Glossary
IRMAA (Income-Related Monthly Adjustment Amount)
An income-based surcharge added to your Medicare Part B and Part D premiums when your modified adjusted gross income exceeds CMS thresholds.
Also known as: Income-Related Monthly Adjustment Amount, Medicare income surcharge, Part B IRMAA, Part D IRMAA
Quick answer
IRMAA is an extra amount higher-income Medicare beneficiaries pay on top of the standard Part B and Part D premiums. The Social Security Administration calculates it each fall using your modified adjusted gross income (MAGI) from two years prior — so 2026 IRMAA is based on your 2024 IRS return. There are five income tiers above the standard threshold, and the surcharge scales with each tier.
Why it matters
IRMAA can add hundreds of dollars per month to a couple's Medicare bill. Retired senior officers, dual-income households, recent home or business sale proceeds, large Roth conversions, and required minimum distributions can all push you into an IRMAA bracket without warning.
Why this matters at age 65
The year you retire is often your highest-IRMAA year — because IRMAA looks back two years to when you were still working. If your income drops in retirement, you can file SSA Form SSA-44 to request a reconsideration based on a 'life-changing event' (work stoppage, work reduction, marriage, divorce, death of spouse). Many retirees overpay IRMAA for an entire year because nobody told them about SSA-44.
When you'll encounter it
Each fall you'll receive an 'Initial IRMAA Determination Notice' from SSA for the following calendar year. The amount is automatically deducted from your Social Security check (or billed via Medicare Easy Pay/quarterly invoice if you aren't yet on Social Security).
Impact on Medicare
Increases your monthly Part B (and Part D if you have one) premium. It does not change covered services, networks, or cost-sharing.
Impact on TRICARE For Life
IRMAA does not change TFL itself — TFL has no income test. But because Part B must remain active for TFL to stay active, you still have to pay IRMAA in full to keep TFL.
Impact on Medicare Advantage
Joining a Medicare Advantage plan does NOT eliminate IRMAA — you still pay the full Part B premium plus IRMAA to Medicare. However, a Part B giveback from an MA plan can offset part of the surcharge.
VA Healthcare considerations
VA Healthcare is completely separate from IRMAA — VA pension and disability income are generally excluded from MAGI for IRMAA purposes. Note: VA disability compensation may be excluded from tax-based MAGI for IRMAA even though it is generally counted under the SSI-based rules that determine Medicare Savings Program and Extra Help eligibility. These are different eligibility systems. Always confirm with a tax professional what counts toward MAGI in your situation.
Military-specific context
Military retired pay IS counted in MAGI. Survivor Benefit Plan (SBP) annuity income is also counted. VA disability compensation is not. Many retirees underestimate IRMAA by forgetting their retired pay and pension distributions both flow into MAGI.
Common misconceptions
- "IRMAA is permanent once you're in a bracket." — It's recalculated every year. When your income drops, your IRMAA drops the following year automatically — and you can appeal sooner via SSA-44 for life-changing events.
- "I can avoid IRMAA by joining Medicare Advantage." — MA does not reduce IRMAA at all. The Part B premium and any IRMAA still go to Medicare.
- "VA disability pay triggers IRMAA." — VA disability compensation is not counted in MAGI for IRMAA.
Common mistakes to avoid
- Not filing SSA-44 the year you retire — the single most common and costly IRMAA mistake.
- Doing a large Roth conversion two years before Medicare without realizing it will trigger IRMAA at 65.
- Selling a home with large capital gains and not planning for the IRMAA hit two years later.
- Assuming the IRMAA notice can't be appealed — it can be, for specific life-changing events.
Real-world scenario: A retired Air Force colonel and his spouse both file jointly with $250,000 MAGI in 2024 (his last working year). In 2026 they receive an IRMAA notice adding $443/month to his Part B premium.
