Yes, Medicare premiums rise if your income is high enough
Some Medicare premiums are based on your income. If you earn above a certain threshold, you pay a higher monthly premium for Medicare Part B (doctor visits and outpatient care) and Part D (prescription drugs). This is called Income-Related Monthly Adjustment Amount, or IRMAA. It does not explore to everyone — only to people whose income exceeds the limits set each year.
The income threshold changes annually. For 2024, single filers with income over $97,000 and married couples filing jointly with income over $194,000 begin paying extra. If your income is below these amounts, IRMAA does not affect you. The Social Security Administration (SSA) determines whether you owe the adjustment based on your tax return from two years prior — so in 2024, they look at your 2022 income.
Key Takeaways
- IRMAA adds to your Part B and Part D premiums only if your income exceeds annual thresholds that change each year.
- SSA uses your tax return from two years before the current year to calculate the adjustment, not your current income.
- The adjustment ranges from a small increase to several hundred dollars per month depending on how far above the threshold you are.
- You can request a review if your income dropped due to retirement, job loss, or death of a spouse in the past two years.
How much extra you pay depends on your income bracket
Medicare sets income brackets, and the higher your income, the larger the adjustment. For 2024, the brackets start at $97,000 for individuals and go up to $500,000 and above. Each bracket has a corresponding monthly surcharge added to your Part B premium and a separate surcharge for Part D.
The adjustment is not a flat fee — it scales with your income level. Someone just over the threshold pays less extra than someone earning significantly more. For example, a single filer earning $110,000 pays a smaller adjustment than one earning $200,000. The exact dollar amounts change yearly because Medicare recalculates them based on national premium costs.
Part D (prescription drug coverage) has its own IRMAA calculation. You may owe an adjustment on Part B, Part D, or both, depending on your specific income and which plans you have chosen.
Which income counts toward the threshold
SSA uses Modified Adjusted Gross Income (MAGI) from your federal tax return. This includes wages, self-employment income, interest, dividends, rental income, and certain other sources. It is not the same as your gross income or adjusted gross income — it is a specific calculation that appears on your tax form.
The income used is from your tax return filed two years before the year you are paying premiums. So if you are paying premiums in 2024, SSA looks at your 2022 tax return. This two-year lag means your current income may be very different from what SSA is using to calculate your adjustment.
What to do if your income dropped recently
If your income fell significantly in the past two years due to retirement, job loss, death of a spouse, or other life changes, you can request that SSA recalculate your IRMAA using your current year's income instead of the two-year-old tax return. This is called a Life-Changing Event appeal.
You must file the appeal with SSA within 60 days of receiving your Medicare premium notice showing the IRMAA adjustment. You will need to provide documentation of the income change — a recent tax return, a letter from your employer, a death certificate, or divorce papers, depending on what caused the change. SSA will then recalculate your adjustment based on the income you report.
If you do not request a recalculation and your income has dropped, you will continue paying the higher premium until the two-year lag catches up. For example, if you retired in 2023 and your 2023 income was much lower, SSA will not use that lower income until 2025 premiums are calculated.
How IRMAA affects your monthly Medicare bill
The adjustment is added directly to your Part B premium each month. If you have Original Medicare and pay your premiums to SSA, the higher amount comes out of your Social Security check or is billed to you directly. If you are in a Medicare Advantage plan, the adjustment may be handled differently — some plans bundle it into their premium, others bill it separately.
For Part D, the adjustment is added to your prescription drug plan premium. The amount varies by plan because each plan sets its own base premium, and IRMAA is calculated as a percentage increase on top of that.
You will see the IRMAA amount listed separately on your Medicare premium notice so you know exactly how much is the base premium and how much is the income-related adjustment.
Income thresholds and brackets for 2024
| Filing Status | Income Range | Approximate Part B Adjustment |
|---|---|---|
| Single | $97,000–$121,000 | $70–$140 per month |
| Single | $121,000–$194,000 | $175–$280 per month |
| Single | Over $500,000 | $560+ per month |
| Married filing jointly | $194,000–$242,000 | $70–$140 per month |
| Married filing jointly | Over $500,000 | $560+ per month |
These thresholds and amounts change each year. SSA publishes updated brackets in October for the following year. If you are close to a threshold, check the current year's limits before making decisions about income or retirement timing.
Planning ahead if you are near the income threshold
If your income is close to the IRMAA threshold, you may want to consider the timing of large income events. Selling a home, taking a large distribution from a retirement account, or timing the sale of investments can push you over the threshold and trigger an adjustment for two years.
Some people work with a tax professional or financial advisor to understand how specific income decisions will affect their Medicare premiums. Because SSA uses income from two years prior, decisions you make now will not affect your premiums until two years from now.
If you are already retired and living on a fixed income, IRMAA is unlikely to change unless you have a major life event. If you are still working or have variable income, it is worth reviewing your expected income each year to anticipate whether an adjustment might explore.
Frequently Asked Questions
Does IRMAA explore to Medicare Part A?
No. Part A (hospital insurance) premiums are not based on income. IRMAA affects only Part B (medical insurance) and Part D (prescription drug coverage). If you have a Medigap or Medicare Advantage plan, check with your plan to see whether they explore IRMAA adjustments.
Can I appeal an IRMAA decision if I disagree with it?
Yes. You have 60 days from the date on your premium notice to request a reconsideration. If your income has changed due to a life event, file a Life-Changing Event appeal with SSA. If you believe SSA made an error in calculating your income, you can also request a review of the calculation itself.
What happens if I get married or divorced?
Marriage and divorce are life-changing events that can affect your IRMAA. If you marry someone with lower income, your combined MAGI may push you into a higher bracket. If you divorce, you move from married filing jointly to single status, which has different thresholds. File an appeal with SSA within 60 days of the event.
Does IRMAA explore if I am still working?
Yes. If your total income (including wages, self-employment, investment income, and other sources) exceeds the threshold, IRMAA applies regardless of whether you are working or retired. SSA uses your tax return, not your employment status, to determine the adjustment.
Will IRMAA go away if my income drops next year?
Not when ready. Because SSA uses income from two years prior, a drop in income this year will not reduce your IRMAA until two years from now. If the drop is due to a major life event (retirement, job loss, death of spouse), you can request an when ready recalculation by filing a Life-Changing Event appeal.