IRMAA and Medicare Premiums: What Counts as Income

IRMAA is an extra monthly charge on Medicare Part B and Part D premiums for higher incomes, based on your tax return from two years earlier. For 2026 it generally starts above $109,000 of modified adjusted gross income for most filers and $218,000 for joint filers. Pre-tax withdrawals and the taxable part of a Roth conversion count.

What Is IRMAA, and When Does It Apply?

IRMAA stands for income-related monthly adjustment amount. The law requires higher-income Medicare beneficiaries to pay more for Part B (medical insurance) and for Medicare prescription drug coverage (Part D).[1] SSA says most beneficiaries pay about 25% of the Part B cost, while higher-income beneficiaries pay 35%, 50%, 65%, 80% or 85% depending on their income.[1][2]

The standard Part B premium for 2026 is $202.90 a month, according to CMS and Medicare.gov. Medicare.gov describes it as "or higher depending on your income."[3][4] For Part D, SSA says the extra amount is tied to a base premium, not to the price of the plan you chose, and it is deducted from your Social Security payment even if you pay your plan premium another way.[1]

Limitation: If your income is below the thresholds, IRMAA does not apply at all, so it is only one of several costs to weigh. Premiums, deductibles and thresholds are set each year and can change.

What Are the 2026 IRMAA Income Levels?

SSA publishes the 2026 amounts below. The amounts are added to the standard Part B premium and to your own Part D plan premium.[1]

2026 modified adjusted gross income, single filers	2026 modified adjusted gross income, married filing jointly	Added to Part B each month	Added to Part D each month
$109,000 or less	$218,000 or less	None	None
Above $109,000 up to $137,000	Above $218,000 up to $274,000	$81.20	$14.50
Above $137,000 up to $171,000	Above $274,000 up to $342,000	$202.90	$37.50
Above $171,000 up to $205,000	Above $342,000 up to $410,000	$324.60	$60.40
Above $205,000 and below $500,000	Above $410,000 and below $750,000	$446.30	$83.30
$500,000 or more	$750,000 or more	$487.00	$91.00

Source: SSA, Premiums: Rules for Higher-Income Beneficiaries, 2026 premium table, as of November 2, 2026.[1] "Single" here means the table SSA lists for individuals. SSA lists a separate table with different thresholds for people who are married, lived with their spouse during the year and file separately.[1]

Each level is a step, not a gradual slope. Once your income is above a threshold, the amount for that level applies.[1]

Limitation: These are 2026 figures. CMS released the 2026 amounts on November 14, 2025.[3] As of November 2, 2026, we did not find 2027 premium amounts or thresholds published on CMS's fact sheet pages, so the figures above are expected to change. Check SSA's page for the current table before relying on any number here.

Which Income Counts, and From Which Year?

SSA uses modified adjusted gross income (MAGI), which it defines as your adjusted gross income plus tax-exempt interest income.[1] It uses the most recent federal tax return the IRS provides, which is generally from two years before the premium year. For 2026 that is generally the 2024 return, and SSA's operations manual says it is not more than three years prior.[1][2]

Here is how common retirement income lines up:

• Pre-tax withdrawals and required minimum distributions (RMDs). The IRS says withdrawals are included in taxable income except for any part that was already taxed or can be received tax-free.[5] RMDs generally begin at age 73 or 75 depending on birth year.[5][9]
• The taxable part of a Roth conversion. The IRS says a conversion to a Roth IRA results in taxation of any untaxed amounts in the traditional IRA.[6] That taxable amount is part of that year's income.
• Qualified Roth withdrawals. The IRS says qualified distributions from designated Roth accounts are tax-free, and withdrawals from Roth IRAs are not required during the owner's lifetime.[5][7] Qualified distributions are generally not part of gross income.
• Social Security benefits. The IRS says up to 85% of benefits may be taxable, and the taxable part is included in income.[8]
• Tax-exempt interest. SSA adds it back when it calculates MAGI.[1]

Limitation: Roth money that is withdrawn in a qualified way may keep reported income lower in a later year, but the converted amount was taxed at conversion, and the effect on any one household depends on the rest of its income. The rules for what counts as income are set by tax law and can change.

Why This Matters for Households With Large Pre-Tax Balances

When most savings sit in 401(k) plans and IRAs, income in the early years of retirement is often a choice about timing as well as amount. IRMAA adds a second reason to look at the calendar:

• The look-back reaches into your working years. Because SSA generally uses a return from two years earlier, income in the year you turn 63 may be the income SSA looks at when you are 65. A large conversion or a one-time sale in the final working years could therefore show up in your first Medicare premiums. Limitation: The same conversion might also be what lowers required withdrawals later, so the Medicare effect is one cost among several, not a verdict on the decision.
• Required withdrawals can arrive later and keep going. A large pre-tax balance can produce RMDs that count as income each year. Limitation: Reducing the balance earlier generally means paying income tax sooner than required, and no one can know future tax rules or account values in advance.
• A smaller conversion is not automatically better. Keeping income below a threshold may avoid a premium step. Limitation: It may also leave more in pre-tax accounts for later, so the trade-off is worth reviewing with your tax professional rather than treating a threshold as a target. Our Roth conversion pros and cons guide covers that decision, and our RMD and Roth conversion explainer explains why an RMD itself cannot be converted.
• A filing-status change can move a household across a line. After a spouse dies, a surviving spouse's filing status can change, and the first IRMAA threshold for single filers is half the joint one.[1] Our guide to Social Security survivor benefits and how they are taxed walks through that change. Limitation: SSA lists the death of a spouse as a reason to ask for a new decision if your income has gone down, as explained below.[1]

Our traditional vs. Roth 401(k) guide also touches on how contribution choices can affect income two years before Medicare.

