Education / IRMAA
2026 IRMAA Reference Card
A quick-reference card for the 2026 IRMAA brackets, the two-year MAGI lookback, the MAGI calculation, and the SSA-44 life-changing event appeal.
Updated: Sat May 02 2026 00:00:00 GMT+0000 (Coordinated Universal Time)
IRMAA — the Income-Related Monthly Adjustment Amount — adds a Medicare premium surcharge for higher-income beneficiaries. It's a cliff function, not a smooth slope: one dollar over a threshold puts you fully into the next tier for the entire year.
This reference card has six sections you can scan in 5 minutes:
- The 2026 brackets (illustrative; verify the actual current year).
- How MAGI is calculated for IRMAA purposes (different from MAGI for ACA).
- The two-year lookback.
- SSA-44 — when you can appeal IRMAA for a "life-changing event".
- The cliff math, with worked numbers.
- Practical planning rules.
1. 2026 brackets — illustrative
Note: Final 2026 IRMAA tier dollar amounts are set annually by CMS and published in the fall of the prior year. The numbers below are illustrative based on recent-year tier shapes. Always cross-check at Medicare.gov — Part B costs before making decisions tied to a specific tier boundary.
| Tier | MAGI (single filer) | MAGI (married filing jointly) | Part B surcharge | Part D surcharge |
|---|---|---|---|---|
| 0 (standard premium) | up to ~$106,000 | up to ~$212,000 | $0 | $0 |
| 1 | $106,001 – $133,000 | $212,001 – $266,000 | ~$74/mo | ~$13/mo |
| 2 | $133,001 – $167,000 | $266,001 – $334,000 | ~$185/mo | ~$33/mo |
| 3 | $167,001 – $200,000 | $334,001 – $400,000 | ~$295/mo | ~$54/mo |
| 4 | $200,001 – $500,000 | $400,001 – $750,000 | ~$406/mo | ~$74/mo |
| 5 | over $500,000 | over $750,000 | ~$443/mo | ~$81/mo |
Important: these are per-person surcharges. A married couple where both spouses are on Medicare pays the surcharge twice — once on each spouse's Part B premium and once on each spouse's Part D premium. A Tier-2 couple faces about $436/month ($185 × 2 Part B + $33 × 2 Part D) in IRMAA surcharges, or about $5,232/year.
2. How MAGI is calculated for IRMAA
MAGI for IRMAA purposes is not the same as MAGI for ACA premium tax credits or for Roth contribution phase-outs. The IRMAA-specific definition:
IRMAA MAGI = Adjusted Gross Income (Form 1040, Line 11) plus tax-exempt interest (Form 1040, Line 2a) plus certain foreign-earned income exclusions
Notably, IRMAA MAGI does include:
- Roth conversions (the converted amount is added to AGI)
- Realized capital gains (long-term and short-term)
- Qualified and ordinary dividends
- Traditional IRA / 401(k) withdrawals (including RMDs)
- Taxable Social Security benefits
- Tax-exempt municipal-bond interest (the most common surprise — munis are IRMAA-counted even though they're federal-tax-free)
It does not add back:
- Pretax 401(k) contributions (already reduced AGI)
- HSA contributions (already deductible)
- Pre-tax health insurance premiums
- Standard or itemized deductions (these are below the AGI line)
3. The two-year lookback
IRMAA is calculated using the MAGI from your tax return filed two years prior. So:
| Medicare year | IRMAA MAGI source |
|---|---|
| 2026 | 2024 tax return (filed in 2025) |
| 2027 | 2025 tax return (filed in 2026) |
| 2028 | 2026 tax return (filed in 2027) |
This lookback creates two distinct planning surprises:
Surprise A — early Medicare years. Someone retiring in 2026 may be living on $40,000/year, but their 2026 IRMAA is based on their 2024 MAGI (when they were still working). They pay surcharges in their first year of retirement based on their highest-income year.
