IRMAA Explained: Thresholds and the Two-Year Lookback
IRMAA is the income-related monthly adjustment amount, an extra charge added to Medicare Part B and Part D premiums for people whose income is above set thresholds. For 2026, Social Security generally uses your 2024 tax return. Those who have had certain life-changing events may ask for a new decision based on more recent income.
Medicare is not priced the same for everyone. Higher-income enrollees pay more for Part B and for drug coverage. That extra charge has a long name, the income-related monthly adjustment amount, or IRMAA. This page explains what it is, how the 2026 brackets work, and why the income used is from years ago. It explains rules only. It is not tax or Medicare advice.
What is IRMAA?
IRMAA is an extra charge added to a Medicare premium for higher-income enrollees. The Social Security Administration (SSA) describes it this way in its program manual, and notes it "may also be referred to as the Medicare subsidy reduction" (SSA POMS HI 01101.001).
There are two kinds:
- IRMAA-B is added to the Medicare Part B premium.
- IRMAA-D is added to the premium for drug coverage, for people in a Medicare prescription drug plan or a Medicare Advantage plan with drug coverage (SSA POMS HI 01101.001).
If your income is below the threshold for your filing status, you do not pay IRMAA (SSA-44; the tables below show the 2026 thresholds).
What income counts?
The measure is modified adjusted gross income (MAGI). SSA's form defines it as your adjusted gross income from line 11 of IRS Form 1040, plus tax-exempt interest income from line 2a of Form 1040 (SSA-44).
Your tax preparer can tell you what is included in adjusted gross income on your own return. This page does not try to list every item.
What are the 2026 IRMAA brackets?
SSA's program manual lists the 2026 tables. The amounts below are the total Part B premium and the Part D add-on at each level. The Part D add-on is paid in addition to your own drug plan's premium. The income used is from 2024, or from 2023 if 2024 is not available (SSA POMS HI 01101.020).
Single, head of household, or qualifying surviving spouse with a dependent child
| 2024 MAGI | Part B monthly premium | Part D add-on |
|---|---|---|
| Up to $109,000 | Standard premium ($202.90) | None |
| More than $109,000 to $137,000 | $284.10 | $14.50 |
| More than $137,000 to $171,000 | $405.80 | $37.50 |
| More than $171,000 to $205,000 | $527.50 | $60.40 |
| More than $205,000 to under $500,000 | $649.20 | $83.30 |
| $500,000 or more | $689.90 | $91.00 |
Married filing jointly
| 2024 MAGI | Part B monthly premium | Part D add-on |
|---|---|---|
| Up to $218,000 | Standard premium ($202.90) | None |
| More than $218,000 to $274,000 | $284.10 | $14.50 |
| More than $274,000 to $342,000 | $405.80 | $37.50 |
| More than $342,000 to $410,000 | $527.50 | $60.40 |
| More than $410,000 to under $750,000 | $649.20 | $83.30 |
| $750,000 or more | $689.90 | $91.00 |
Married filing separately
| 2024 MAGI | Part B monthly premium | Part D add-on |
|---|---|---|
| Up to $109,000 | Standard premium ($202.90) | None |
| More than $109,000 to under $391,000 | $649.20 | $83.30 |
| $391,000 or more | $689.90 | $91.00 |
The $202.90 standard Part B premium comes from SSA's Medicare premiums page. The manual's tables also say the Part B figures are plus any applicable surcharges and minus any Medicare Advantage reduction, and that drug premiums may also include late-enrollment fees (SSA POMS HI 01101.020).
The amounts are monthly figures. Each bracket is a step: once income is above a line, the next level applies.
Why does Medicare use income from two years ago?
SSA's manual defines "PY-2" as the tax year two years before the premium year, and "PY-3" as three years before (SSA POMS HI 01101.001). SSA's planner page says that for 2026 premiums the tax year used is generally 2024, and that SSA occasionally has only 2023 data (SSA Medicare premiums page).
In plain terms, a 2024 tax return sets the 2026 charge. A big one-time income event in a year (a business sale, a large withdrawal) can therefore show up in your Medicare premium two years later.
| Premium year | Income year SSA generally uses |
|---|---|
| 2026 | 2024 (2023 if 2024 is not available) |
SSA's manual also says that "if the data received from IRS does not indicate that a beneficiary must pay an IRMAA, SSA cannot impose an IRMAA" (SSA POMS HI 01101.001).
