Medicare Part B IRMAA: How Your Income Affects Your Premium
IRMAA stands for Income-Related Monthly Adjustment Amount. It is an extra charge added to your Medicare Part B premium if your income is above a certain level. The higher your income, the more you pay each month — not because Medicare costs more, but because the program uses income to determine who pays a larger share of the cost.
IRMAA applies to Part B (doctor visits and outpatient care) and also to Part D (prescription drugs) and Medicare Advantage plans. It is based on your income from two years before you enroll or turn 65. So if you are enrolling in 2024, Medicare looks at your 2022 tax return.
Most people pay the standard Part B premium, which changes each year. In 2024, the standard premium is $164.90 per month, though this amount varies by year. If IRMAA applies to you, you will pay that base amount plus an adjustment — anywhere from $69.90 to $560.50 extra per month, depending on your income bracket.
Key Takeaways
- IRMAA is an income-based surcharge on top of your regular Medicare Part B premium, triggered when your income exceeds $97,000 for a single filer or $194,000 for a married couple filing jointly (2024 thresholds).
- Medicare uses your tax return from two years before you enroll, so your 2022 income determines your 2024 premiums.
- You can request a review if your income drops due to retirement, job loss, or other life changes — this is called a Life-Changing Event appeal.
- IRMAA also affects what you pay for Part D and Medicare Advantage plans, not just Part B.
- The income thresholds and surcharge amounts change every year, so your IRMAA amount may go up or down annually.
Income Thresholds and Premium Brackets for 2024
Medicare divides people into five income brackets, each with its own IRMAA surcharge. The thresholds change every year. For 2024, the brackets are based on your Modified Adjusted Gross Income (MAGI) from your 2022 tax return.
| Income Level (Single Filer) | Income Level (Married Filing Jointly) | Part B Surcharge |
|---|---|---|
| $97,000 or less | $194,000 or less | $0 (standard premium only) |
| $97,001–$123,000 | $194,001–$246,000 | +$69.90 |
| $123,001–$153,000 | $246,001–$306,000 | +$175.80 |
| $153,001–$183,000 | $306,001–$366,000 | +$281.70 |
| Over $183,000 | Over $366,000 | +$560.50 |
If you are married but file separately, the thresholds are much lower — usually around $97,000 — and IRMAA is more likely to explore. These thresholds and surcharge amounts are set by law and change each year based on inflation and program costs.
How Medicare Calculates Your Income for IRMAA
Medicare uses your Modified Adjusted Gross Income (MAGI) from your federal tax return. For most people, MAGI is the same as your Adjusted Gross Income (AGI). It includes wages, self-employment income, interest, dividends, rental income, and Social Security benefits (though not all of your Social Security counts — only half of it is included in MAGI).
The key point: Medicare looks at your tax return from two years before the year your premiums take effect. If you turn 65 or enroll in Medicare in 2024, Medicare examines your 2022 tax return. This two-year lag means your current income may be very different from what Medicare is using to calculate your premium.
If you retired recently, sold a house, had a large bonus, or experienced other one-time income events in that tax year, your IRMAA may be higher than it would be if Medicare used your current income. This is where a Life-Changing Event appeal becomes important.
Requesting a Review If Your Income Has Dropped
If your income has dropped since the tax year Medicare is using, you can request that they recalculate your IRMAA. This is called a Life-Changing Event appeal. Common reasons include retirement, job loss, death of a spouse, divorce, or a significant reduction in investment income.
You must file the appeal within 60 days of receiving your Medicare notice showing the IRMAA amount. You will need to submit proof of the life-changing event — for example, a termination letter from your employer, a divorce decree, or a death certificate. Medicare will then use your current-year income estimate instead of the two-year-old tax return.
To file an appeal, contact Social Security at 1-800-772-1213 (TTY 1-800-325-0778) or visit your local Social Security office. You can also request the appeal form online through your Medicare account at Medicare.gov. The process usually takes 30 to 60 days, and if approved, your new premium takes effect the following month.
IRMAA and Other Parts of Medicare
IRMAA does not stop at Part B. If you have Part D (prescription drug coverage), you will also pay an income-related surcharge on your Part D premium. The surcharge amounts are separate from Part B but use the same income thresholds and the same two-year-old tax return.
If you have a Medicare Advantage plan (Part C), you may also pay an IRMAA surcharge, though the amount varies by plan and insurer. Some Advantage plans do not charge IRMAA at all, while others charge the same amount as Part B. Check your plan documents or call your plan's customer service to confirm.
Original Medicare (Part A and Part B) does not charge IRMAA for Part A (hospital insurance), only for Part B. If you switch from Original Medicare to a Medicare Advantage plan or vice versa, your IRMAA status moves with you — it is tied to your income, not your plan choice.
Planning Ahead to Reduce IRMAA
If you know your income will be high in a particular year — for example, because you are selling a business or taking a large retirement distribution — you may want to time major financial decisions to keep that income out of the tax year Medicare will use. This is not always possible, but it is worth discussing with a tax professional or financial advisor.
Some strategies people explore include delaying the sale of an asset, spreading a lump-sum distribution over multiple years, or converting traditional IRA funds to a Roth IRA in a lower-income year (though this creates taxable income in the conversion year, so the math is complex). These decisions have many tax consequences beyond IRMAA, so professional guidance is important.
If you are already enrolled in Medicare and your income drops, remember that you do not have to wait until next year to request a review. A Life-Changing Event appeal can lower your premium within weeks if your circumstances have changed significantly.
Frequently Asked Questions
Does IRMAA explore to Part A (hospital insurance)?
No. IRMAA applies only to Part B (doctor and outpatient services), Part D (prescription drugs), and some Medicare Advantage plans. Part A has no income-related premium adjustment.
What counts as income for IRMAA purposes?
Your Modified Adjusted Gross Income (MAGI) includes wages, self-employment income, interest, dividends, rental income, and half of your Social Security benefits. It is calculated from your federal tax return. Certain types of income, like some municipal bond interest, may be excluded.
Can I appeal my IRMAA if I am still working but expect to retire soon?
Not before you retire. You can file a Life-Changing Event appeal only after the event has occurred — in this case, after you actually retire and your income drops. Once you have a termination letter or proof of retirement, you can request a recalculation within 60 days of receiving your IRMAA notice.
What happens if I disagree with Medicare's calculation of my income?
You can request a review by contacting Social Security at 1-800-772-1213. If you believe your tax return was filed incorrectly or if there is a discrepancy between what you reported and what Medicare received, bring documentation from the IRS or your tax preparer to support your case.
Does IRMAA change every year?
Yes. The income thresholds and surcharge amounts are adjusted annually, usually in October or November, based on inflation and program costs. Your IRMAA amount may go up, down, or stay the same depending on how the thresholds shift and whether your income has changed.