Surprise B — late retirement actions. A large Roth conversion or capital gain in 2026 affects 2028 IRMAA, not 2026 or 2027. By the time the surcharge appears, the action that caused it is two years in the past.
4. SSA-44 — life-changing event appeal
Form SSA-44 lets you ask Social Security to recalculate IRMAA using your expected current-year income instead of the two-year-prior figure. SSA accepts SSA-44 only for specific qualifying "life-changing events":
- Marriage
- Divorce or annulment
- Death of a spouse
- Work stoppage (full retirement, layoff, etc.)
- Work reduction (cut hours that significantly reduces income)
- Loss of income-producing property (not by your own action — disaster, fraud, theft)
- Loss of pension income
- Employer settlement payment (e.g., back pay or settlement that distorted the lookback year)
Action items:
- File SSA-44 in the same calendar year as the life-changing event (or early the next year). SSA cannot apply it retroactively beyond a small window.
- Bring documentation: marriage certificate, retirement letter, death certificate, etc.
- Provide a good-faith estimate of your current-year MAGI. SSA will reconcile against your actual return when it's filed.
For "I planned a Roth conversion that pushed me over a tier" — that's not an SSA-44 qualifying event. Voluntary income decisions don't qualify.
5. The cliff math, with worked numbers
The brackets are tiered as cliffs, not marginal slopes. One dollar over a threshold puts you into the next tier for the entire year.
Worked example: married couple, both on Medicare. Their 2024 MAGI projects to $265,800. They're considering a $500 year-end charitable distribution from their IRA (a Qualified Charitable Distribution, which reduces MAGI) vs. doing nothing. With QCD: MAGI $265,300 (still in Tier 0). Without: MAGI $265,800 (still in Tier 0). Either way they're under the $266,000 threshold.
But add a $250 year-end Roth conversion: MAGI $266,050. Now they're in Tier 1. The cost:
| Tier 0 | Tier 1 | |
|---|---|---|
| Part B surcharge per person | $0 | $74/mo |
| Part D surcharge per person | $0 | $13/mo |
| Total per person/month | $0 | $87/mo |
| Couple/year | $0 | $2,088 |
A $250 Roth conversion that crossed the cliff cost the couple $2,088 in extra Medicare premiums two years later. That's an effective marginal tax rate of 836% on the dollars that crossed the boundary.
The lesson: when MAGI is near a tier boundary in a year that drives a future IRMAA, every dollar of additional income carries an outsized hidden cost. Sizing decisions to stop short of the boundary, rather than exceed it by a small margin, is one of the highest-leverage moves in tax planning for households in the IRMAA-exposed income range.
6. Practical planning rules
Three rules cover most decisions:
-
Cluster, don't drip. If you're going to do Roth conversions across multiple years, prefer larger conversions in years you're already in a higher tier (e.g., a one-time spike year due to a sale or RMD-driven year) over small amounts that drift each year just over a tier boundary.
-
Time capital gains. A planned stock sale near a tier boundary is one of the cheapest places to apply tax-aware sizing. Sell down to the boundary, hold the rest until next year, especially if next year's other income is projected lower.
-
Watch the muni-bond add-back. Tax-exempt municipal-bond interest is federal-tax-free at the AGI level but is added back for IRMAA MAGI. Households with significant muni portfolios should verify the IRMAA add- back when modeling tier sensitivity.
Primary sources
- Medicare.gov — Part B costs and IRMAA
- SSA — Medicare premiums and IRMAA
- SSA Form SSA-44 — Life-Changing Event
- CMS — Annual Medicare premium and IRMAA announcements
This reference card is published by NestPilot Foundation Inc. — a nonprofit (501(c)(3) filing in progress). The dollar amounts are illustrative based on recent-year IRMAA structure. The actual 2026 thresholds and surcharges are set annually by CMS — verify at Medicare.gov before applying these numbers to a specific decision.