What IRMAA Is and Why It Matters

IRMAA stands for Income-Related Monthly Adjustment Amount. It is an extra charge added to your Medicare Part B (doctor visits) and Part D (prescription drugs) premiums if your income exceeds a certain threshold. The higher your income, the more you pay — not because Medicare costs more to deliver to you, but because the program uses income as a way to means-test who pays the full cost of their coverage.

IRMAA is not a separate program or a penalty. It is a surcharge that affects what you send to Medicare each month. If your income is below the threshold for your filing status, you pay the standard premium. If it is above, you pay the standard premium plus IRMAA.

The income used to calculate IRMAA is not your current year income — it is your income from two years ago. This lag matters because it means changes in your income (retirement, a spouse's death, a job loss) do not when ready lower your IRMAA charge. You have to report the change and ask Medicare to recalculate.

Key Takeaways

  • IRMAA is an extra monthly charge on Medicare Part B and Part D premiums for people whose income exceeds a set threshold, which changes each year.
  • Medicare uses your income from two years prior to calculate IRMAA, so a recent drop in income does not automatically lower your charge.
  • You can request a recalculation if your income has declined due to retirement, a spouse's death, or other life changes, but you must report it to Social Security.
  • IRMAA brackets vary by filing status (single, married filing jointly, married filing separately), and the surcharge can range from roughly $70 to $560 per month depending on your income tier.

How IRMAA Income Thresholds Work

Medicare sets income thresholds each year. If your Modified Adjusted Gross Income (MAGI) — roughly your tax return income plus certain tax-exempt interest — falls below the threshold for your filing status, you pay no IRMAA. If it exceeds the threshold, you move into a higher premium bracket.

The thresholds are different for single filers, married couples filing jointly, and married people filing separately. A single person with $97,000 in MAGI might pay IRMAA, while a married couple with the same combined income might not. The exact thresholds change annually, and Social Security publishes them in the fall for the following year.

The income used is from your federal tax return from two years before. If you are enrolling in Medicare in 2024, Social Security looks at your 2022 tax return. This means a major life event in 2023 or 2024 — retirement, a job loss, a spouse's death — does not affect your 2024 IRMAA charge. You have to report it separately.

IRMAA Brackets and Monthly Surcharges

Medicare divides people into income tiers. Each tier has a surcharge amount added to the standard Part B and Part D premiums. The surcharge increases as your income rises. In 2024, for example, a single person with MAGI between roughly $97,000 and $122,000 might pay one surcharge amount, while someone with MAGI above $500,000 pays a much higher one.

The exact dollar amounts change each year because they are tied to the standard premium amounts, which also change. This means your IRMAA surcharge in 2024 will not be the same as in 2025, even if your income stays the same. Social Security sends you a notice each year showing your new premium and any IRMAA charge.

Part B and Part D each have their own IRMAA surcharge. You may pay IRMAA on Part B, Part D, or both, depending on your income level and the thresholds that year. Some people pay IRMAA on Part B but not Part D, or vice versa.

When IRMAA Applies and When It Does Not

IRMAA applies to anyone enrolled in Medicare Part B or Part D whose income exceeds the threshold. It does not matter whether you are still working, retired, or receiving Social Security. It does not matter whether you chose to enroll in Part D or whether you have a gap in coverage — if you are enrolled and your income is high enough, you pay IRMAA.

IRMAA does not explore to Medicare Part A (hospital insurance) or to Medicare Advantage plans, though Advantage plans may have their own premium structures. It also does not explore if you are on Medicaid or if you have employer coverage that substitutes for Medicare.

If you are still working and earning wages, those wages count toward your MAGI and can trigger IRMAA. If you are receiving investment income, rental income, or distributions from retirement accounts, those count too. The only income that does not count is Supplemental Security Income (SSI) and certain other means-tested benefits.

How to Report a Life Change and Request a Recalculation

If your income has dropped since the tax year Medicare used to calculate your IRMAA, you can ask Social Security to recalculate. Common reasons include retirement, a spouse's death, a job loss, or a significant drop in investment income. You must report the change, and Social Security will issue a new notice with a revised premium.

