A $1 increase in income can sometimes raise a retiree’s Medicare premiums for an entire year. That is why a guide to Medicare IRMAA brackets belongs in every retirement-income plan, especially for households drawing from traditional IRAs, managing capital gains, or considering Roth conversions.
IRMAA stands for Income-Related Monthly Adjustment Amount. It is an additional charge paid by higher-income Medicare beneficiaries on top of the standard Medicare Part B premium and, when applicable, Part D prescription drug coverage. The charge is based on income reported on a federal tax return from two years earlier. For 2026 premiums, Medicare generally looks at your 2024 tax return.
That two-year delay creates both a planning opportunity and a potential surprise. A high-income year before retirement can follow you into Medicare, while a carefully coordinated income plan can help you anticipate premium changes before they arrive.
How Medicare IRMAA Brackets Work
The Social Security Administration determines whether IRMAA applies using your modified adjusted gross income, or MAGI. For Medicare purposes, this is generally your adjusted gross income plus tax-exempt interest income.
MAGI can include wages, pension income, traditional IRA and 401(k) withdrawals, Roth conversion income, interest, dividends, realized capital gains, rental income, and the taxable portion of Social Security. Qualified Roth IRA withdrawals generally do not increase MAGI. Interest from municipal bonds may be federally tax-exempt, but it is added back for Medicare IRMAA calculations.
Medicare uses tax-return information, not just the amount you withdraw from an investment account. A household may have modest spending needs but still trigger IRMAA because of a one-time capital gain, the sale of a business interest, a large Roth conversion, or an inherited IRA distribution.
IRMAA is also a cliff, not a gradual phase-in. Moving only slightly over a threshold can place you in the next premium tier. That does not mean avoiding every threshold should be the only goal. Paying a higher premium for a year may be reasonable if a Roth conversion meaningfully reduces future required minimum distributions, taxes, or survivor tax exposure. The key is making that trade-off intentionally.
2026 Medicare IRMAA Brackets
The following 2026 brackets generally apply to people who file individual tax returns and married couples filing jointly. The income shown is your 2024 Medicare MAGI.
| 2024 MAGI | Individual return | Married filing jointly | 2026 Part B premium | Monthly Part D IRMAA | |—|—:|—:|—:|—:| | Standard tier | $109,000 or less | $218,000 or less | $202.90 | $0.00 | | First IRMAA tier | $109,001-$137,000 | $218,001-$274,000 | $284.10 | $14.50 | | Second IRMAA tier | $137,001-$171,000 | $274,001-$342,000 | $405.80 | $37.50 | | Third IRMAA tier | $171,001-$205,000 | $342,001-$410,000 | $527.50 | $60.40 | | Fourth IRMAA tier | $205,001-$499,999 | $410,001-$749,999 | $649.20 | $83.30 | | Highest tier | $500,000 or more | $750,000 or more | $689.90 | $91.00 |
The Part D amount is an extra charge in addition to your plan’s regular prescription drug premium. Even if you have drug coverage through a Medicare Advantage plan, the Part D IRMAA may still apply. Medicare will notify you when an adjustment is due, and the additional amount is typically paid separately from the plan premium.
These figures are updated annually. Anyone filing separately has different and often less favorable thresholds, so married households should consider filing status as part of their broader tax and retirement planning discussion.
Why the Two-Year Lookback Matters in Retirement
Consider a Mesa couple that retires in 2026 after earning $300,000 in 2024. Their current income may be far lower, but Medicare will generally use the 2024 return to set their 2026 IRMAA tier. Without further action, they could pay premiums based on earnings they no longer receive.
On the other hand, a Gilbert retiree may have low ordinary income but decide to convert $125,000 from a traditional IRA to a Roth IRA. That conversion could be a sound long-term tax move. It can also increase MAGI and affect Medicare premiums two years later. The proper question is not simply, “Will this trigger IRMAA?” It is, “Does the lifetime tax benefit outweigh the added premiums and taxes?”
This is where coordinated planning matters. Medicare premium decisions should not be made separately from Social Security taxation, capital-gains planning, required minimum distributions, charitable giving, and the income needed to support your lifestyle.
Income Events That Commonly Trigger IRMAA
A recurring withdrawal strategy can cause IRMAA, but the bigger surprises often come from single-year events. Four situations deserve particular attention:
- A large Roth conversion can push MAGI into a higher tier, even though the converted money stays invested for retirement.
- Selling appreciated stock, real estate, or a business can create capital gains that increase Medicare income.
- Required minimum distributions can raise income after age 73, particularly for households with substantial pre-tax retirement balances.
- An inherited traditional IRA may require distributions within a limited period, potentially concentrating income in years when Medicare is already in place.
For charitably inclined retirees age 70 1/2 or older, a qualified charitable distribution from an IRA can be valuable. When handled correctly, a QCD can satisfy part or all of a required minimum distribution without adding the distributed amount to adjusted gross income. It will not solve every IRMAA issue, but it may help eligible households support causes they value while managing taxable income.
When You Can Appeal an IRMAA Decision
An IRMAA notice is not always the final word. If your income dropped because of a qualifying life-changing event, you may be able to ask Social Security to use a more recent estimate of your income. This is commonly done with Form SSA-44.
Qualifying events can include retirement or a reduction in work, marriage, divorce or annulment, the death of a spouse, loss of pension income, loss of income-producing property because of circumstances beyond your control, or certain employer settlement payments.
The distinction is important. You generally cannot appeal simply because you dislike the premium or because a tax-planning decision increased your income. But if the return Social Security used reflects employment income that has ended, an appeal may be appropriate. Supporting documents, such as a letter showing retirement or a recent pay statement, can strengthen the request.
Do not assume the adjustment will correct itself quickly. Review every Medicare IRMAA determination when it arrives. If the income used no longer reflects your household’s financial reality, act promptly and keep copies of the documentation submitted.
Planning Around Medicare IRMAA Without Letting It Control Everything
Trying to stay below an IRMAA bracket at all costs can create a different problem: a retiree may postpone useful Roth conversions, realize gains inefficiently, or allow future RMDs to grow unnecessarily. A better approach is to model several years rather than focus on one tax return.
Start by estimating your regular income sources, including Social Security, pensions, dividends, interest, planned IRA withdrawals, and RMDs. Then identify irregular income events before the year begins. If a conversion, property sale, or concentrated-stock sale is under consideration, calculate its effect on federal taxes, Arizona taxes, Medicare premiums, and future distributions.
Sometimes spreading income across multiple years is prudent. In other cases, deliberately entering a higher IRMAA tier for one year may be worthwhile to reduce taxes over the remainder of retirement. The answer depends on age, account balances, charitable goals, marital status, projected survivor income, and how long retirement assets need to provide income.
At Roberts Tax & Retirement Planning, retirement-income decisions are evaluated through that broader lens: what supports your monthly lifestyle now while helping protect the assets you have worked to build for the years ahead. Before taking a major distribution or conversion, put the proposed decision beside your tax return, Medicare timeline, and long-term income plan. That small step can turn an unexpected premium notice into a decision you already anticipated.
