Medicare IRMAA Explained: Brackets and How to Appeal

Key Takeaways

IRMAA (Income-Related Monthly Adjustment Amount) can raise your 2026 Part B premium from the standard $202.90 up to $689.90 per month, based on your income from two years earlier (SSA POMS; CMS, retrieved 2026-09-07).

Roughly 8% of Medicare beneficiaries pay IRMAA today, up from about 5% in 2013 (CMS; KFF, retrieved 2026-09-07).

You can appeal IRMAA using Form SSA-44, but only for one of 8 specific life-changing events, not for a one-time income spike.

A Roth conversion, a large RMD, or a home sale in the lookback year generally does not qualify for an SSA-44 appeal, even though it's what triggered the higher premium.

Keep paying the higher amount while an appeal is pending. SSA's official target is 30-45 days, but real-world processing commonly runs longer.

If your Medicare Part B premium jumped well above the standard rate, it's probably IRMAA. It's probably based on income you earned two years ago, not this year. Here's exactly how the 2026 brackets work, what actually qualifies for an appeal, and the specific trap that catches people who did a Roth conversion or sold a house.

Not affiliated with the federal Medicare program. PlanAlert is an independent consumer tool. For official information, use Medicare.gov, call 1-800-MEDICARE, or contact the Social Security Administration at 1-800-772-1213 for IRMAA-specific questions.

What Is IRMAA, and Why Did I Get a Higher Bill?

IRMAA stands for Income-Related Monthly Adjustment Amount. It's a surcharge added to your Part B and Part D premiums if your income is above a set threshold, on top of what everyone else pays. The base 2026 Part B premium is $202.90 a month, and it applies if your income is at or below $109,000 (single) or $218,000 (married filing jointly). If you're new to how Part B and Part D fit together in the first place, our Medicare 101 guide covers the basics.

The part that surprises people: your 2026 IRMAA is based on your 2024 tax return, a two-year lookback. If your income dropped significantly in 2025 or 2026, your premium won't reflect that until 2027 or 2028, unless one of the appeal triggers below applies to you right now.

IRMAA affects more people than it used to. CMS estimates roughly 8% of Part B beneficiaries pay it in 2026, and the 2025 Medicare Trustees Report similarly puts IRMAA-payers at about 8% of Part B enrollees (CMS; SSA, 2025 Trustees Report summary, retrieved 2026-09-07). A separate figure, about 5.1 million people for Part B and 4.4 million for Part D, comes from the same report as cited via MOAA, retrieved 2026-09-07. Back in 2013, only about 5.0% of beneficiaries, 2.4 million people, paid it, at thresholds of $85,000 and $170,000 (KFF, retrieved 2026-09-07). The brackets have moved up since then, but so has the share of people who cross them.

The 2026 IRMAA Brackets

2024 MAGI (single)	2024 MAGI (married, joint)	Part B total/month	Part D add-on/month
$109,000 or less	$218,000 or less	$202.90	$0
$109,001 - $137,000	$218,001 - $274,000	$284.10	+$14.50
$137,001 - $171,000	$274,001 - $342,000	$405.80	+$37.50
$171,001 - $205,000	$342,001 - $410,000	$527.50	+$60.40
$205,001 - $499,999	$410,001 - $749,999	$649.20	+$83.30
$500,000 or more	$750,000 or more	$689.90	+$91.00

Part D add-on is on top of your plan's own premium. Top-tier thresholds ($500,000 / $750,000) are fixed by law and not adjusted for inflation. Sources: SSA POMS HI 01101.020, effective 12/02/2025; CMS 2026 Medicare Parts A & B Premiums and Deductibles fact sheet, Nov 14, 2025. Retrieved 2026-09-07.

Every bracket uses your MAGI, modified adjusted gross income, which includes tax-exempt interest on top of your adjusted gross income. It is not just your taxable income, which is one reason municipal bond interest and other "tax-free" income can still push you into a higher IRMAA bracket.

What This Actually Costs You Per Year

The monthly numbers understate the real cost. Here's what each bracket adds up to annually, in Part B alone, per person, calculated from the table above:

Bracket	Extra Part B cost per year (per person)
Tier 1	$974
Tier 2	$2,435
Tier 3	$3,895
Tier 4	$5,356
Tier 5 (top)	$5,844

Calculated as (tier monthly premium minus $202.90 standard premium) times 12. A married couple who both pay IRMAA pays this twice, once per person. Part D add-ons are extra and not included here. Figures derived from CMS/SSA 2026 rate tables; not a directly published CMS total.

A married couple in the top tier is looking at nearly $11,700 a year in Part B surcharges alone, before Part D. That's real money, and it's exactly why the appeal process below matters if your income has genuinely changed. It's also worth weighing against your broader coverage costs; see how Medicare Advantage and Medigap premiums compare if IRMAA is pushing you to reconsider your overall Medicare spending.