How will I find out I owe IRMAA?
Social Security sends an Initial IRMAA Determination notice if you have Part B or Part D and it decides IRMAA applies to you. Medicare.gov says it can arrive "at any time," advises you to keep it, and says the notice includes information about appeal rights (Medicare.gov). A "predetermination" notice, if you receive one, is not a final decision and has no appeal rights (SSA POMS HI 01140.001).
What if my income has dropped since then?
SSA lets you ask for a new decision if certain life-changing events reduced your income. Form SSA-44 lists these events:
- Marriage
- Divorce or annulment
- Death of your spouse
- You or your spouse stopped working, or reduced work hours
- Involuntary loss of income-producing property, such as from a disaster, arson, fraud or theft
- Loss of pension income
- An employer settlement payment
(SSA-44)
You must show evidence of the event, for example a marriage record, divorce decree, death certificate, employer statement, or pension administrator letter, plus a signed copy of the tax return or an IRS transcript for the more recent year you report. The form says the year you report must show a reduction in income because of the event (SSA-44).
Whether your situation qualifies depends on the facts, so check the form's instructions or ask SSA.
Other reasons to ask for a new decision
SSA's manual lists other cases where you can ask for a new initial determination (SSA POMS HI 01120.001):
- An amended tax return for the year SSA used.
- Corrected IRS information for that year. The manual says it is the beneficiary's responsibility to contact the IRS for a correction.
- SSA used three-year-old information and you have a return from two years before the premium year.
- You filed married filing separately but lived apart from your spouse for the entire year.
A request applies only to the person who files it, not to a spouse or ex-spouse. The manual also says SSA cannot impose IRMAA using beneficiary-provided data if IRS data shows none is owed.
How do I appeal an IRMAA decision?
You can request reconsideration within 60 days of receiving the notice. SSA treats the date received as 5 days after the date on the notice, and may accept a late request if you show good cause (SSA POMS HI 01140.001).
The manual also says an appeal is "not always necessary": for life-changing events, amended returns and similar cases, "a new initial determination can provide the beneficiary with the same results as an appeal." An appeal is generally for someone who disagrees with the decision itself.
Common mistakes and edge cases
- Assuming the charge reflects this year's income. It generally reflects an older return.
- Forgetting Part D. The add-on is separate from your drug plan's own premium.
- Missing the 60-day window. Keep the notice and note the date.
- Skipping the evidence. Requests based on estimates must later be backed by a signed return, per the form.
- Treating this page as a calculator. Thresholds are reset for each premium year, and 2027 figures were not checked for this page.
Where do gold and silver IRAs fit?
IRMAA depends on the income figure on your tax return, not on what type of account you hold. This page does not say any account type raises or lowers it. If you are weighing how retirement account choices affect your tax return, a qualified tax professional can model that for you. For how metals IRAs work, including their costs and risks, see the Gold IRA guide, fees and risks.
Related questions
- How does the age you start Social Security affect planning?
- What does the 2027 Social Security COLA change?
- Where does this fit in your retirement budget?
- See the full retirement planning guide.
What we did not check
We did not open the Medicare.gov costs page, the CMS fact sheet announcing 2026 premiums, or SSA's rule on which tax year applies (HI 01101.030). The 2027 IRMAA thresholds were not checked. Always confirm current amounts with SSA or Medicare.gov.
Sources
- SSA - POMS: HI 01101.020 - IRMAA Sliding Scale Tables, Social Security Administration. Accessed Invalid Date.
- SSA - POMS: HI 01101.001 - Description of the Medicare Income-Related Monthly Adjustment Amount (IRMAA), Social Security Administration. Accessed Invalid Date.
- Medicare Income-Related Monthly Adjustment Amount - Life-Changing Event (Form SSA-44), Social Security Administration. Accessed Invalid Date.
- SSA - POMS: HI 01120.001 - Overview of New Initial Determinations on the IRMAA Using Beneficiary Provided Information, Social Security Administration. Accessed Invalid Date.
- SSA - POMS: HI 01140.001 - Overview of the Appeals Process for the IRMAA, Social Security Administration. Accessed Invalid Date.
- Benefits Planner: Retirement - Medicare premiums, Social Security Administration. Accessed Invalid Date.
- Initial IRMAA Determination, Medicare.gov. Accessed Invalid Date.
This guide is general education, not personalized financial, tax or legal advice. See our financial disclaimer, editorial policy and advertising disclosure.