IRMAA (the Income-Related Monthly Adjustment Amount) is a surcharge Medicare adds to your Part B and Part D premiums once your income crosses certain thresholds. In 2026, surcharges kick in above a modified adjusted gross income (MAGI) of $109,000 for single filers and $218,000 for married couples, and they’re based on the tax return you filed two years ago — your 2024 income determines your 2026 premiums. At the highest bracket, a married couple can pay over $13,800 a year in surcharges alone, and because IRMAA is a cliff, a single dollar of extra income can cost you thousands.
From the Retirement Tax Planning hub — Evergreen Wealth Management — proactive year-round tax planning for retirees: Roth conversions, withdrawal sequencing, and Medicare IRMAA strategy.
I’m Nick Stevens, CFP®, founder of Evergreen Wealth Management, a flat-fee firm in Boston. IRMAA is one of the most frustrating surprises my clients run into, because it punishes the exact people who saved diligently — folks with healthy IRAs, pensions, and brokerage accounts. The good news is that with two or three years of planning, IRMAA is one of the most controllable costs in retirement. Here’s how it works and what you can do about it.
What exactly is IRMAA?
IRMAA is an extra charge added on top of your standard Medicare Part B and Part D premiums when your income exceeds a threshold. The standard Part B premium in 2026 is $202.90 per month per person. If your income is high enough, Social Security tacks on a surcharge that can more than triple that base premium.
The income figure that matters is your MAGI, which for IRMAA purposes is your adjusted gross income plus any tax-exempt interest (think municipal bond income). That last part catches a lot of people off guard — those “tax-free” muni bonds still count toward IRMAA.
What are the 2026 IRMAA brackets?
The brackets below show the total monthly Part B premium and the additional Part D surcharge per person. Remember: these 2026 amounts are based on the MAGI from your 2024 tax return.
| MAGI — Married Filing Jointly | Part B (monthly) | Part D surcharge (monthly) |
|---|---|---|
| ≤ $218,000 | $202.90 (standard) | $0 |
| $218,001 – $274,000 | $284.10 | $14.50 |
| $274,001 – $342,000 | $405.40 | $37.50 |
| $342,001 – $410,000 | $486.60 | $60.60 |
| $410,001 – $750,000 | $567.90 | $83.60 |
| > $750,000 | $689.90 | $91.00 |
| MAGI — Single / Head of Household | Part B (monthly) | Part D surcharge (monthly) |
|---|---|---|
| ≤ $109,000 | $202.90 (standard) | $0 |
| $109,001 – $137,000 | $284.10 | $14.50 |
| $137,001 – $171,000 | $405.40 | $37.50 |
| $171,001 – $205,000 | $486.60 | $60.60 |
| $205,001 – $500,000 | $567.90 | $83.60 |
| > $500,000 | $689.90 | $91.00 |
Both surcharges are per person, so a married couple on Medicare pays them twice. At the top bracket, that means each spouse pays $487 more per month for Part B ($689.90 minus the $202.90 standard) plus $91 for Part D — roughly $578 per person per month, or about $13,870 per year for the couple in surcharges above and beyond the standard premiums.
Why is IRMAA called a cliff?
Because there’s no phase-in. Unlike income tax brackets, where only the income above a threshold is taxed at the higher rate, IRMAA jumps the instant you cross the line. One extra dollar of MAGI can push you into the next bracket and cost you the full surcharge.
Here’s a real example. Suppose a married couple has a 2024 MAGI of $274,000 — right at the edge of the second bracket. Their combined surcharge is about $2,300 for the year. Now suppose they took one extra $1,000 IRA distribution in December 2024, pushing MAGI to $274,001. That single dollar over the line moves them into the third bracket, where the combined annual surcharge jumps to roughly $5,400. A $1 mistake costs more than $3,000. That’s the cliff.
How do I avoid or reduce IRMAA?
The key is managing MAGI in the years that count — and remembering the two-year lookback. The income decisions you make this year set your Medicare premiums two years from now. A few strategies that work well for my clients:
- Time Roth conversions carefully. Roth conversions are one of the best tax moves in retirement, but the converted amount counts as income for IRMAA. The trick is to do conversions in lower-income years — ideally before you start Medicare at 65, or in early retirement before Social Security and RMDs ramp up your income. If you’re already on Medicare, size conversions to “fill up” a bracket without spilling over the next cliff.
- Use Qualified Charitable Distributions (QCDs). Once you’re 70½, you can send up to about $108,000 (2026 limit) directly from your IRA to charity. A QCD satisfies your required minimum distribution but is excluded from AGI — so it lowers MAGI and can keep you under an IRMAA threshold.
