How much does IRMAA cost in 2026?
For a married couple, crossing into Tier 1 (>$212,000 MAGI) adds about $1,950 per spouse per year to Medicare premiums — roughly $3,900 for the household. Tier 5 (>$750,000 MAGI) adds $7,150 per spouse, or $14,300 per household. The same amounts apply to single filers at the corresponding thresholds.
Can I appeal IRMAA?
Yes — file Form SSA-44 with documentation of a "life-changing event" that reduced your income. Qualifying events: marriage, divorce, death of spouse, retirement, work-hour reduction, loss of pension, or loss of income from settlement. The SSA can recalculate IRMAA using your current year's expected income instead of the lookback year.
Does Roth conversion trigger IRMAA?
Yes — the conversion amount counts as ordinary income in the year converted, raising your MAGI two years before the IRMAA hit. Smart conversion planning targets the dollars below the next IRMAA cliff each year. A $50,000 conversion that crosses the cliff can cost $4,000+ in extra Medicare premiums two years later.
What income counts toward IRMAA?
IRMAA MAGI = AGI plus tax-exempt municipal bond interest. So Roth conversions, traditional IRA/401(k) withdrawals, RMDs, capital gains, dividends, rental income, pension income, and Social Security all count. Roth withdrawals, HSA withdrawals for qualified medical expenses, and qualified life insurance loans do not.
When does IRMAA start applying?
IRMAA applies from the moment you enroll in Medicare Part B or Part D — typically at age 65. The lookback uses your tax return from two years prior, so 2026 premiums (for someone enrolling at 65 in 2026) are based on 2024 income.