If your income is above a certain level, Medicare adds a surcharge to your Part B and Part D premiums called IRMAA. Here is how it works, who it hits, and how to push back if your income dropped.
IRMAA stands for Income-Related Monthly Adjustment Amount. It is an extra charge added on top of your standard Medicare Part B and Part D premiums if your income is above the threshold. It is not a separate bill you choose; Social Security applies it automatically based on your tax return.
The key surprise for most people: IRMAA is based on your income from two years ago. So your 2026 premiums are based on the income reported on your 2024 tax return (your modified adjusted gross income, or MAGI).
Social Security looks at your MAGI from two years prior and places you in an income bracket. The higher the bracket, the larger the surcharge added to both Part B and Part D. Married couples filing jointly have higher thresholds than single filers. Because the exact dollar amounts and brackets change every year, we walk through your specific numbers with you rather than guess.
Two things catch people off guard: IRMAA looks back two years, and a one-time income spike (selling a home, a large IRA withdrawal, capital gains) can push you into a higher bracket for a year even if your normal income is modest.
If your income has gone down since that two-year-old tax return because of a life-changing event, you can ask Social Security to use your more recent income instead. Qualifying events include:
You stopped working or cut back hours, so your income dropped.
A change in marital status that changed your household income.
Loss of pension, or loss of income-producing property through no fault of your own.
You file Form SSA-44 with proof. We can point you to the form and what to gather; the determination is made by Social Security.
Real reviews from the people we have helped navigate Medicare.
If a high-income surcharge hit you, or you think it shouldn't apply anymore, we will walk through your situation and point you to the right next step. No fees, no obligation, no pressure.
Cole Insure, LLC is a licensed independent insurance agency. This is an advertisement for insurance-related services. Figures, income brackets, enrollment rules, and deadlines are set by Medicare and the Social Security Administration, change annually, and depend on your personal situation; the examples here are general and not a determination for your case. Medicare has neither reviewed nor endorsed this information. We are not affiliated with or endorsed by the U.S. government or the federal Medicare program. To get information on all of your options, contact Medicare.gov, 1-800-MEDICARE (TTY 1-877-486-2048), or your local State Health Insurance Program (SHIP). Details are current as of 2026 and subject to change.