Medicare IRMAA: what it is and how to get it reduced

Short answer

IRMAA — the Income-Related Monthly Adjustment Amount — is an extra monthly charge on Medicare Part B and Part D premiums for higher-income beneficiaries. In 2026, it starts above $109,000 for an individual filer and $218,000 for a couple. It uses the tax return from two years ago, which is why retirees often see a charge that no longer matches their actual income. A qualifying life change lets you request a reduction on form SSA-44.

How the IRMAA surcharge works

IRMAA is administered by the Social Security Administration, not by Medicare directly. Each year, SSA compares the modified adjusted gross income reported on the most recent tax return the IRS has on file — usually from two years earlier — against income thresholds published by the Centers for Medicare & Medicaid Services. Beneficiaries above the first threshold pay a surcharge on top of the standard Part B premium and a separate surcharge on top of whatever Part D drug plan they are enrolled in.

There are two important structural points caregivers miss more often than any other detail.

The surcharge attaches to premiums, not to services. IRMAA does not change what Medicare covers or how much a doctor visit costs. It is a monthly addition to what your loved one pays for coverage, deducted or billed in the same rhythm as the regular Part B premium.

Part B and Part D are separate calculations. The same income triggers both, but they are two distinct amounts on two separate bills. Part B IRMAA goes to CMS; Part D IRMAA is added to the plan-side premium your loved one pays their Medicare Advantage or stand-alone Part D plan.

The 2026 IRMAA brackets

The standard 2026 Part B premium is $202.90 per month. Beneficiaries above the income thresholds below pay that amount plus a monthly surcharge, for a total monthly Part B premium up to $689.90 at the highest band.

Part B — individual filers

Part B — joint filers

Part D — separate surcharge

Part D IRMAA is added on top of whatever plan-specific premium your loved one already pays for their drug coverage. The 2026 Part D national base premium — the reference figure Medicare uses to calculate the surcharge — is $38.99. The Part D IRMAA surcharge in 2026 ranges from $0 for beneficiaries below the first threshold up to $91.00 per month at the highest band, using the same income tiers as Part B.

Married beneficiaries who file taxes separately fall on a different schedule with only two bands — above $109,000 pays the highest surcharge — and should check the specific tier that applies to their filing status on the SSA notice they receive each year.

Why you may be charged when your income has dropped

The single largest source of legitimate IRMAA challenges is timing. The 2026 surcharge is calculated using the 2024 tax return — the medicare.gov cost fact sheet describes it as “your modified adjusted gross income as reported on your IRS tax return from 2 years ago.” For a beneficiary who was still working full-time in 2024 and retired in 2025, the 2026 letter will look like a bill from a life they no longer live.

The two-year lookback is not a mistake. Tax returns for the current year are not yet available when Medicare sets the following year’s premiums, so SSA reaches back to the most recent completed return. But when income has dropped between then and now for a specific reason — retirement, a spouse’s death, hours cut, a pension lost — the surcharge can be reset to reflect the new reality.

That reset is what the reduction request is for.

How to ask for IRMAA to be reduced

The form is SSA-44 — Medicare Income-Related Monthly Adjustment Amount – Life-Changing Event. It can be completed online, faxed or mailed to a local Social Security office, or filled out at an in-person appointment scheduled through ssa.gov.

SSA-44 recognizes eight qualifying life-changing events. Each has its own evidence requirement, taken directly from the form:

Two practical notes for caregivers helping with SSA-44.

Retirement counts as a work-stoppage event. If your loved one retired and their income has dropped as a result, that is the qualifying event to select. The evidence is a signed statement from the former employer or documentation of the retirement date.

The estimate on the form is a projection, not a return. The form asks for the beneficiary’s modified adjusted gross income for the year the reduction is being requested for, plus the year after. Those are estimates. They do not have to match a filed tax return — they should reflect the beneficiary’s realistic expected income under the new circumstances.

If your reduction request is refused

Denials happen. When they do, the appeal route is through Social Security, not through Medicare — SSA is the agency that determines IRMAA, and it is the agency whose decisions are appealed. The route runs through SSA’s standard reconsideration and hearing process. The first step is a request for reconsideration, filed through the ssa.gov appeals portal.

Two boundaries matter here.

IRMAA appeals are administrative, not judicial. The reconsideration is a review by a different SSA employee. If that reviewer upholds the surcharge, the next step is a hearing before an Administrative Law Judge, then the SSA Appeals Council, and finally federal district court. Most legitimate life-changing-event denials are resolved at the reconsideration step when the evidence documenting the event is complete.

Do not confuse IRMAA appeals with Medicare denial appeals. If your loved one is trying to appeal a coverage denial — a service Medicare refused to pay for — that is a Medicare appeal, and the route is different. Our guide to how to appeal a Medicare denial covers that pathway. IRMAA is not a coverage decision; it is a premium calculation, and it runs through SSA.

