Medicare IRMAA: the Cliff Nobody Warns You About
Earn one dollar over the line and your Medicare premium rises for the whole year. Crossing $109,000 as a single person costs $1,148. A couple pays it twice, so $2,297. And it is based on your tax return from two years ago - so a house sale or a Roth conversion reaches forward and raises your premiums long after the money is gone.
A cliff, not a slope
Almost everything in the tax system tapers. Cross a tax band and only the money above the line is taxed higher. Nothing reaches backwards.
IRMAA does not work that way.
Go one dollar over an income line and the entire surcharge applies for the whole year. There is no phasing in and no partial amount.
| Single income | Surcharge that year |
|---|---|
| $108,999 | nothing |
| $109,001 | $1,148 |
Two dollars of income. $1,148 of cost. That is the whole point of this page.
The full ladder
For 2026, from the IRMAA calculator:
| Single income up to | Part B premium | Costs you a year |
|---|---|---|
| $109,000 | $202.90 | nothing |
| $137,000 | $284.10 | $1,148 |
| $171,000 | $405.80 | $2,885 |
| $205,000 | $527.50 | $4,620 |
| $500,000 | $649.20 | $6,355 |
| above that | $689.90 | $6,936 |
The standard premium is $202.90. At the top it is $689.90 - more than three times as much, for the identical cover.
Couples pay it twice
This is the detail that catches people hardest.
The income lines are based on joint income. The surcharge is charged per person.
A couple with $250,000 of joint income, both on Medicare:
| Amount | |
|---|---|
| Surcharge each | $1,148 |
| Household total | $2,297 |
So the real cliff for a couple is double what the published table appears to show. Worth knowing before planning income around a line.
The two-year lookback
Your 2026 surcharge is normally based on your 2024 tax return.
That lag is what makes IRMAA genuinely awkward to plan around, because a single unusual year reaches forward:
- Selling a house or a rental property
- A large Roth conversion
- Cashing in shares with a big gain
- An inheritance that produced taxable income
- A final year of high earnings before retiring
Any of those can raise your premiums two years later, at a point when your income has already fallen and the money is long spent.
It also means the reverse: the year you retire is not the year your premiums drop. They stay high for two more years unless you appeal.
The appeal most people never make
If your income has fallen because of a life-changing event, you can ask for the surcharge to be based on your current income instead.
Qualifying events include retirement, losing a job, divorce, the death of a spouse, and a few others.
This is not obscure or difficult - it is a standard form. But nobody tells you it exists, and plenty of people pay a surcharge for two years on income they no longer have.
If you have recently retired and your premium jumped, this is the first thing to check.
Planning around it
Watch the lines in the years that count. Two years before you go on Medicare, and every year after.
Time large events deliberately. A Roth conversion, a property sale, or a big withdrawal is often flexible by a few months. Splitting it across two tax years can keep you under a line in both - see the Roth conversion calculator for the tax side of that decision.
Watch out for forced withdrawals. From 73 you must take money from retirement accounts whether you need it or not, and that income counts. A large traditional balance can push you over a line without any choice on your part - which is one of the better arguments for converting some of it earlier. The RMD guide covers how big those withdrawals get.
Know your room. If you are $2,000 below a line, a modest extra withdrawal in December could cost $1,148. Worth knowing in advance rather than in a letter.
What to do
- Find out which bracket your income from two years ago puts you in.
- Work out how much room you have before the next line.
- If you are near one, time flexible income deliberately.
- If your income has dropped, appeal. Most people do not know they can.
- Remember a couple pays twice.
Check your own position in the Medicare IRMAA calculator - it shows every bracket, how close you are to the next line, and exactly what one dollar over would cost.
Common questions about medicare irmaa
What is IRMAA?
A surcharge added to your Medicare Part B and prescription drug premiums when your income is above a set line. The name stands for income-related monthly adjustment amount. Most people first hear of it when a letter arrives saying their premium has gone up.
Why is it based on income from two years ago?
Because that is the most recent tax return the government has when premiums are set. The 2026 surcharge normally uses your 2024 return. It means a one-off event two years back - selling a house, a large Roth conversion, cashing in shares - raises premiums long after the money has been spent.
How much does crossing a line cost?
Crossing the first line at $109,000 as a single person costs $95.70 a month, or $1,148 for the year. There is no phasing in - one dollar over and the entire surcharge applies. That single dollar is among the most expensive in the tax system.
Do both spouses pay it?
Yes, and couples miss this constantly. The income lines are based on your joint income, but the surcharge is charged per person. A couple both on Medicare with $250,000 of income pays $2,297 a year, not $1,148.
Can I appeal it?
Yes, if your income has fallen because of a life-changing event - retirement, losing a job, divorce, the death of a spouse. You file a form asking them to use your current income rather than the two-year-old return. Many people never learn this is possible.