IRMAA and Income-Related Medicare Premiums

Most Medicare beneficiaries pay a standard monthly premium for Part B. However, if your income exceeds defined thresholds, you pay more — an additional charge called IRMAA, the Income-Related Monthly Adjustment Amount. IRMAA applies to both Part B and Part D, and it is calculated using income data from two years prior. Understanding how IRMAA works, which income amounts trigger each tier, and what recourse exists if your income has changed helps you plan your Medicare costs more accurately. This page explains the mechanics of IRMAA in general terms; the specific dollar figures are updated by CMS annually, and individual tax situations vary.

Why IRMAA exists

Medicare Part B is partially subsidized by general federal revenue. CMS determined that beneficiaries with higher incomes should contribute a larger share of the program’s costs. IRMAA was established under the Medicare Modernization Act of 2003 and has been modified by subsequent legislation. Since 2011, IRMAA has also applied to Part D. The result is a sliding-scale surcharge structure in which higher-income beneficiaries pay progressively higher monthly premiums.

How income is measured: MAGI

IRMAA is based on Modified Adjusted Gross Income (MAGI), not total income or gross wages alone. For IRMAA purposes, MAGI is generally your adjusted gross income (line 11 of your IRS Form 1040) plus any tax-exempt interest income you received. Social Security benefits that are included in your taxable income are also part of this calculation.

Importantly, IRMAA is calculated using the most recently available IRS tax data — which is typically from two years prior. For your 2024 Part B and Part D premiums, IRMAA is determined using your 2022 tax return. For your 2025 premiums, your 2023 return is used.

2024 IRMAA income brackets and Part B premiums

The table below shows approximate 2024 IRMAA brackets and total monthly Part B premiums per person. CMS adjusts these figures annually.

2022 MAGI (Individual filer)	2022 MAGI (Joint filer)	2024 Total Part B Premium
$103,000 or less	$206,000 or less	$174.70 (standard)
$103,001 – $129,000	$206,001 – $258,000	$244.60
$129,001 – $161,000	$258,001 – $322,000	$349.40
$161,001 – $193,000	$322,001 – $386,000	$454.20
$193,001 – $500,000	$386,001 – $750,000	$559.00
Above $500,000	Above $750,000	$594.00

These are per-person amounts. A married couple both on Medicare and both in the highest bracket would each pay the highest amount.

How IRMAA affects Part D

IRMAA adds a surcharge to your Part D premium as well. The IRMAA tiers for Part D mirror the Part B income brackets but add a flat dollar surcharge on top of whatever your Part D plan charges. For 2024, the Part D IRMAA surcharges ranged from approximately $12.90 to $81.00 per month depending on income tier. Unlike Part B’s IRMAA (which SSA bills directly), the Part D IRMAA surcharge is also billed by SSA, not by your Part D plan — you will see it on your Social Security or Medicare premium bill.

How SSA notifies you and when IRMAA applies

The Social Security Administration sends IRMAA determination notices, typically in late fall for the coming year. If you receive Social Security benefits, the IRMAA surcharge is deducted from your benefit payment automatically. If you do not receive Social Security benefits, you are billed directly for your Medicare premiums including any IRMAA surcharge.

If your income is near a threshold boundary, a relatively small change in MAGI can move you into or out of an IRMAA bracket — a consideration in retirement income planning decisions.

Documents and terms you’ll see

When reviewing IRMAA notices and planning Medicare costs, these terms appear frequently:

• IRMAA — the income-related surcharge added to Part B and Part D premiums for higher-income beneficiaries; SSA determines it using IRS data
• Modified Adjusted Gross Income — the income measure used for IRMAA; generally AGI plus tax-exempt interest; found on your federal tax return
• Life-changing event — a qualifying event such as retirement or spousal death that allows you to request SSA recalculate IRMAA using more recent income data via Form SSA-44
• Form SSA-44 — the Social Security Administration form used to appeal an IRMAA determination based on a recent qualifying life change

Appealing IRMAA: using the life-changing event process

IRMAA is determined automatically based on the IRS data available to SSA. If your income has dropped significantly since the tax year used in your determination — for example, because you retired, experienced a reduction in pension income, or your spouse died — you can request that SSA use more recent income information.

The process involves:

1. Completing Form SSA-44 (Medicare Income-Related Monthly Adjustment Amount — Life-Changing Event).
2. Identifying the qualifying event — retirement, reduced work hours, divorce, death of a spouse, loss of pension, loss of income-producing property, or employer settlement.
3. Providing documentation: your most recent tax return or other income evidence appropriate to the qualifying event.
4. Submitting the form to your local Social Security office or SSA’s online portal.

If SSA approves the appeal, they will recalculate your IRMAA using the more recent income figure and adjust your premium accordingly, sometimes retroactively.

What does not count as a qualifying life-changing event

Not every income reduction qualifies for an IRMAA appeal. The sale of property (if it is not the loss of that property as an income source), one-time capital gains, or voluntary decisions to reduce income generally do not qualify. The SSA’s Form SSA-44 instructions and the agency’s IRMAA guidance describe the specific qualifying events; if your situation is unclear, contacting SSA directly or working with a benefits counselor is advisable.

IRMAA in the context of retirement income planning

Because IRMAA looks back two years, a large income event in a given year — a retirement with severance, a large Roth IRA conversion, a property sale, or a significant distribution from a retirement account — can affect Medicare premiums two years later. People approaching retirement sometimes plan distributions with this look-back in mind, though the tax and financial planning considerations involved go well beyond IRMAA alone.

The Medicare Basics guide situates IRMAA alongside the broader structure of Part B, Part D, and supplemental coverage options, providing context for how these premiums interact with the overall cost of Medicare coverage.

How IRMAA is billed

For most people who receive Social Security retirement benefits, the IRMAA surcharge — along with the standard Part B premium — is deducted automatically from the monthly Social Security payment. You do not receive a separate bill from Medicare for the standard premium or the IRMAA add-on; instead, your net Social Security deposit is reduced.

If you have not yet started Social Security retirement benefits, CMS bills you directly for Part B and Part D IRMAA through quarterly Medicare premium billing notices. Payments are due before the coverage month they apply to. If you miss a payment, CMS will send notices; persistent non-payment can result in loss of Part B coverage, so monitoring the billing schedule is important for people who are not yet collecting Social Security.

SSA may also notify you mid-year if your IRMAA tier changes — for example, if an amended tax return for the look-back year reduces your reported income into a lower bracket. In that case, SSA adjusts your premium going forward and may credit prior overpayments.

Step-by-step: what to do if you receive an IRMAA notice

1. Review the notice to identify which tax year’s income SSA used to determine your IRMAA tier.
2. Verify that the income figure matches your tax return for that year; errors in SSA’s IRS data extract occasionally occur.
3. If the figure is wrong, gather your tax return and contact SSA to correct the record.
4. If the figure is correct but your income has since dropped due to a qualifying life-changing event, obtain Form SSA-44 from SSA’s website.
5. Gather supporting documentation: a copy of your most recent tax return, a letter from your former employer documenting retirement date, or other evidence of the qualifying event.
6. Submit Form SSA-44 to your local SSA office or through the appropriate SSA channel; retain a copy of everything you submit.
7. Follow up with SSA if you do not receive a determination within the timeframe noted in their instructions.