What Exactly Is the Medicare IRMAA?
The Income-Related Monthly Adjustment Amount, or IRMAA, is an extra charge that some Medicare beneficiaries pay for their Part B (Medical Insurance) and Part D (Prescription Drug Coverage) premiums. It's not a penalty or a tax; instead, it's a mechanism designed to have higher-income individuals contribute a larger share toward their Medicare costs. Social Security determines who pays IRMAA based on the income reported to the IRS. Specifically, they look at your Modified Adjusted Gross Income (MAGI) from two years prior. So, for your 2026 Medicare premiums, the Social Security Administration will be looking at your 2024 tax return. MAGI is calculated by taking your Adjusted Gross Income (AGI) from your tax form and adding back certain deductions, such as tax-exempt interest. If your MAGI is above a certain level, you'll be required to pay the standard Part B premium plus an additional monthly amount. The same logic applies to your Part D plan; if you are subject to IRMAA, you will pay your plan's specific premium plus a separate, fixed IRMAA amount for Part D. This adjustment is paid directly to Medicare, not to your insurance company.
2026 IRMAA Income Brackets and Costs (Projected)
The IRMAA brackets are adjusted annually for inflation. While the exact figures for 2026 won't be finalized by Social Security until late 2025, we can look at the most recently published numbers to understand how it works. These brackets are based on your MAGI from two years prior. Below are the 2024 IRMAA brackets, which are based on 2022 tax returns. It's important to use these as a guide to understand the structure, as the thresholds for 2026 will likely be higher.
For 2024, based on 2022 income:
If your yearly income is: - Individuals: $103,000 or less - Couples Filing Jointly: $206,000 or less - Result: You pay only the standard Part B premium.
- Individuals: Above $103,000 up to $129,000 - Couples Filing Jointly: Above $206,000 up to $258,000 - Result: You pay the standard premium plus a Part B and a Part D adjustment.
- Individuals: Above $129,000 up to $161,000 - Couples Filing Jointly: Above $258,000 up to $322,000 - Result: Your adjustment amount increases.
- Individuals: Above $161,000 up to $193,000 - Couples Filing Jointly: Above $322,000 up to $386,000 - Result: The adjustment amount continues to climb.
- Individuals: Above $193,000 and less than $500,000 - Couples Filing Jointly: Above $386,000 and less than $750,000 - Result: You are in the second-to-highest bracket.
- Individuals: $500,000 or more - Couples Filing Jointly: $750,000 or more - Result: You pay the maximum Part B and Part D adjustments.
Social Security will mail you a determination letter if they find your income falls into one of these higher brackets. This letter will explain what your total premium will be and which income information they used.
How Social Security Decides If You Owe IRMAA
The process is quite straightforward and automated. The Social Security Administration (SSA) has an agreement with the Internal Revenue Service (IRS) to share income data. Every year, the SSA receives a feed of tax return information from the IRS for all Medicare beneficiaries. As mentioned, they use a two-year look-back period. This delay is simply because it’s the most recent, complete set of tax data available when they make their annual determinations. For example, when the SSA decides on your 2026 premiums in the fall of 2025, the most recent full-year tax return information they can reliably access for everyone is from the 2024 tax year.
The key figure they look for is your Modified Adjusted Gross Income (MAGI). For most people in Northeast Ohio, MAGI is the same as their Adjusted Gross Income (AGI), which you can find on line 11 of your Form 1040 tax return. However, if you have tax-exempt interest income—from sources like municipal bonds, for example—you must add that back to your AGI to get your MAGI. If this calculated MAGI is above the lowest threshold for the given year, you will receive an IRMAA notification letter in the mail. The letter itself is the official start of the process and will specify the income year they used and the total premium you are now expected to pay.
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How to Appeal an IRMAA Decision in Ohio
Receiving an IRMAA letter can be frustrating, especially if your income has changed significantly since the tax year Social Security reviewed. Fortunately, there is a formal appeal process. The most common reason for a successful appeal is experiencing a "Life-Changing Event" that has reduced your income. Social Security lists several specific qualifying events:
- Marriage - Divorce or Annulment - Death of a Spouse - Work Stoppage (you or your spouse retired) - Work Reduction (you or your spouse are earning less) - Loss of Income-Producing Property (due to disaster or other event beyond your control) - Loss of Pension Income (e.g., your former employer's pension plan failed) - Employer Settlement Payment (a one-time payment from a current or former employer due to closure or bankruptcy)
If one of these events caused your income to decrease, you can request a new determination. To do this, you must complete Form SSA-44, "Medicare Income-Related Monthly Adjustment Amount — Life-Changing Event." On this form, you will document the event, state your estimated lower income for the current year, and provide evidence. For example, if you retired, you might provide a letter from your former employer. You would then submit this form to your local Social Security Administration office. Ohio residents have access to several offices, and it's best to work with the one closest to you.
