If you have done well over your career, you may open your first Medicare bill and find it is higher than you expected. That extra amount usually has a name: IRMAA, the Income-Related Monthly Adjustment Amount. It is not a penalty and it is not a mistake. It is a surcharge that higher-income beneficiaries pay on top of the standard Medicare Part B and Part D premiums.
This guide explains, in plain English, how IRMAA works for 2026, who it affects, and what higher-income Californians can do to plan for it. It is educational information only, not tax or financial advice.
What IRMAA is
Most people pay the standard Medicare Part B premium, which is $202.90 per month in 2026. Part D (prescription drug) coverage has its own premium that varies by plan.
If your income is above a certain level, the Social Security Administration (SSA) adds a surcharge to both of those premiums. That surcharge is IRMAA. It is billed on top of your standard Part B premium and on top of whatever your Part D plan charges.
Two things are worth understanding right away:
- IRMAA is set by the government, not by an insurance company or a broker. No agent can lower it, waive it, or negotiate it. It is based entirely on your income as reported to the IRS.
- It is recalculated every year. If your income drops, your IRMAA can drop too. It is not a permanent label.
How SSA decides whether you owe IRMAA
SSA looks at your Modified Adjusted Gross Income (MAGI) from your tax return two years earlier. For 2026, that means your 2024 tax return. MAGI is generally your adjusted gross income plus any tax-exempt interest.
This two-year lookback surprises a lot of newly retired people. You may have a much lower income in 2026 than you did in 2024, but your 2026 premium is based on that earlier, higher-earning year. (There is a way to ask SSA to use more recent income — see “life-changing events” below.)
For 2026, the first surcharge tier begins when MAGI is above:
- $109,000 for a single filer (or married filing separately in most cases), or
- $218,000 for a married couple filing jointly.
If your income is at or below those amounts, you pay the standard premium and no IRMAA applies. Above them, there are several income tiers, and the surcharge climbs at each one. The highest tier applies to the largest incomes and adds several hundred dollars a month to Part B, plus an additional Part D amount.
2026 IRMAA brackets (from CMS)
| Individual tax return | Joint tax return | Part B premium per month | Part D amount added per month |
|---|---|---|---|
| $109,000 or less | $218,000 or less | $202.90 | $0.00 |
| Above $109,000, up to $137,000 | Above $218,000, up to $274,000 | $284.10 | $14.50 |
| Above $137,000, up to $171,000 | Above $274,000, up to $342,000 | $405.80 | $37.50 |
| Above $171,000, up to $205,000 | Above $342,000, up to $410,000 | $527.50 | $60.40 |
| Above $205,000, less than $500,000 | Above $410,000, less than $750,000 | $649.20 | $83.30 |
| $500,000 or more | $750,000 or more | $689.90 | $91.00 |
Different income lines apply to married people who lived with their spouse during the year and file separately; the CMS fact sheet lists them. Your own amount is shown on the notice Social Security sends you about your Medicare premiums for the year, and Medicare.gov carries the current figures.
2027 IRMAA brackets: what is known so far
As of October 13, 2026, CMS has not published the 2027 Part B premium or the 2027 IRMAA brackets. CMS announces them together each fall; the 2026 amounts were published on November 14, 2025.
What is already known:
- The tax year. Your 2027 IRMAA will generally be based on your 2025 tax return — the one most people filed in spring 2026.
- Most of the table is recalculated. CMS sets new dollar amounts each year and adjusts most income lines for inflation, so the 2027 table will likely differ from the 2026 table above. Under current law the top income line ($500,000 individual, $750,000 joint) is not inflation-adjusted until 2028.
- Numbers online are estimates. Any 2027 figures you see before the CMS announcement are projections, not official amounts.
This page will be updated when CMS publishes the 2027 amounts. If your income has dropped since 2025 because you stopped working, reduced your hours or had another life-changing event, you can ask Social Security, with Form SSA-44, to use more recent income for 2027; Social Security decides each request.
The “cliff” that catches people
IRMAA is a cliff, not a gradual phase-in. Going even one dollar over a tier threshold moves you into that tier for the entire year — for both Part B and Part D. Someone with MAGI of $109,001 as a single filer pays the same surcharge as someone at $130,000.
That single feature is why IRMAA planning matters for higher-income households. A Roth conversion, a large capital gain, a year with an unusually big required minimum distribution, or the sale of a California property can all push MAGI over a threshold two years before the premium arrives. Coordinating those decisions with your tax professional is where the real savings live — not in the Medicare plan itself.