He files SSA Form SSA-44 documenting his work stoppage. SSA recalculates using projected 2026 income (military retirement + Social Security ≈ $110,000) and removes IRMAA entirely starting the following month. Savings: roughly $5,300 for the year.
What should I do?
- 1Open your annual IRMAA determination letter from SSA the moment it arrives — don't file it away unread.
- 2If your income has dropped (work stoppage, retirement, loss of income-producing property, marriage/divorce/death of spouse), file SSA Form SSA-44 within the deadline on the notice.
- 3Before triggering a large MAGI event (Roth conversion, home sale, RMD bunching), check the IRMAA brackets for two years out — that's the year you'll pay.
- 4Confirm IRMAA is the only reason your Part B premium changed — late penalties stack separately and are not appealable.
- 5Keep paying Part B in full even while appealing. TFL terminates the moment Part B lapses.
Questions people commonly ask
- Why is my Part B premium so high?
- Can I appeal IRMAA after I retire?
- Does VA disability count toward IRMAA?
- Does joining Medicare Advantage lower my IRMAA?
Continue learning
— suggested by the knowledge graph- What is Medicare? A complete overview for retired militaryA plain-English, handbook-grounded overview of the federal health insurance program for people 65 and older, written specifically for retired service members and their families.
- Understanding Original Medicare (Parts A & B) for veteransExactly what Part A and Part B cover, what they cost in 2026, and why both are required to keep TRICARE For Life.
- Enrolling in Medicare: timing, methods, and the military-specific rulesWhen and how to sign up for Medicare Parts A and B — and the timing that protects your TRICARE For Life activation.
- Avoiding the Medicare late-enrollment penaltyThe Part B late penalty is permanent — and TRICARE does not waive it. Here's how to make sure you never owe it.
- Late Enrollment Penalty (Part B and Part D)A permanent monthly surcharge added to your Part B (10% per 12 months delayed) or Part D (1% per month delayed) premium for as long as you have Medicare.
- Premium-Free Part AMost people pay no monthly premium for Medicare Part A because they (or a spouse) paid Medicare taxes for at least 40 quarters (10 years) of work.
- Benefit Period (Part A)The Part A timeframe used to measure hospital deductibles and coinsurance — it resets after 60 days out of the hospital.
- Creditable CoverageNon-Medicare coverage that CMS deems at least as good as a standard Medicare Part D plan — TRICARE Pharmacy qualifies, so TFL beneficiaries don't need Part D.
- Creditable Drug CoveragePrescription drug coverage that CMS certifies is at least as good as standard Medicare Part D — including TRICARE Pharmacy and VA Pharmacy.
- Disability Medicare Eligibility (Under 65)Medicare eligibility before age 65 — automatic after 24 months of SSDI, immediately for ALS, and based on dialysis/transplant for ESRD.
- How much does Medicare Part B cost?Most people pay the standard Part B premium (roughly $202.90/month in 2026). Higher-income retirees pay IRMAA on top. Lower-income retirees may qualify for help paying it.
- What is IRMAA and will I owe it?IRMAA is the income-based surcharge on Medicare Part B (and Part D). It kicks in above roughly $106,000 single / $212,000 joint MAGI, using your tax return from 2 years ago.
- Why did one extra dollar of income raise my Part B premium hundreds of dollars?IRMAA uses cliff thresholds, not gradual tiers. Crossing a bracket by even $1 jumps you to the next premium amount for the entire year.
- I'm turning 65. What should I do first?About 3 months before your 65th birthday, sign up for Medicare Parts A and B at SSA.gov. TRICARE For Life activates automatically once both are effective and DEERS is current.
- I just retired and my income dropped. Can I lower my IRMAA?Yes. File SSA Form SSA-44 and provide proof of a 'life-changing event' (retirement, work stoppage, divorce, death of spouse, loss of pension, employer settlement).
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Last reviewed January 2026 against the 2026 Medicare & You and TRICARE For Life handbooks.