An Ohio IRMAA Scenario: The Retired Accountant of Solon
Let's consider a practical example here in Northeast Ohio. A 68-year-old man in Solon retired from his accounting practice at the end of 2023. His wife, also 68, is a retired nurse. Throughout 2022, he was working full-time and their joint income was high, placing them in an upper IRMAA bracket. In late 2023, when Social Security reviewed their 2022 income to set their 2024 premiums, they were correctly assigned a high IRMAA. Their combined Part B premiums were hundreds of dollars more than the standard amount. They were concerned this would affect their budget for the Medicare Advantage plan they chose, which gave them access to specialists at both the Cleveland Clinic and University Hospitals systems.
This is a classic case for an IRMAA appeal. The husband's retirement is a qualifying "Work Stoppage" Life-Changing Event. They filled out Form SSA-44, documenting that his earned income had stopped completely. They provided an estimate of their 2024 income, which would consist only of Social Security, pensions, and some investment income. They submitted the form and supporting documents to their local SSA office. Within a couple of months, they received a new determination letter reflecting their lower income, and their Part B premiums were reduced back to the standard amount, retroactive to the beginning of the year. This is a perfect illustration of why the appeal process exists: to correct for the two-year lag in income data.
How We Help You Plan Around IRMAA
Understanding IRMAA is one thing, but building a healthcare budget that accounts for it is another. For higher-income retirees in Ohio, an IRMAA can add a significant, non-negotiable cost to your annual healthcare spending. It doesn't matter whether you choose Original Medicare with a Medigap plan or a Medicare Advantage plan; the IRMAA for Part B is a separate charge from the federal government. If you are subject to IRMAA and have a prescription drug plan (either standalone or as part of Medicare Advantage), you'll also pay the Part D IRMAA.
While our agency cannot provide tax advice, we can help you understand how these costs fit into your overall picture. When we sit down with families from Akron to Ashtabula, we factor in all potential costs—premiums, deductibles, copayments, and known fixed costs like IRMAA—to find a plan that aligns with their budget and healthcare needs. For someone facing a high IRMAA, perhaps a plan with lower monthly premiums or a different cost-sharing structure makes more sense. For others, the network and benefits of a particular plan might be worth the total cost. We can lay out the specific numbers for the plans available in your ZIP code so you can make an informed decision. If you have questions about which plans are available to you and how your potential IRMAA would factor into your total costs, fill out the callback form on this page. We'll get in touch to provide personalized guidance.
Frequently asked questions
Is IRMAA a one-time charge, or will I pay it every year?
IRMAA is determined annually. Each fall, the Social Security Administration will review your tax return from two years prior and decide if you need to pay an IRMAA for the following year. If your income drops below the threshold, the IRMAA will go away. If your income fluctuates, you may find yourself paying IRMAA in some years but not in others. For example, a large one-time capital gain from selling a property could trigger IRMAA for just one year.
If I have to pay IRMAA, does my spouse have to pay it too?
Not necessarily. IRMAA is determined individually, even if you file a joint tax return. Social Security takes your joint income, divides it by two, and compares that figure to the income brackets for individuals 'married filing separately'. If you both have Medicare, you will each receive your own determination letter and will each be assessed an IRMAA based on your shared income. If only one of you is on Medicare, only that person will be subject to the adjustment.
Does IRMAA affect my Medicare Supplement (Medigap) plan premiums?
No, IRMAA does not directly affect your Medigap premium. IRMAA is an adjustment charged by the federal government for your Medicare Part B and Part D coverage only. Your Medigap premium is a separate amount that you pay directly to the private insurance company that provides your plan. While a high IRMAA increases your total monthly Medicare costs, it has no bearing on the price of your Medigap policy itself.
I disagree with my IRMAA but don't have a Life-Changing Event. What can I do?
If you believe Social Security used incorrect income data—for instance, they used an old tax return or made a clerical error—you can still file for a reconsideration. This is different from an appeal based on a life-changing event. You would need to provide a copy of the correct IRS tax transcript to prove your income was actually lower. If the IRMAA is based on correct data but you just feel it's unfair, there is unfortunately no appeal. The income brackets are set by law.
If my IRMAA appeal is approved, will I get a refund?
Yes. If you successfully appeal your IRMAA determination and have already paid the higher premiums, you will be refunded the overpayment. The process can take a few months, but Social Security will reimburse you for the extra amount you paid. The refund may come as a check in the mail or as a credit that reduces your future Part B premium deductions from your Social Security benefit check.
Can I get help with Form SSA-44 in Ohio?
Yes, you can get help. While we cannot fill out the form for you, the Ohio Senior Health Insurance Information Program (OSHIIP) offers free, unbiased counseling and may be able to walk you through the form. You can also contact your local Social Security Administration office directly with questions. The form itself comes with detailed instructions, and the most important part is clearly stating your qualifying life-changing event and providing accurate proof of your income reduction.
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