- Harvest capital gains in low-income years. If you have a year with unusually low income, realizing long-term gains then (rather than later) can keep a future year’s MAGI down. Conversely, avoid bunching big gains in a single year if it would trigger IRMAA.
- Watch your “tax-free” muni bond interest. It’s exempt from income tax but still counts toward MAGI for IRMAA.
- Coordinate withdrawals across account types. Pulling from taxable, tax-deferred, and Roth accounts in the right sequence each year smooths your income and keeps you out of the higher brackets.
This is exactly the kind of multi-year coordination I work through with clients — and it pairs closely with broader withdrawal planning. If you’re weighing conversions, it’s worth reading our deeper guide on Roth conversions and the window retirees shouldn’t ignore, and if you give to charity, our piece on smarter charitable giving covers QCDs in more detail.
Can I appeal an IRMAA surcharge?
Yes. Because IRMAA looks back two years, it can hit you based on income you no longer earn — for example, the year you retired or sold a business. If you’ve had a qualifying life-changing event, you can file Form SSA-44 to ask Social Security to use your current, lower income instead.
Qualifying events include marriage, divorce, death of a spouse, work stoppage or reduction (retirement counts), loss of pension income, or loss of income-producing property. A one-time spike — like a big capital gain or a Roth conversion — does not qualify for an appeal, which is why planning ahead matters so much.
How does flat-fee planning help with IRMAA?
IRMAA planning is detailed, year-by-year work: projecting MAGI, modeling conversions against the brackets, timing charitable gifts, and coordinating withdrawals. At Evergreen Wealth Management, I charge a flat monthly fee regardless of how large your portfolio is. That matters here for a simple reason — IRMAA management doesn’t get easier or harder based on your account size, so you shouldn’t pay more for it just because you saved more.
Under the traditional 1% assets-under-management model, a retiree with a $3 million portfolio would pay around $30,000 a year. The same planning under our flat fee costs a flat annual fee — and IRMAA coordination is part of it, not an upsell. As a fee-only fiduciary, I don’t earn commissions on any product, so the only incentive is to keep your total costs, including those Medicare surcharges, as low as possible. You can see exactly how we charge on our fee structure page.
Frequently Asked Questions
What income is used to determine my IRMAA?
Medicare uses your MAGI, which is your adjusted gross income plus any tax-exempt interest, from your tax return two years prior. So your 2026 premiums are based on your 2024 return. This includes IRA and 401(k) withdrawals, Roth conversions, capital gains, dividends, pension income, and even municipal bond interest.
Do Roth conversions trigger IRMAA?
Yes. The amount you convert from a traditional IRA to a Roth counts as ordinary income in the year of conversion, which raises your MAGI two years later. That said, Roth conversions reduce future required minimum distributions, which can lower IRMAA down the road. The goal is to convert strategically — enough to fill a bracket without crossing the next cliff. Our guide to Roth conversions in retirement walks through the trade-offs.
Does Evergreen’s flat fee cover IRMAA planning?
Yes. IRMAA modeling, Roth conversion timing, and withdrawal coordination are all part of the flat monthly fee at Evergreen Wealth Management. Because we’re a fee-only fiduciary firm in Boston, there are no commissions and no charges that scale with your portfolio — the planning is included regardless of your asset level.
Can I get IRMAA removed if my income dropped?
If your income fell because of a qualifying life-changing event — retirement, divorce, death of a spouse, or loss of pension income — you can file Form SSA-44 with Social Security to have your surcharge recalculated using your current income. A one-time event like a large capital gain doesn’t qualify, so plan those carefully in advance.
One of the cleanest ways to pull your MAGI back under an IRMAA bracket line is to stop taking charitable gifts out of your checking account. If you are 70½ or older, giving directly from your IRA through a qualified charitable distribution removes that income from AGI entirely — which is exactly the lever IRMAA responds to.
A home sale is a classic IRMAA trap because the gain is one-time income and does not qualify for an SSA-44 appeal. If a sale is on the horizon, see how capital gains on selling a Massachusetts home can raise your Medicare premiums two years later.
Planning ahead beats appealing later
IRMAA rewards people who look two years down the road. With a clear picture of your projected income, conversions, and withdrawals, you can usually keep these surcharges in check — and sometimes avoid them entirely. If you’d like help building that picture, you can learn more about becoming a client and how we work together.
Nick Stevens, CFP® is the founder of Evergreen Wealth Management in Boston, a flat-fee financial planning and investment management firm. Evergreen charges a fixed monthly fee regardless of portfolio size. Learn more about how we work at our fee structure page or get in touch at our contact page.