IRMAA: Medicare's income surcharge, and how to get it lowered

How IRMAA works

Who decides

Social Security, using income the IRS reports. Medicare sets the dollar amounts each year.

Which income

Generally adjusted gross income plus tax-exempt interest (a few other items, such as foreign earned income, are added in for some people).

Which year

The tax return from two years before: 2024 income for 2026. If that return isn't available yet, Social Security uses the year before it, then updates the amount when the IRS sends the newer return. You can speed this up by sending a signed copy yourself.

Who pays it

About 8% of people with Part B. Each year is decided separately, so a high-income year raises only one year's premiums.

If you don't file a tax return and IRS records show income above the limit, Social Security charges the highest amount until you correct it.

The 2026 amounts

Married, filing separately

If you lived with your spouse at any time in the year: $202.90 up to $109,000; $649.20 (Part D +$83.30) up to $391,000; $689.90 (+$91.00) above. If you lived apart all year, tell Social Security and the single brackets apply.

2027

The 2027 brackets and amounts are usually announced in November. The 2027 notices use 2025 tax returns.

How it's paid

Part B

Added to your Part B premium: taken from your Social Security, Railroad Retirement or federal retirement benefit, or billed by Medicare.

Part D

Paid to Medicare, never to your plan. It's taken from your Social Security, Railroad Retirement or federal retirement benefit, or Medicare bills you monthly. It applies to drug plans, Medicare Advantage plans with drug coverage, and employer plans that are Medicare drug plans, even if the employer pays your premium.

• If you don't pay a Part D IRMAA bill, you have a 3-month grace period. After that, Medicare removes you from your drug plan, or from your whole Medicare Advantage plan if it includes drug coverage. You may not be able to rejoin right away, and you may owe a late enrollment penalty.

Getting it lowered after a life change

If your income dropped because of one of these 8 events, Social Security can use a more recent year's income instead:

Marriage, divorce or annulment, or the death of a spouse

Proof: a marriage certificate, divorce decree or death certificate (certified copies or originals).

You or your spouse stopped working or cut back hours

Proof: a letter from the employer, pay stubs, papers showing you sold or handed over your business, or your own signed statement under penalty of perjury.

Loss of a pension

An employer pension that stopped, ended or was cut back. Proof: a letter from the pension administrator.

Loss of income-producing property you didn't choose

Such as a disaster, arson, or fraud or theft by someone else. Proof: an insurance claim or adjuster's statement; for fraud or theft, also proof of a conviction. A sale or ordinary investment losses don't count.

A settlement from an employer

Paid because the employer closed, went bankrupt or reorganized.

1. 1

   Check the drop is big enough

   The newer income has to put you in a lower bracket, or below the limit.
2. 2

   Gather proof

   Proof of the event, and of the newer income: your filed tax return for that year, or an estimate if it isn't filed yet (send the return once you file).
3. 3

   Ask Social Security

   Fill in form SSA-44 and upload it after signing in to your account, mail or fax it, or call 1-800-772-1213 (TTY 1-800-325-0778) or visit an office. Each spouse asks separately.
4. 4

   Ask in time

   Any time during the year your income dropped because of the event. If the event happens October to December, you have until March 31 of the next year. Late requests can still be accepted for good cause.

Other ways to fix it

An amended tax return

If you amended the return Social Security used, send a copy with IRS proof that it was filed. The new figures apply, even if they're higher.

Wrong IRS information

Send the IRS letter or transcript showing the correction.

They used a 3-year-old return

Send a signed copy of the newer one.

You think the decision is simply wrong

Ask for a reconsideration within 60 days of the notice, using form SSA-561. If you have one of the reasons above, use it instead: it usually gets the same result.

One-time income

Anything that raises your adjusted gross income for a year, such as a taxable gain from selling property, a business or investments, or large taxable withdrawals from retirement accounts, can raise IRMAA two years later. It affects only that one year. Social Security looks at the total, not where it came from, and a sale you chose isn't a life-changing event.

This is general information, not tax advice. A tax professional can tell you how a sale or withdrawal will affect your income.

Common questions

Keep reading

• What Medicare costs in 2026, and what's already set for 2027The 2026 Part B premium and deductible, Part A hospital costs, the income-based IRMAA surcharges, Part D drug limits and Medicare Advantage's yearly cap, plus the 2027 figures already announced.
• Paying for prescriptions with Medicare: the yearly cap, the payment plan and $35 insulinThe yearly limit on what you pay for covered drugs, how the Medicare Prescription Payment Plan spreads costs out, the $35 insulin cap, $0 vaccines, negotiated prices and coupons.
• How to appeal a Medicare denial: steps and deadlinesYour plan or Medicare said no. The first step and its deadline for Original Medicare, Medicare Advantage and Part D, fast appeals when care is ending, the 2026 prior-authorization deadlines, and who can help for free.