The 8 Life-Changing Events That Qualify for an Appeal

IRMAA isn't permanent, and it isn't unappealable. Social Security will recalculate your premium using more recent income if you've had one of these 8 specific life-changing events, verbatim from SSA's own rules:

Marriage
Divorce or annulment
Death of a spouse
Work stoppage (you or your spouse stopped working)
Work reduction (you or your spouse reduced hours)
Loss of income-producing property (beyond your control, such as a natural disaster or fraud)
Loss of pension income (your employer's pension plan was terminated or reorganized)
An employer settlement payment, often tied to an employer's bankruptcy

(SSA POMS HI 01120.005, retrieved 2026-09-07)

If one of these happened to you, you can file Form SSA-44 to have your IRMAA recalculated using a more recent year's income, or your own estimate, instead of the two-year-old tax return SSA would otherwise use.

What Does Not Qualify (This Trips People Up)

Notice what's missing from that list: a one-time income spike. A Roth conversion, a large required minimum distribution (RMD), or a home sale with a taxable gain are not on SSA's life-changing-event list, even when one of them is exactly what caused your higher IRMAA bracket.

This creates a specific, common trap. Say you converted part of a traditional IRA to a Roth in 2024. That shows up as income on your 2024 tax return, which sets your 2026 IRMAA. If your income in 2025 and 2026 has returned to normal, you generally cannot use Form SSA-44 to fix this early, because "my income was temporarily higher two years ago" isn't a qualifying event. Your IRMAA will correct itself automatically in 2028, once your 2026 tax return becomes the basis, but not before.

The practical lesson: if you're planning a Roth conversion, a large RMD, or selling a highly appreciated asset, factor the resulting IRMAA bump two years later into your math ahead of time. It's a predictable cost, not a surprise, if you plan for it.

How to File Form SSA-44

Confirm you have a qualifying event. Match your situation against the 8 events above. If it's a one-time income spike rather than a change in your ongoing financial circumstances, SSA-44 likely won't apply.
Gather your evidence. This typically means the relevant tax documents plus proof of the life-changing event itself (a marriage certificate, a termination letter, a pension plan notice).
Submit Form SSA-44 by fax or mail to your local Social Security office. If your evidence isn't ready yet, SSA can log your claim as pending, generally requiring the missing documentation within 30 days (SSA POMS HI 01120.001, retrieved 2026-09-07).
Keep paying the higher, billed amount while your appeal is pending. Stopping payment risks a lapse in your Part B coverage. If your appeal is approved, SSA applies the correction retroactively to your life-changing event and refunds the difference.
Expect the process to take time. SSA's official target is 30 to 45 days. Many filers report real-world timelines closer to 60-120 days for a decision, plus another 60-150 days for a refund (Medicare Interactive, retrieved 2026-09-07). Neither SSA nor CMS publishes an approval-rate statistic for these appeals. Budget for the higher amount until you have a decision in hand.

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Frequently Asked Questions

Does IRMAA apply to Part D as well as Part B?

Yes. The same income brackets add a surcharge to your Part D premium on top of whatever your specific drug plan charges. See the table above for both amounts.

Will my IRMAA go away automatically if my income drops?

Eventually, yes, because each year's IRMAA is based on your tax return from two years earlier. If your income has genuinely dropped and stayed down, it will show up in your premium once that year's return becomes the basis, typically a two-year delay unless you qualify for an SSA-44 appeal sooner.

Do I need to reapply for an IRMAA appeal every year?

Generally no for an ongoing change like retirement or a reduced pension, since SSA uses your updated estimate going forward. A one-time appeal for a permanent change should carry into future years until your regular tax-return data catches up; check with SSA if your circumstances change again.

What happens if my SSA-44 appeal is denied?

You can request a formal reconsideration and, if needed, an appeal through the Social Security appeals process. Keep paying the billed amount throughout, since the appeal doesn't pause your premium.

Why are the top-tier thresholds ($500,000 and $750,000) different from the others?

The top bracket's income thresholds are fixed by law and don't adjust for inflation, unlike the four brackets below it. Over time, more households will likely cross into the lower IRMAA tiers as wages rise, even without earning genuinely more in real terms.

The Bottom Line

IRMAA is based on your tax return from two years ago, not your current income.
2026 Part B premiums with IRMAA range from $284.10 to $689.90 a month, plus a separate Part D add-on.
Only 8 specific life-changing events qualify for a Form SSA-44 appeal; a one-time income spike like a Roth conversion or home sale generally does not.
Keep paying the higher amount while any appeal is pending, and budget for a longer real-world timeline than SSA's official target.
If you're planning a large one-time income event, build the IRMAA bump two years later into your plan now.