Written By
Greg Wohl
Licensed Medicare Specialist
Most people know that Medicare Part B has a standard monthly premium ($185 in 2026). What many do not realize is that higher-income beneficiaries pay significantly more through a surcharge called the Income-Related Monthly Adjustment Amount, or IRMAA.
In 2026, IRMAA can add up to $628.90 per month to your Part B premium and up to $85.80 per month to your Part D premium. For a couple, that is potentially over $17,000 per year in additional Medicare costs.
The good news is that IRMAA is not fixed. There are legal strategies to reduce it, and in some cases you can appeal it entirely. This guide explains how IRMAA works, what triggers it, and the most effective ways to lower your Medicare premiums.
Key Takeaways
- IRMAA is based on income from 2 years ago: In 2026, your IRMAA surcharge is based on your 2024 Modified Adjusted Gross Income (MAGI) as reported to the IRS. This lag creates opportunities to appeal if your income has dropped significantly.
- There are 5 IRMAA tiers above the standard premium: IRMAA surcharges are tiered. In 2026, the Part B surcharge ranges from $74.00 to $628.90 per month above the standard $185 premium, depending on your income bracket.
- A life-changing event can trigger an appeal: If your income dropped due to retirement, divorce, death of a spouse, loss of income-producing property, or other qualifying events, you can request a reduction using SSA Form SSA-44.
- Roth conversions and capital gains can push you into a higher tier: Large one-time income events like Roth IRA conversions, property sales, or required minimum distributions can temporarily spike your MAGI and trigger IRMAA two years later.
- Low-income programs can eliminate premiums entirely: The Medicare Savings Program (MSP) and Extra Help (LIS) programs can eliminate Part B and Part D premiums for beneficiaries who meet income and asset limits.
- Strategic income planning before 65 matters: The income decisions you make in the 2 to 3 years before turning 65 directly affect your Medicare premiums. Working with a financial advisor before Medicare enrollment can prevent costly surprises.
How IRMAA Works: The 2026 Income Brackets
IRMAA is calculated using your Modified Adjusted Gross Income (MAGI) from your most recent tax return on file with the IRS. In 2026, Social Security uses your 2024 tax return.
MAGI for IRMAA purposes includes: adjusted gross income plus tax-exempt interest income. It does not include Social Security benefits that are not taxable.
Here are the 2026 IRMAA brackets for Part B:
| 2024 MAGI (Individual) | 2024 MAGI (Joint) | Monthly Part B Premium |
|---|---|---|
| Up to $106,000 | Up to $212,000 | $185.00 (standard) |
| $106,001 - $133,000 | $212,001 - $266,000 | $259.00 |
| $133,001 - $167,000 | $266,001 - $334,000 | $370.00 |
| $167,001 - $200,000 | $334,001 - $400,000 | $480.90 |
| $200,001 - $500,000 | $400,001 - $750,000 | $591.90 |
| Above $500,000 | Above $750,000 | $813.90 |
Part D IRMAA surcharges range from $13.70 to $85.80 per month on top of your plan premium, using the same income brackets.
How to Appeal IRMAA After a Life-Changing Event
Because IRMAA is based on income from 2 years ago, it can feel unfair when your income has dropped significantly since then. The good news is that Social Security allows you to appeal IRMAA if your income decreased due to a qualifying life-changing event.
Qualifying life-changing events include:
- Marriage, divorce, or annulment
- Death of a spouse
- Work stoppage or reduction (including retirement)
- Loss of income-producing property (due to disaster or other involuntary circumstances)
- Loss of pension income
- Receipt of employer settlement payment
How to appeal: Complete SSA Form SSA-44 (Medicare Income-Related Monthly Adjustment Amount - Life-Changing Event) and submit it to your local Social Security office along with documentation of the event and your current or estimated income. You can download the form at ssa.gov.
If approved, Social Security will recalculate your IRMAA based on your more recent income. The reduction takes effect the month after your request is processed.
Note: A general decline in investment income, stock losses, or voluntary income reduction (such as choosing to work fewer hours) does not qualify as a life-changing event for IRMAA appeal purposes.
