
Bottom Line
If your 2026 Social Security notice says you owe IRMAA, do two things. Confirm the 2024 MAGI they used against your own return, because a transposition or a missing amendment is fixable. Then check the eight-event list. If retirement, a divorce, a death or a pension loss cut your income after 2024, file SSA-44 with proof and ask for a new initial determination. If the cause was a one-time gain you chose to realize, the surcharge is going to stand for one year and then fall off on its own.