What IRMAA Is (and Isn't)
IRMAA — the Income-Related Monthly Adjustment Amount — is not a penalty. It's a surcharge that higher-income Medicare beneficiaries pay on Part B and Part D, based on the tax return from two years earlier. For 2026 premiums, that means your 2024 return.
The Two-Year Lookback Catches Retirees
The most common IRMAA surprise: you retire, your income drops sharply, and Medicare bills you based on your last high-earning year. That's exactly what the appeal process is for. If a life-changing event — retirement or work reduction among them — has lowered your income since the tax year Medicare used, Form SSA-44 asks Social Security to use your current, lower income instead. It's a standard form, not a long-shot appeal.
Planning Around the Cliffs
IRMAA brackets are cliffs, not slopes — one dollar over a threshold moves your entire premium to the next tier. For anyone doing Roth conversions, taking capital gains, or timing retirement withdrawals in their early 60s, the 2026 thresholds above are worth keeping on the desk: the income decisions you make this year set the Medicare premiums you pay two years from now.