Strategy 1: Manage Roth Conversions and Capital Gains Carefully
One of the most common triggers for unexpected IRMAA surcharges is a large one-time income event in the 2 years before or during Medicare enrollment. The most common culprits are:
- Roth IRA conversions: Converting a traditional IRA to a Roth IRA generates taxable income in the year of conversion. A large conversion can push your MAGI into a higher IRMAA bracket two years later.
- Capital gains from property or investment sales: Selling a rental property, vacation home, or large stock position can spike your MAGI significantly.
- Required Minimum Distributions (RMDs): Once you reach RMD age, mandatory withdrawals from traditional IRAs and 401(k)s add to your MAGI each year.
The strategy is not to avoid these transactions, but to time and size them carefully. For example, spreading a Roth conversion over several years rather than doing it all at once can keep your MAGI below the next IRMAA threshold. Working with a financial planner who understands Medicare's income rules is essential for this kind of planning.
Strategy 2: Use Qualified Charitable Distributions (QCDs)
If you are 70.5 or older and charitably inclined, a Qualified Charitable Distribution (QCD) is one of the most effective tools for reducing IRMAA.
A QCD allows you to transfer up to $105,000 per year (2026 limit) directly from your IRA to a qualified charity. The distribution counts toward your Required Minimum Distribution but is excluded from your taxable income, which means it does not add to your MAGI for IRMAA purposes.
For a beneficiary in the second IRMAA tier, a $30,000 QCD that replaces a taxable RMD could reduce their Part B premium from $259/month to $185/month, saving $888 per year. The tax savings on the charitable deduction are an additional benefit.
QCDs must go directly from the IRA custodian to the charity. You cannot withdraw the funds yourself and then donate them.
Strategy 3: Explore Low-Income Assistance Programs
If your income and assets are modest, you may qualify for programs that eliminate Medicare premiums entirely rather than just reduce them.
Medicare Savings Programs (MSPs) are state-administered programs that help pay Medicare Part B premiums and, in some cases, Part A premiums, deductibles, and copays. In Florida, there are four MSP levels:
- Qualified Medicare Beneficiary (QMB): Pays Part A and B premiums, deductibles, and copays. Income limit: approximately 100% of the federal poverty level (FPL).
- Specified Low-Income Medicare Beneficiary (SLMB): Pays Part B premium only. Income limit: approximately 120% FPL.
- Qualifying Individual (QI): Pays Part B premium only. Income limit: approximately 135% FPL.
- Qualified Disabled and Working Individuals (QDWI): Pays Part A premium for certain disabled working individuals.
Extra Help (Low Income Subsidy / LIS) is a federal program that helps pay Part D drug plan premiums, deductibles, and copays. In 2026, full Extra Help eliminates the Part D premium entirely for benchmark plans and caps drug copays at $4.50 for generics and $11.20 for brand-name drugs.
To apply for MSPs in Florida, contact the Florida Department of Children and Families or call 1-866-762-2237. To apply for Extra Help, contact Social Security at 1-800-772-1213 or apply at ssa.gov. Our advisors can help you determine which programs you qualify for at no cost.
Strategy 4: Consider a Medicare Advantage Plan
IRMAA applies to Original Medicare Part B and Part D premiums. It does not affect the plan premium for a Medicare Advantage plan itself. However, you still pay the Part B premium (including any IRMAA surcharge) regardless of whether you are enrolled in Original Medicare or Medicare Advantage.
Where Medicare Advantage can help with costs is through its overall value proposition. Many Florida Medicare Advantage plans have $0 plan premiums, lower out-of-pocket maximums, and extra benefits that can offset the IRMAA surcharge you are paying on Part B.
For example, a beneficiary paying $259/month for Part B (first IRMAA tier) who enrolls in a $0 premium Medicare Advantage plan with a $3,500 out-of-pocket maximum may have significantly lower total annual costs than someone on Original Medicare with a Medigap supplement, depending on their health utilization.
See our guide to the best Medicare Advantage plans in Florida for a full comparison.
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