Medicare IRMAA: Why Your Premium Is Higher and How to Appeal

1What IRMAA is, and which income counts

The standard Part B premium is the same for everyone with moderate income. IRMAA adds to it, and to the Part D drug plan premium, once income passes a threshold. It is part of the law that people with higher incomes pay a larger share of the real cost of Medicare, rather than a penalty for anything you did.

The measure is modified adjusted gross income: the adjusted gross income on your tax return plus any tax-exempt interest. That means income that is not obvious on a paycheck counts, such as a large capital gain, a Roth conversion, the sale of a business or a big withdrawal from a retirement account. The measure comes from the return filed two years before the premium year, so the 2026 premium is set from 2024 income. If that return is not available, the agency uses the one before it.

The bracket depends on how you file. Married couples filing jointly have thresholds twice those of single filers, except at the very top. Someone who is married but files separately and lived with their spouse at any point in the year has three tiers only, and moves to the top very quickly.

2The 2026 brackets

Swipe sideways to see the whole table.

The surcharge is the difference from $202.90: $81.20 in the first tier up to $487.00 in the last. Part D has its own surcharge in the same brackets, and it is paid to the government rather than to your drug plan. It comes out of your Social Security check if you receive one, or is billed to you if you do not.

The thresholds are adjusted each year. Our Medicare premium calculator uses the 2026 figures and shows your bracket.

3How the notice reaches you

Social Security mails a notice when it decides that you owe an adjustment, typically in the fall for the coming year. It states your income, the tax year it came from, the premium and the rights you have to challenge it. The notice is an initial determination, and it is the starting point for both of the ways to reduce the amount.

People who enroll in Medicare for the first time often get one without having expected it. A person who sold a home or took retirement account money in the year they retired can find that a single high-income year, one that no longer reflects their income, sets their premium for the next year.

4One dollar over a line

The brackets work as cliffs, not slopes. A single filer with $109,000 of modified adjusted gross income pays the standard $202.90. At $109,001 the premium is $284.10, which is $81.20 more a month, or $974.40 over a year. The surcharge is a flat amount for the whole bracket and is not figured on the income above the line, so a few dollars of extra income can cost far more than the dollars themselves.

That makes it worth knowing where you stand before the year ends. Things that commonly lift income in a single year include a Roth conversion, the sale of a home or investments at a gain, cashing out a retirement account and a bonus or severance payment on leaving a job. Spreading a gain over two years, or timing a withdrawal, can keep income under a line. Gifts to charity made directly from an IRA, called qualified charitable distributions, generally do not count in adjusted gross income for people old enough to make them.

The two-year lag cuts both ways. A spike in income in 2026 reaches your premium in 2028, and a year of low income now pays off two years from now. A tax professional can model a particular sale or withdrawal against the brackets before you make it.

5Reducing it: a life-changing event

If your income has dropped since the year the agency used, you can ask for a new decision that uses a lower estimate. The request is made on Form SSA-44, and it requires one of the events that Social Security recognizes:

• marriage, divorce or annulment;
• the death of a spouse;
• work stopping or work reduction;
• loss of income-producing property, such as rental property;
• loss of pension income; or
• an employer settlement payment, such as a payout on leaving a job.

The event has to be reflected in lower income, and you will need to show it with evidence. The agency may ask for original documents or certified copies rather than photocopies. A retirement letter, a divorce decree, a death certificate or a pension statement are examples. The agency's IRMAA page explains how to submit it, and the form can also be sent by mail or fax, or handed in at a local office.

The form also asks for your estimated income for the year the new decision would cover, so have a figure ready that you can support. Asking is worthwhile even when the lower income is only temporary. The agency can use your estimate for the year, and it checks the actual figures against your tax return when they arrive. If your income turns out to be higher than you estimated, the premium can be adjusted back, so estimate honestly.

6When the data itself is wrong

Sometimes the problem is not a change in your life but the numbers. If you filed an amended return, or the IRS corrected your return, you can provide the amended return and a letter from the IRS acknowledging it, or a transcript, and ask for a new decision. If the agency used a return that is three years old and you have since filed the more recent one, you can submit the signed copy or a transcript so that it is used instead. For an error on the IRS side, contact the IRS first and bring the correction to Social Security.

7How the surcharge is paid

If you receive Social Security, the Part B premium and any surcharge are normally deducted from your monthly benefit, so the deposit is smaller by that amount. If you do not, Medicare bills you for the premium. The Part D adjustment is paid to the government, not to your drug plan, and it is collected the same way, so a plan that charges a low premium does not reduce it. Switching plans does not change IRMAA either.

When a new decision lowers your premium, the agency adjusts what is withheld going forward and refunds any amount you overpaid for the months already covered. Keep the decision letter so you can check the refund against your statements. For how the surcharge fits with the rest of Medicare, including what Medicaid can pay for, see our guide to Medicare and Medicaid.

8If you disagree with the decision

A request for reconsideration is the formal appeal. You have 60 days from receiving the notice, and the agency presumes you received it five days after the date it carries. It is filed on Form SSA-561. A person who did not make the first decision reviews it, and a further appeal goes to an administrative law judge.

The two routes are not interchangeable. If your facts fit a life-changing event, the new initial determination is the right route, and an appeal without a qualifying event can simply be dismissed. If you are unsure which applies, call 1-800-772-1213 before you file, and keep the 60-day clock in mind while you do.

10What no guide can settle

Brackets and premiums change every year, and the agency decides each request. This is general information and not tax advice. A tax professional can help you see how a withdrawal or a sale will move your bracket before you make it.