IRMAA and Social Security: Medicare Premium Surcharges

Last Updated: March 17, 2026

IRMAA (Income-Related Monthly Adjustment Amount) adds a surcharge to Medicare Part B and Part D premiums for higher-income retirees. According to the Social Security Administration, which administers IRMAA determinations, the surcharge is based on your income from two years prior — meaning your 2024 income determines your 2026 Medicare premiums. For couples, both spouses face the surcharge independently, and Social Security income counts toward the threshold. Strategic couples can often avoid or reduce IRMAA through coordinated Roth conversions and withdrawal sequencing before Medicare begins. For the complete household tax picture — combining IRMAA planning with combined income management, Roth conversion windows, and the survivor tax cliff — see our Social Security tax strategy guide for couples.

IRMAA is one of the most expensive surprises in retirement planning. A couple who each trigger the second IRMAA bracket can pay $400–$600/month more in Medicare premiums than the standard rate — over $5,000 more per year, every year. Unlike most tax brackets, IRMAA is a cliff: one dollar of additional income can push both spouses into the next bracket simultaneously.

How IRMAA Works: The Two-Year Lookback

The Social Security Administration uses your Modified Adjusted Gross Income (MAGI) from two years prior to set your current year's Medicare premiums. This creates what's sometimes called the "two-year lag."

Practical implication: You cannot lower your current IRMAA bracket by reducing income this year. You are paying for decisions you made two years ago. This makes advance planning — specifically in the years before Medicare begins — essential.

What counts as income for IRMAA:

• Wages and self-employment income
• IRA and 401(k) withdrawals
• Pension income
• Capital gains (including home sales)
• Social Security benefits (up to 85% is included in MAGI)
• Rental income
• Taxable interest and dividends

What does NOT count:

• Roth IRA distributions (if qualified)
• Return of principal from annuities
• Life insurance proceeds
• HSA distributions for qualified medical expenses

Note: Unlike the combined income formula for Social Security taxation, Roth distributions are excluded from IRMAA income. This is the core reason Roth conversions are powerful for IRMAA management.

2026 IRMAA Brackets and Surcharges

The surcharge tiers are adjusted annually. For 2026, the brackets based on 2024 income are:

For couples: These surcharges apply per person. A couple in Tier 2 pays $185 × 2 = $370/month in Part B surcharges alone — $4,440/year more than standard.

The cliff effect is significant: a couple with joint MAGI of $265,999 pays Tier 1 surcharges; at $266,000 they jump to Tier 2. A $1 difference in income costs an additional $222/month ($2,664/year) for the couple.

How Social Security Income Affects IRMAA

Social Security income contributes to MAGI and therefore to IRMAA calculations. Up to 85% of your Social Security benefits can be included in your MAGI — specifically, the taxable portion of your Social Security (determined by the combined income formula) flows into your AGI and thus your IRMAA calculation.

The feedback loop: A larger Social Security benefit means higher MAGI, which can push you into a higher IRMAA bracket, which increases Medicare premiums, which effectively reduces your net Social Security income.

Claiming age interaction: Claiming Social Security at 70 produces a larger benefit — but that larger benefit also contributes more to your MAGI. For couples near an IRMAA threshold, this dynamic deserves explicit modeling before deciding on claiming age.

The delayed claiming tradeoff: A couple where the higher earner delays to 70 will have a larger combined Social Security benefit after both are claiming. If that larger benefit pushes them into a higher IRMAA tier than they'd otherwise be in, the net after-IRMAA benefit may be smaller than the gross calculation suggests. Most of the time delaying still wins — but couples near the bracket edges should run the numbers.

For the full claiming age analysis, see the Social Security claiming age guide and the break-even guide.

Strategies to Reduce IRMAA

Strategy 1: Roth conversions before age 63

Medicare premiums begin at 65, and the IRMAA determination uses income from two years prior. This means your income at ages 63 and 64 determines your Medicare premiums at 65 and 66.

Converting traditional IRA funds to Roth before age 63 reduces your future MAGI during the years that matter. Once converted, Roth distributions don't count toward IRMAA income. The conversion itself increases your MAGI in the year of conversion — but you're paying that cost before Medicare begins, at a time when you can still manage the bracket.

For the full Roth conversion strategy, see Roth conversion before claiming Social Security.

Strategy 2: Manage IRA withdrawal timing

Large IRA withdrawals in a single year are the most common trigger for unexpected IRMAA surcharges. Spreading withdrawals across multiple years keeps annual MAGI lower.

Couples can coordinate: one spouse takes larger withdrawals in a year when the other has lower income. This requires deliberate sequencing — it doesn't happen automatically.

Strategy 3: Qualified Charitable Distributions (QCDs)

Once you're 70½ or older, QCDs let you donate directly from your IRA to charity. These distributions are excluded from your AGI — reducing MAGI and potentially reducing IRMAA. You can donate up to $105,000/year per person using this strategy.

Strategy 4: Capital gains harvesting timing

Capital gains from selling investments flow directly into MAGI. If you have appreciated assets you plan to sell, consider the year carefully. Avoid triggering a large gain in a year when your other income is already near an IRMAA threshold.

Strategy 5: IRMAA appeals for life-changing events

If you experienced a significant income change due to a qualifying life-changing event — retirement, divorce, death of a spouse, reduced work hours — you can appeal your IRMAA determination using SSA Form SSA-44. The SSA can use more recent income data rather than the two-year-prior figure.

Couples: Coordinate Both Spouses' Income

The most underutilized IRMAA strategy for couples is explicit income coordination between spouses in the years leading up to Medicare eligibility.

The problem: Each spouse's IRMAA is determined by joint MAGI (for those filing jointly). Both spouses hit the surcharge together if joint income crosses a threshold — and both spouses are assessed the surcharge independently.

The opportunity: Couples filing jointly have more flexibility in how they time income recognition. If one spouse has a large capital gain to realize or an IRA withdrawal to take, the couple can choose the year based on where their joint MAGI sits relative to IRMAA thresholds.

Pre-Medicare years as the critical window: The years from retirement to age 65 are typically the lowest-income years of a couple's retirement. These are the prime years for Roth conversions, strategic withdrawals, and IRMAA bracket management — before Medicare begins and before larger Social Security benefits (if delaying to 70) start flowing.

For the complete tax coordination picture for couples, see the married couples strategy guide and the Social Security taxation guide.

Frequently Asked Questions

Next Steps

• Roth Conversion Before Claiming Social Security — full Roth conversion strategy and timing
• Is Social Security Taxable? — combined income formula and tax reduction strategies
• Married Couples Strategy Guide — full household income coordination
• Spousal Benefits Calculator — model your household benefit and income projections

For a complete pre-Medicare income planning strategy that accounts for IRMAA thresholds, Roth conversion timing, and Social Security claiming coordination, the $67 Couples Strategy Kit at /couples-kit includes IRMAA bracket worksheets and a Roth conversion timeline.