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:

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:

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.

Because the exact dollar figures for each tier can change year to year, the most reliable place to confirm your specific 2026 amount is Medicare.gov or your SSA “New Initial Determination” notice. If you want to see the full current bracket table before you talk to anyone, start there.

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:

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:

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:

  1. 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.
  2. 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.
  3. 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.
  4. Confirm your exact tier at the source. Use Medicare.gov or your SSA determination letter, not a memory of last year’s numbers.
  5. 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

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

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: July 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.