How the IRMAA surcharge gets paid

If your loved one receives Social Security benefits, the total Part B premium — the standard premium plus any IRMAA surcharge — is deducted directly from the monthly Social Security payment. The Part D IRMAA is billed separately by SSA and paid directly to Medicare, not to the drug plan.

If your loved one is not yet drawing Social Security, both surcharges arrive as quarterly bills from CMS. Missed payments can lead to termination of coverage, so setting up automatic bank drafts through Medicare Easy Pay is worth doing before the first bill.

What this article does not cover

This guide is about navigating and challenging the IRMAA charge — the mechanics of what it is, when to appeal it, and how. It is not tax planning.

There is a separate conversation about managing income to stay below the thresholds — the sequencing of retirement account withdrawals, the timing of Roth conversions, the year-of-arrival for capital gains. That is legitimate work for a financial adviser or CPA with Medicare expertise. It is not advocacy work, and it is not what this article does.

If you are wondering whether that adviser conversation is worth having for your family, the answer is usually yes if your loved one has significant retirement account balances and any flexibility about when to draw from them. But that is a different professional than a patient advocate.

When to work with a patient advocate on IRMAA

Most IRMAA cases do not need an advocate — the SSA-44 form is straightforward when the life-changing event is clear-cut and the evidence is in hand. Where an advocate earns their keep is in the messier cases.

• Multiple overlapping events. A beneficiary who retired and whose spouse died in the same year has two qualifying events with different evidence requirements; sequencing the request and the evidence packet cleanly reduces the odds of a denial.
• Documentation that is thin or contested. Pension terminations from employers no longer in business, work reductions without a clear employer statement, or property losses in mixed-cause events (partial insurance, partial uncompensated) benefit from someone who has assembled comparable packets before.
• Denials that are borderline. When a first request has been refused and the family is deciding whether reconsideration is worth pursuing, an advocate can read the denial notice against the evidence and give a clear read on whether the second try is likely to succeed.

Baba’s patient advocates handle Medicare navigation for families and can help with an IRMAA reduction request when the situation warrants it. Start with our guide to what a Medicare patient advocate does, or learn about the service at callbaba.com/service.

Frequently asked questions

Does retirement count as a qualifying event for reducing IRMAA?

Yes. Retirement is treated as a work-stoppage event on form SSA-44. The evidence is documentation of the retirement date — a signed statement from the former employer, a pension notification, or a similar record.

What if my spouse died and their income drops off the joint return?

Death of a spouse is one of the eight qualifying life-changing events. Evidence is a certified death certificate, a certified copy of the public record of death, or a certified copy of a coroner’s certificate. The reduction request can be filed as soon as the event has occurred.

What happens if I appeal an IRMAA denial and lose?

The next step after reconsideration is a hearing before an Administrative Law Judge, then the SSA Appeals Council, then federal district court. Most legitimate life-changing-event cases resolve at the reconsideration step; the further steps exist but are rarely used for IRMAA.

Is IRMAA permanent once I’m charged?

No. IRMAA is recalculated every year based on the tax return two years back. If income drops in a later year, the surcharge drops with it — sometimes automatically, sometimes only after a reduction request.

Does IRMAA change every year?

The dollar amounts of the surcharge are recalculated annually, and the income thresholds move with inflation. CMS publishes the new figures in mid-November each year, usually a few weeks before the letters go out.

What if I amend my tax return after IRMAA is applied?

An amended return can be submitted to SSA as evidence that the income used for the IRMAA calculation was incorrect. The recalculation applies retroactively for the year in question.

Does IRMAA apply to Medicare Advantage plans?

Yes. Enrolling in a Medicare Advantage plan (Part C) does not change IRMAA. The Part B surcharge still applies because Part C delivers Part B benefits, and the Part D surcharge still applies if the MA plan includes drug coverage (an MAPD plan). The two IRMAA amounts are paid the same way: Part B through the Social Security deduction or a direct CMS bill, and Part D via a separate SSA bill.

What if I cannot afford the IRMAA surcharge?

Extra Help and Medicare Savings Programs can reduce Part B premiums and drug costs, but they have income and resource thresholds well below the IRMAA thresholds — the two programs almost never overlap. If your loved one is close to the first IRMAA threshold and struggling with the surcharge, the reduction request based on a life-changing event is the relevant route. If they are well below the threshold and still struggling, they may qualify for Extra Help or an MSP; those are separate applications.

→ Call Baba at (855) 765-9011 or schedule a free 20-minute consult at schedule a call to talk through whether an IRMAA reduction request fits your loved one’s situation.

This information is for educational purposes and should not substitute for professional guidance. Healthcare coverage details vary by individual plan. Consult with Baba’s support team or your insurance provider for information specific to your situation.