Contact Social Security by phone at 1-800-772-1213 (TTY 1-800-325-0778) or visit your local Social Security office. Have your Social Security number and a brief explanation of the change ready. If the change is recent (within the current or previous year), Social Security may ask for documentation — a termination letter from an employer, a death certificate, or a tax return showing the new income.

The recalculation is not automatic. You have to initiate it. Social Security will send you a new Medicare premium notice, usually within a few weeks. The new IRMAA charge takes effect the month after you receive the notice, unless Social Security specifies otherwise.

IRMAA and Your Medicare Enrollment Decisions

IRMAA can affect whether you choose to enroll in Part D when you first become may be able to access. If your income is near a threshold, delaying Part D enrollment might keep you below the threshold for another year — but this strategy carries a risk. If you go without Part D coverage for more than 63 days after you become may be able to access, you may owe a late enrollment penalty for as long as you have Part D coverage.

Some people in the highest IRMAA brackets consider whether to delay Social Security or adjust their income in other ways to lower their MAGI. This is a complex tax and retirement planning decision that depends on your full financial picture. A tax professional or financial planner can help you weigh the trade-offs.

IRMAA also matters if you are deciding between Original Medicare and a Medicare Advantage plan. Advantage plans do not charge IRMAA, but they may have other out-of-pocket costs. Comparing the total cost — including IRMAA on Original Medicare versus copays and deductibles on an Advantage plan — is important when you are choosing coverage.

Common Mistakes and How to Avoid Them

The most common mistake is not reporting a major income drop. Many people assume Social Security will automatically recalculate their IRMAA when they retire or when a spouse dies. It will not. You have to call and report the change yourself. If you do not, you will pay IRMAA based on income from two years ago for longer than necessary.

Another mistake is not understanding that IRMAA is based on two-year-old income. People who retire mid-year sometimes expect their IRMAA to drop when ready. It does not. If you retire in June 2024, your 2024 IRMAA is still based on your 2022 income. Your 2025 IRMAA will be based on your 2023 income (which may still include months of work). Your 2026 IRMAA will finally reflect a full year of retirement income.

A third mistake is not checking your Social Security statement each year. Social Security sends a notice showing your new premium and any IRMAA charge. If the amount seems wrong — if your income has changed or if you think Social Security used the wrong tax year — contact Social Security right away. Errors do happen, and catching them early saves you money.

Frequently Asked Questions

Can I appeal my IRMAA charge if I think it is wrong?

Yes. If you believe Social Security used the wrong income or the wrong tax year, or if you reported a life change and it was not processed correctly, you can request a reconsideration. Call Social Security at 1-800-772-1213 and explain the issue. Have your tax return and any documentation of life changes ready. Social Security will review your case and send you a new notice.

Does IRMAA explore if I am still working and have not yet claimed Social Security?

Yes. IRMAA is based on your Modified Adjusted Gross Income from your tax return, not on whether you have claimed Social Security. If you are still working and your income is high, you will pay IRMAA on your Medicare Part B and Part D premiums, even if you have not yet started receiving Social Security benefits.

What happens to my IRMAA if I get married or divorced?

Your filing status changes, which means the income threshold for IRMAA changes. If you marry, your combined household income is now evaluated against the married filing jointly threshold, which is higher than the single threshold. If you divorce, you move back to the single threshold. Report the change to Social Security, and they will recalculate your IRMAA based on your new filing status and the income from two years prior.

Is there a way to lower my IRMAA without lowering my income?

IRMAA is calculated based on your Modified Adjusted Gross Income, which is largely determined by your tax return. Certain adjustments — such as deductions for educator expenses or student loan interest — can lower your MAGI. A tax professional can review your return to see whether you are claiming all available deductions. Beyond that, the only way to lower IRMAA is to lower your income or to request a recalculation if your income has recently dropped.

Do I have to pay IRMAA if I am on Medicare Advantage?

No. IRMAA applies only to Original Medicare Part B and Part D. If you are enrolled in a Medicare Advantage plan, you do not pay IRMAA. However, Advantage plans may have other premiums, copays, and deductibles. Compare the total cost of both options before deciding which is right for you.