If your income has gone down: the SSA-44 appeal
If you are paying IRMAA because of a life-changing event, you can ask SSA to use your more recent, lower income instead of the two-year-old figure. Qualifying events include:
- Retirement or reduced work hours (very common)
- Marriage, divorce, or the death of a spouse
- Loss of pension income
- Loss of an income-producing property through a disaster or other event outside your control
You request this using Form SSA-44, “Medicare Income-Related Monthly Adjustment Amount – Life-Changing Event.” You file it with SSA, not with Medicare or your insurance company, and you attach proof such as a retirement letter or a more recent tax return. If you believe SSA used the wrong figures or your situation changed, this is the correct path.
Does IRMAA change which Medicare plan makes sense?
Not directly. IRMAA is added to your premiums no matter which route you choose:
- If you have Original Medicare plus a Medicare Supplement (Medigap) and a stand-alone Part D plan, IRMAA is added to your Part B premium and to your Part D premium.
- If you have a Medicare Advantage plan that includes drug coverage, IRMAA is still added to your Part B premium and to the Part D portion, even when the plan’s own premium is $0.
So IRMAA is not a reason on its own to pick one type of coverage over another. Your health needs, doctors, prescriptions, and travel patterns should drive that decision. If you are weighing the two paths, our plain-English Medicare Advantage vs. Medicare Supplement comparison walks through the trade-offs, and our Medicare costs, explained guide covers the other pieces of what Medicare costs beyond IRMAA.
What higher-income Californians can actually do
You cannot argue your way out of IRMAA, but you can plan around it:
- Know your two-year lookback. Before a big financial move, ask how it will affect your MAGI — and remember the premium impact shows up two years later.
- Watch the thresholds around one-time income. Property sales, Roth conversions, and large distributions are the usual triggers. Timing them across tax years can keep you under a cliff.
- File SSA-44 promptly if you retire. Do not simply accept a surcharge based on your peak earning year if your income has since dropped.
- Confirm your exact tier at the source. Use Medicare.gov or your SSA determination letter, not a memory of last year’s numbers.
- Loop in your tax professional. IRMAA is an income question first and a Medicare question second.
A Medicare broker’s role here is simply to help you understand where IRMAA fits in your overall costs and make sure your Part D and medical coverage still fit your needs — not to change the surcharge, which no one can do.
Frequently asked questions
- What are the 2027 IRMAA brackets?
- CMS has not published them as of October 13, 2026. It announces the Part B premium and the IRMAA brackets together each fall; the 2026 amounts came out on November 14, 2025. Your 2027 IRMAA will generally be based on your 2025 tax return. Until CMS publishes, any 2027 figures you see are projections.
- Is IRMAA a one-time charge?
- No. It is a monthly surcharge added to your Part B and Part D premiums for the year it applies, and SSA recalculates it every year based on your most recent tax data. If your income falls below the threshold, it can go away the following year.
- What income does SSA use for my 2026 IRMAA?
- Your Modified Adjusted Gross Income (MAGI) from your 2024 federal tax return — a two-year lookback. MAGI is generally your adjusted gross income plus tax-exempt interest.
- I just retired and my income dropped. Do I still have to pay?
- You can ask SSA to use your current, lower income by filing Form SSA-44 and documenting the life-changing event (such as retirement). If SSA approves it, your IRMAA is recalculated on the more recent figure.
- Can a broker or insurance agent lower my IRMAA?
- No. IRMAA is set by the Social Security Administration based on your income. No agent, broker, or insurance company can reduce or waive it. Be cautious of anyone who claims otherwise.
- Does choosing Medicare Advantage instead of a Supplement avoid IRMAA?
- No. IRMAA is added to your Part B premium and Part D coverage regardless of which path you choose, even for a Medicare Advantage plan with a $0 premium. Choose coverage based on your health needs, then plan for IRMAA separately.
Sources & official references
- CMS: 2026 Medicare Parts A & B Premiums and Deductibles (November 14, 2025) — 2026 Part B premium and income-related amounts
- Medicare.gov — Medicare costs (Part B premium & income-related amounts)
- Social Security Administration — Medicare premiums for higher-income beneficiaries
- Form SSA-44 — Medicare IRMAA Life-Changing Event
- California Department of Aging (HICAP) — free Medicare counseling
This is a non-government resource and is not affiliated with or endorsed by Medicare.gov or the federal Medicare program. An independent broker may not offer every plan available in your area. For all of your options, contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Assistance Program (SHIP) — in California, HICAP. Last reviewed: October 2026. Sources: Medicare.gov (Part B costs); Social Security Administration (IRMAA and Form SSA-44). Confirm the current-year premium and bracket amounts with Medicare.gov or your SSA determination notice. Educational information only, not tax, financial, or individualized advice.
