October 24, 2026 · fireandretire.com

IRMAA: Why a Good Year Can Raise Your Medicare Premiums

Medicare premiums aren't flat. Higher-income retirees pay an Income-Related Monthly Adjustment Amount — IRMAA — on top of the standard Part B and Part D premiums. Because IRMAA uses your tax return from two years ago, a single large Roth conversion, property sale, or bonus can raise your Medicare costs long after the fact. Here's how to stay ahead of it.

What IRMAA Is

Part B (medical insurance) and Part D (prescription drug coverage) premiums are means-tested. If your modified adjusted gross income (MAGI) exceeds a threshold, you pay a surcharge. The more you earn, the higher the surcharge — up to several hundred dollars per month above the standard premium.

The Two-Year Lookback

This is the part that catches people. Your 2026 Medicare premiums are based on your 2024 tax return. So decisions you make in one year affect your premiums two years later. A retiree who does a big Roth conversion at 63 can find their Medicare premiums spiking at 65 — right when they enroll.

Why the thresholds matter

IRMAA is a cliff, not a gradual phase-in. Cross a threshold by one dollar and you jump to the next surcharge tier for the whole year. That makes "just under the line" a meaningful planning target, especially if you're near a boundary.

Who It Affects

  • Higher-income retirees whose MAGI exceeds the first threshold — roughly $106,000 single / $212,000 married for the relevant tax year (indexed annually).
  • Anyone doing large Roth conversions near or during Medicare age.
  • People who sell a business, rental property, or highly appreciated stock in a single year.
  • New retirees whose last working year's income was high, even though retirement income is now modest.

How to Avoid Surprise IRMAA

  • Model conversions against the IRMAA thresholds. When doing Roth conversions before Medicare, leave a buffer below the cliff rather than converting "up to" an income target.
  • Spread large income events. If you must realize a big gain, consider splitting it across two tax years to stay under a threshold in each.
  • Do the math on 63–64 especially. Income in the two years before you enroll at 65 determines your first Medicare premiums.
  • Coordinate with other cliffs. The same MAGI that triggers IRMAA can also trigger the net investment income tax and higher capital gains rates — plan the whole picture, not one program at a time.

If You Get Hit by IRMAA Unfairly: Form SSA-44

Sometimes IRMAA is based on income that no longer reflects reality — you retired, your spouse died, you divorced, or you lost a pension. In those cases you can request a reduction by filing Form SSA-44 (Medicare Income-Related Monthly Adjustment Amount — Life-Changing Event). Qualifying events include:

  • Work stoppage (retirement)
  • Reduction in work hours
  • Loss of income-producing property
  • Loss of pension income
  • Marriage, divorce, or death of a spouse

Submit SSA-44 with proof of the event, and Social Security can reduce or eliminate the surcharge for that year.

Why This Belongs in Your Retirement Plan

IRMAA is a tax on income decisions, and it's easy to trigger accidentally. Treating it as a known constraint — like a bracket or a contribution limit — lets you capture Roth conversions and gain harvesting at low rates without handing back the savings in Medicare premiums two years later.

Read the full Medicare guide for premium amounts and enrollment timing, and model how conversions interact with income thresholds in our Roth conversion calculator.

The Bottom Line

IRMAA is one more reason retirement tax planning is a multi-year puzzle. Know your thresholds, leave a buffer, and remember the two-year lookback. If a life-changing event makes the surcharge unfair, SSA-44 is your remedy — but avoiding the cliff in the first place is far easier.

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