Can IRMAA Be Reduced or Appealed?

SSA says it may make a new decision about your IRMAA if your income has gone down because of one of these events:[1]

• You married or divorced, or your spouse died
• You or your spouse stopped working or reduced your work hours
• You or your spouse lost income-producing property because of a disaster or other event beyond your control
• You or your spouse experienced a scheduled cessation, termination or reorganization of an employer's pension plan
• You or your spouse received a settlement from an employer or former employer because of the employer's closure, bankruptcy or reorganization

You report this on SSA's Medicare Income-Related Monthly Adjustment Amount life-changing event form (Form SSA-44) and provide documents showing the event and the lower income.[1][10] If SSA used a return that you later amended, SSA says to send a copy of the amended return and the IRS acknowledgment. If you disagree with the MAGI amount the IRS reported to SSA, SSA says you must correct it with the IRS.[1]

Limitation: A reduction applies only for the listed events and only if the documents support it. Choosing to take a smaller distribution or conversion is not a listed event. Decisions are SSA's, and you can appeal a decision you disagree with.[1]

Common Questions

Do Roth conversions count as income for IRMAA? The taxable part of a conversion is included in that year's income, which can raise the MAGI that SSA sees two years later.[1][6] Whether it moves a household across a threshold depends on its other income. A tax professional can review a specific plan before any transaction.

How far back does Medicare look at income? SSA says it generally uses the tax return filed two years earlier, so 2026 premiums generally use 2024 income. If the IRS has only the return from three years earlier, SSA may use that one instead.[1][2]

Does IRMAA apply to Part D drug coverage too? Yes. SSA says higher-income beneficiaries with Medicare prescription drug coverage pay their plan premium plus an additional amount, and the amount is tied to a base premium rather than to the plan's price.[1]

Is IRMAA permanent? No. SSA determines it for each premium year from the most recent return the IRS provides, so a household can move to a different level, or off IRMAA, as its reported income changes.[1] Whether that happens depends on future income and on thresholds that are set by law.

Does Social Security income count? Only the taxable part. The IRS says up to 85% of benefits may be taxable, and that amount is included in income.[8] That is one reason pre-tax withdrawals and Social Security taxation are often reviewed together.

Questions to Bring to a Planning Conversation

• Which year's income will SSA look at when I first enroll in Medicare, and what is already planned for that year?
• How could RMDs, conversions or one-time income affect MAGI in the two years before and after I enroll?
• Is there a life-changing event, such as retirement, that could support a request for a new decision?
• How do Social Security taxation, filing status and Medicare premiums interact in my plan?
• What should I confirm with SSA and my tax professional before making a change?

Start With a Conversation

The firm's tax planning service looks at withdrawals, conversions, Social Security and Medicare in one picture, and the who-i-help page describes the households it works with. You can also review how the firm charges for advice. If you would like to talk through your situation, start with a conversation. It is a 30-minute introductory call, and nothing in this article is a recommendation to convert, withdraw or delay any income.

Sources

All sources accessed November 2, 2026.

1. Social Security Administration, Premiums: Rules for Higher-Income Beneficiaries, 2026 premium table, definition of MAGI, the tax return used, life-changing events and appeals.
2. Social Security Administration, POMS HI 01101.010, Modified Adjusted Gross Income (MAGI), effective December 2, 2025, on the two-year look-back, and POMS HI 01101.031, How IRMAA is Calculated, on the percentage of Part B cost by level.
3. CMS, 2026 Medicare Parts A & B Premiums and Deductibles, released November 14, 2025, on the 2026 standard Part B premium.
4. Medicare.gov, Costs, 2026 Part B premium "or higher depending on your income."
5. IRS, Retirement topics: Required minimum distributions (RMDs), on withdrawals being included in taxable income, no RMDs from Roth IRAs during the owner's life, and the starting age.
6. IRS, Retirement plans FAQs regarding IRAs, "How do I convert my traditional IRA to a Roth IRA?", on taxation of untaxed amounts in a conversion.
7. IRS, Retirement plans FAQs on designated Roth accounts, on qualified distributions.
8. IRS, Publication 915 (2025), Social Security and Equivalent Railroad Retirement Benefits, on the taxable part of benefits being included in income, up to 85%.
9. IRS, Internal Revenue Bulletin 2024-33, T.D. 10001 (final required minimum distribution regulations), on applicable RMD ages by birth year.
10. Social Security Administration, Form SSA-44, Medicare Income-Related Monthly Adjustment Amount, Life-Changing Event.