The Medicare IRMAA Surcharge: What It Is And How To Appeal

If your income has ever nudged your Medicare premium higher, IRMAA is the reason.

What Is the Medicare IRMAA Surcharge?

The Medicare IRMAA surcharge is an extra amount added to your Part B and Part D premiums when your income passes certain thresholds.

IRMAA stands for Income-Related Monthly Adjustment Amount. The Social Security Administration (SSA) sets it using your modified adjusted gross income (MAGI) from two years back. That means your 2026 premiums are based on the income you reported on your 2024 tax return.

For 2026, the standard Part B premium is $202.90 per month. The surcharge starts once your 2024 MAGI passes $109,000 for a single filer, or $218,000 for a couple filing jointly. Five income tiers can push the total Part B premium as high as $689.90 per month.

Part D surcharges add between $14.50 and $91.00 per month on top of your drug plan premium. You can find the full breakdown of the 2026 IRMAA brackets on our blog.

Why One Extra Dollar Can Cost You a Thousand

IRMAA is a cliff, not a slope.

Cross a threshold by even one dollar, and the full surcharge for that tier applies all year. For a married couple who are both on Medicare, landing in the first tier adds roughly $2,300 per year in combined Part B and Part D surcharges.

Tip: the income you take in 2026 sets your premiums for 2028. Large IRA withdrawals, Roth conversions, and property sales all count toward MAGI. A conversation with your tax advisor before year-end can keep a one-time spike from becoming a two-year surcharge.

The Part Most People Miss: You Can Appeal

Many readers assume the letter from Social Security is the final word.

It is not. If a life-changing event lowered your income after the tax year SSA used, you can ask them to use your more recent income instead. Qualifying events include retirement, reduced work hours, marriage, divorce, and the death of a spouse.

The request is made on Form SSA-44, and there is no fee to file. If SSA approves, your premium drops going forward, and SSA may refund what you already overpaid.

The Numbers Worth Remembering

IRMAA touches fewer people than you might think, but it hits hard when it does.

The Centers for Medicare and Medicaid Services (CMS) reports that roughly eight percent of people with Part B pay an income-related adjustment. At the top tier, Part B alone costs $689.90 per month in 2026, which is more than $8,200 per year.

Your Personal Benefits Manager looks at the whole picture, including your Medicare supplement plan or Medicare Advantage plan, and your Part D drug plan, so everything works together.

Your income, not just your plan, decides what Medicare costs you, and both are worth a yearly look.

Your August IRMAA Checklist

Five steps this month can put you back in control.

• Find your most recent IRMAA determination letter from Social Security, and confirm the income figure it used.
• Check the MAGI on your 2024 return against the 2026 thresholds of $109,000 single and $218,000 joint.
• Map any large 2026 income events, such as IRA withdrawals or a property sale, with your tax advisor, because they shape your 2028 premiums.
• File Form SSA-44 if retirement, the loss of a spouse, or another life-changing event has lowered your income.
• Compare your current plan against this year’s options with your Personal Benefits Manager, to make sure it is still the best fit for you.

Medicare Trivia

When Social Security calculates your IRMAA, how far back does it look at your income?

Answer: two years. Your 2026 surcharge comes from your 2024 tax return. Reply to this email and tell us if you got it right.

Wondering whether a different plan could cost you less this year? See your plan options with a free review from your Personal Benefits Manager.

Here’s to your health and wealth,

Wiley P. Long, III
President – MediGap Advisors

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