Question 1

What is IRMAA?

Accepted Answer

IRMAA stands for Income-Related Monthly Adjustment Amount. It is an additional premium surcharge added to Medicare Part B and Part D costs for higher-income beneficiaries. The surcharge is based on your Modified Adjusted Gross Income (MAGI) from two years ago — for 2026 Medicare costs, the IRS looks at your 2024 tax return.

Question 2

Why does Medicare use income from 2 years ago?

Accepted Answer

The Social Security Administration (SSA) uses the most recently filed tax return available, which is typically two years prior. When you apply for Medicare in 2026, your 2024 tax return is already filed and processed, making it the most current data the SSA can access. This two-year lookback is why a Roth conversion or large capital gain in the current year may not affect IRMAA for two years — but you should plan ahead.

Question 3

What is a Life-Changing Event and can it lower my IRMAA?

Accepted Answer

If your income has dropped significantly since the year used for your IRMAA determination, you can appeal using Form SSA-44. Life-changing events that qualify include: marriage, divorce or annulment, death of a spouse, work stoppage or reduction, loss of income-producing property, loss of pension income, or employer settlement payment. If approved, the SSA will use a more recent tax year to determine your IRMAA.

Question 4

Are IRMAA surcharges permanent once triggered?

Accepted Answer

No. IRMAA is recalculated every year based on your income two years prior. If your income drops below a threshold, your surcharge will decrease or disappear the following year. Conversely, if your income increases — due to Roth conversions, capital gains, or Required Minimum Distributions — your IRMAA will increase two years later.

Question 5

How can I avoid or reduce IRMAA?

Accepted Answer

Strategies to reduce IRMAA include: Roth conversions before age 73 (reduce future RMDs), qualified charitable distributions (QCDs) from IRAs after 70½ which count as RMDs but are excluded from MAGI, tax-loss harvesting to reduce capital gains, timing large income events, and keeping income below bracket thresholds. Even staying $1 below a threshold saves the full surcharge amount, so precise income planning is important.

IRMAA Calculator 2026 — Medicare Surcharge by Income

Life-Changing Event — You May Qualify for an Appeal

2026 IRMAA Brackets — All Tiers (Your Bracket Highlighted)

How to Use This IRMAA Calculator

IRMAA Cliff Effect Warning

IRMAA and the 2-Year Lookback

What IRMAA Actually Costs

Roth Conversion IRMAA Impact

IRMAA Impact of Roth Conversion — Before & After

Frequently Asked Questions