What year's income does my 2026 IRMAA use?

Your 2024 tax return (filed in 2025). Medicare uses a 2-year MAGI lookback — 2026 IRMAA is based on 2024 income. Your 2025 income will determine 2027 IRMAA, and so on. This delay means recent income changes don't immediately affect IRMAA; you generally have time to plan or appeal.

Is IRMAA tax-deductible?

Medicare Part B and Part D premiums (including IRMAA portions) are generally tax-deductible as medical expenses if you itemize and your total medical expenses exceed 7.5% of AGI. The Inflation Reduction Act and ongoing tax legislation can affect specific deductibility rules. Consult a tax advisor for your situation. For Social Security beneficiaries who have Medicare premiums deducted from Social Security, the gross Social Security is taxable income; the Medicare deduction doesn't reduce that.

Can I avoid IRMAA by delaying Part B?

Sometimes, but with risks. If you have creditable employer coverage at a 20+ employer and you're still working, delaying Part B (and Part D) avoids paying premiums and IRMAA during that period. Once you retire and trigger the Part B Special Enrollment Period, you start paying premiums (with IRMAA based on your 2-year-prior MAGI). For higher-income retirees still working, this delay can defer IRMAA exposure for years. Without creditable coverage, delaying triggers late-enrollment penalties that may exceed IRMAA over time.

How long does IRMAA last?

IRMAA is recalculated annually based on the most recent 2-year-old tax return. If your MAGI drops below the IRMAA threshold in a subsequent tax year, your IRMAA returns to $0 two years later. For retirees whose high-income years were during working life, IRMAA typically declines or disappears 2-3 years into retirement as MAGI drops.

Are Roth IRA distributions counted in MAGI for IRMAA?

Generally no — qualified Roth IRA distributions don't count toward AGI or MAGI for IRMAA purposes. Tax-free Roth distributions are often used by higher-income retirees specifically to manage IRMAA exposure. Traditional IRA, 401(k), and pension distributions do count toward MAGI. Strategic Roth conversions before Medicare eligibility (and during low-income years) are a common IRMAA management strategy — though the conversion itself increases MAGI in the year converted.

If I'm widowed, does my IRMAA change?

Yes, via SSA-44 appeal. Death of a spouse is a qualifying life-changing event for IRMAA appeal. The surviving spouse can file Form SSA-44 with documentation (death certificate) and an estimate of expected single-filer MAGI. If approved, IRMAA is recalculated based on the new filing status and expected income. This typically results in lower IRMAA for the surviving spouse when household income drops after the spouse's death.

IRMAA: Income-Related Monthly Adjustment Amount (2026 Brackets)

On this page

How IRMAA works (the 2-year MAGI lookback)
2026 IRMAA bracket table (Part B)
Part D IRMAA (separate surcharge)
Married Filing Separately (MFS) rules
Bracket cliffs: why $1 matters
Appealing IRMAA with Form SSA-44
IRMAA in Ohio: distinctive considerations
Common questions

How IRMAA works (the 2-year MAGI lookback)

IRMAA is the mechanism Medicare uses to charge higher-income beneficiaries more for Part B and Part D coverage. The key features:

Based on Modified Adjusted Gross Income (MAGI) — your AGI plus tax-exempt interest, foreign income exclusions, and certain other adjustments.
2-year lookback — your 2026 IRMAA is based on your 2024 tax return (filed in 2025). The IRS provides MAGI data to CMS; CMS calculates IRMAA and notifies beneficiaries via a "Notice of Medicare Premium Payment" each fall.
Adjusted annually — IRMAA brackets are adjusted by the cost-of-living inflation factor each year. Your IRMAA tier can change year-over-year as your income (and the brackets) change.
Automatic implementation — Social Security deducts IRMAA from your Social Security check (if you're collecting), or bills you directly for the Part B portion. Part D IRMAA is billed separately or deducted from Social Security.

2026 IRMAA bracket table (Part B)

For 2026 (based on 2024 MAGI):

2024 MAGI (Single)	2024 MAGI (Joint)	2026 Part B premium	IRMAA tier
≤ $109,000	≤ $218,000	$202.90 (standard)	Standard (no IRMAA)
$109,000 – $137,000	$218,000 – $274,000	$284.10	Tier 1
$137,000 – $171,000	$274,000 – $342,000	$405.80	Tier 2
$171,000 – $205,000	$342,000 – $410,000	$527.50	Tier 3
$205,000 – $500,000	$410,000 – $750,000	$649.20	Tier 4
≥ $500,000	≥ $750,000	$689.90	Tier 5

For comparison, 2025 IRMAA used 2023 MAGI: standard premium $185.00; threshold $103,000 single / $206,000 joint; top tier $628.90. The thresholds and premium amounts have shifted upward for 2026.

