If you earn above a certain income threshold, Medicare charges you more than the standard Part B premium. This extra charge is called IRMAA — the Income-Related Monthly Adjustment Amount — and it can add hundreds or even thousands of dollars to your annual Medicare costs.

What Is IRMAA?

IRMAA stands for Income-Related Monthly Adjustment Amount. It is an additional surcharge added to your Medicare Part B and Part D premiums if your modified adjusted gross income (MAGI) exceeds certain thresholds. The Social Security Administration (SSA) reviews your income from two years prior to determine whether IRMAA applies for the current year.

For example, your 2024 Medicare premiums are based on your 2022 tax return income. If your income that year was above the threshold, you will receive an IRMAA notice from SSA, typically in November of the prior year.

How the 2024 IRMAA Brackets Work

There are six income tiers for single filers and married couples filing jointly. The standard 2024 Part B premium is $174.70 per month. As income rises, Part B premiums step up — reaching $594.00 per month for the highest earners. Part D plans also carry a separate IRMAA surcharge on top of whatever your plan premium is.

Married couples filing separately face a much harsher rule: any income above $103,000 immediately jumps to the Tier 4 rate of $559.00 per month for Part B, regardless of how high the income actually is. This is by design to discourage income shifting.

Use the estimator below to see exactly which bracket applies to your situation and how much extra you can expect to pay annually.

Can You Appeal an IRMAA Determination?

Yes — and many beneficiaries successfully appeal. The SSA will recalculate IRMAA if you experienced a qualifying life-changing event that reduced your income, including: retirement, marriage, divorce or annulment, death of a spouse, loss of income-producing property, loss of pension income, or employer settlement payment.

If your income has dropped significantly since the two-year lookback period, file Form SSA-44 (Medicare Income-Related Monthly Adjustment Amount — Life-Changing Event) with your local Social Security office. Attach documentation of the qualifying event and your more recent income figure.

Strategies to Reduce Future IRMAA

Because IRMAA looks back two years, tax planning today affects your Medicare costs in the future. Strategies that beneficiaries use include Roth conversions (done carefully to avoid large income spikes), managing capital gains distributions, coordinating required minimum distributions (RMDs), and using qualified charitable distributions (QCDs) from IRAs to satisfy RMDs without the income counting toward MAGI.

Working with a fee-only financial planner who understands Medicare income thresholds can pay for itself many times over if it keeps you below an IRMAA tier boundary.

For more detail on the full cost picture, see our guide to Medicare Part B and D costs or read about Medicare Advantage vs. Original Medicare to understand how plan choice affects your overall premium exposure.