Part D IRMAA (separate surcharge)

If you're subject to Part B IRMAA, you also pay Part D IRMAA — a separate surcharge added to your Part D premium:

IRMAA tier	2026 Part D IRMAA (added to plan premium)
Standard (no IRMAA)	$0 (you pay your plan premium only)
Tier 1	$14.50
Tier 2	$37.50
Tier 3	$60.40
Tier 4	$83.30
Tier 5	$91.00

Part D IRMAA applies even if you're enrolled in a Medicare Advantage plan with prescription coverage (MA-PD) — the prescription drug surcharge applies to the Part D component regardless of how it's delivered.

Married Filing Separately (MFS) rules

If you file taxes as Married Filing Separately and lived with your spouse at any point during the tax year, special IRMAA brackets apply:

2024 MFS MAGI	2026 Part B premium
≤ $109,000	$202.90 (standard)
$109,000 – $391,000	$649.20 (Tier 4)
≥ $391,000	$689.90 (Tier 5)

The MFS structure has only three tiers (versus six for Single/Joint). The middle tiers don't apply — you jump directly from standard to Tier 4. This penalizes MFS filers significantly compared to Single filers with the same MAGI. For most retired couples, Married Filing Jointly is the better choice; MFS makes sense only in specific circumstances (income-driven student loan strategies, certain estate planning situations).

MFS IRMAA penalty example

A married couple where each spouse has $150,000 MAGI ($300,000 joint) filing MFS would each pay $649.20/month in Part B premium — total $1,298.40/month. Filing Jointly with the same $300,000 MAGI, they'd each pay $284.10/month — total $568.20/month. The MFS choice costs them $730/month, or $8,760/year, in additional Part B premium.

Bracket cliffs: why $1 matters

IRMAA brackets are cliffs, not gradual phase-ins. Going $1 over a bracket boundary moves you up the entire next tier — there's no proportional adjustment.

Example: A retired couple has $217,999 MAGI in 2024. In 2026, they pay the standard $202.90/month each — total $405.80/month. If instead they had $218,001 MAGI, they'd each pay $284.10/month — total $568.20/month. $2 of additional income costs them $1,948/year in additional Part B premium.

For income that's close to a bracket threshold, tax planning matters significantly. Common tactics:

Roth conversions earlier in retirement (before Medicare-eligibility) to reduce future MAGI.
Charitable distributions from IRAs (QCDs) to reduce MAGI in retirement years.
Bunching capital gains in lower-MAGI years.
Tax-loss harvesting to offset realized gains.
Timing of large distributions or sales (e.g., selling a vacation home) for off-peak years.

Work with a tax advisor familiar with IRMAA implications when making decisions about income recognition near retirement.

Appealing IRMAA with Form SSA-44

If you've experienced a qualifying "life-changing event" that reduced your income from the 2-year-prior tax return, you can appeal IRMAA using Form SSA-44 (Medicare Income-Related Monthly Adjustment Amount – Life-Changing Event):

Qualifying events: marriage, divorce/annulment, death of spouse, work stoppage, work reduction, loss of income-producing property (other than from sale or transfer), loss of pension income (not just declines), receipt of settlement payment from former employer.
What to submit: Form SSA-44 with documentation of the life-changing event and an estimate of your reduced expected MAGI for the current year.
Where to submit: Local Social Security office, by mail, or in some cases online through your my Social Security account.
Decision timeline: typically several weeks; if approved, IRMAA is adjusted for the year and refunded if you've already paid the higher amount.

Note: market losses, investment decline, or non-event-driven income changes don't qualify for SSA-44 appeals. You must have experienced one of the specifically-listed life events.

Ohio Medicare beneficiary facing IRMAA after a life event?A licensed Ohio Medicare agent or tax advisor familiar with IRMAA can help you file Form SSA-44 and plan future income to manage IRMAA tier transitions. No cost for Medicare consultation.

Find a Medicare Agent in Ohio

IRMAA in Ohio: distinctive considerations

IRMAA is a federal program — the brackets and rules are identical in Ohio versus any other state. However, several Ohio-specific factors interact with IRMAA:

Ohio's public pensions (OPERS, STRS Ohio, SERS, OP&F, HPRS): pension income counts toward MAGI. Long-service Ohio public retirees with substantial pensions may face IRMAA earlier than expected.
Goodyear, Timken, P&G, NCR, and similar major Ohio employer retiree benefits: company pension and post-retirement compensation typically count toward MAGI.
Federal civilian retirees from Wright-Patt, NASA Glenn, DSCC: FERS/CSRS pensions count toward MAGI. The Federal Employees Retirement System annuity is a regular income source affecting IRMAA tier placement.
Ohio has no state-level Medicare premium assistance for higher-income beneficiaries — federal Medicare Savings Programs (QMB, SLMB, QI) are income-based at much lower thresholds than IRMAA brackets.

For Ohio retirees with significant pension and Social Security income approaching IRMAA thresholds, tax planning before retirement and during retirement matters. See our Medicare basics in Ohio page for the full cost framework.