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It can come as a shock to learn that you might have to pay higher premiums for your Medicare coverage, but it’s absolutely true. Higher earners may have to pay Medicare Income Related Monthly Adjustment Amounts (IRMAA). These additional premium amounts are designed to help pay for the program and allow lower-earning retirees to access coverage more affordably.
While it can be frustrating to learn about this, you should keep in mind that the income thresholds are fairly high. Most people do not have to pay these higher premium amounts. There are also exceptions for certain life-changing circumstances. Understanding how IRMAA works can help you make a plan for your Medicare coverage and cash flow in retirement.
What is Medicare IRMAA?
Medicare Income Related Monthly Adjustment Amounts can be assessed for two types of Medicare coverage:
The Social Security Administration (SSA) determines whether you’re subject to these extra premiums based on your income tax filings. Each year, SSA looks at your tax return from two years before. So, your 2024 Medicare Premiums are based on your 2022 tax filings that you filed in 2023.
The income used to determine your IRMAA status is known as Modified Adjusted Gross Income (MAGI). MAGI is equal to your Adjusted Gross Income (AGI) for the year, plus certain tax-exempt income, like tax-exempt interest.
The income thresholds used to determine IRMAA status are published in different tables by the Centers for Medicare and Medicaid Services (CMS) each year. You can use an IRMAA table to determine if you will be required to pay the extra premiums.
Since your IRMAA status is determined each year, it’s possible that you may stop paying IRMAA surcharges at some point in time, if your income declines. Or, if your income holds steady, but the thresholds increase (they are adjusted each year). The reverse is also possible; if your income increases at some point, you might become subject to the IRMAA premium adjustments.
Are Medicare IRMAA payments tax-deductible?
The Medicare Income Related Monthly Adjustment Amounts you pay may be deductible on your taxes. Generally, you’d have to itemize your deductions in order to deduct IRMAA charges. Additionally, your total medical expenses have to exceed certain thresholds in order to be deductible. To verify the tax status of your Medicare premiums, be sure to check with your tax advisor.
Medicare Income Related Monthly Adjustment Amount life-changing event
Many people become subject to IRMAA after retiring. This happens when you’re able to cash out unused vacation or sick pay, or when you receive severance packages. In other cases, stock options may vest upon your retirement. When this happens, it can be shocking because your IRMAA-adjusted premium may be a large percentage of your fixed income.
It is possible to appeal if you’re determined to be subject to IRMAA rates. You can file form SSA-44 to make an appeal. Your appeal will be granted if you meet the criteria for experiencing a life-changing event. The most common life-changing events are:
- Marriage, divorce, or death of a spouse;
- Retirement or reduction in hours worked;
- Loss of income production property;
- Employer settlement payment.
If you meet any of these criteria, you can file your appeal form and any required supporting documentation to avoid paying 2024 Medicare IRMAA premiums.
Medicare Part B IRMAA
CMS publishes IRMAA tables each year which show the income thresholds. See the IRMAA table below for the 2024 Part B premium. If your 2022 MAGI exceeds the income listed for your tax filing status, you’re likely subject to the additional premium amounts.
Part B premium table adjusted by IRMAA
| (if Single or Divorced): | (if Married & Filed Joint): | (if Married & Filed Separate): | Part B Premium |
| $103,000 or less | $206,000 or less | $103,000 or less | $174.70 |
| $103,001–$129,000 | $206,001 – $258,000 | —- | $244.60 |
| $129,001–$161,000 | $258,001 – $322,000 | — | $349.40 |
| $161,001–$193,000 | $322,001 – $386,000 | — | $454.20 |
| $193,001–$499,999 | $386,001 – $749,999 | $103,001–$396,999 | $559.00 |
| $500,000 or above | $750,000 or above | $397,000 or above | $594.00 |
Medicare IRMAA Part D
While many people are familiar with IRMAA for Part B, it can be a surprise to learn that these extra premium amounts are also assessed for Part D Plans. If you are enrolled in a Part D drug plan, and your income exceeds the amounts listed in the IRMAA table below, you will be responsible for an additional premium for your Part D coverage. Note that Part D IRMAA is separate from Part B IRMAA; you will pay both additional amounts for any year that your income exceeds the applicable thresholds.
Part D premium table adjusted by IRMAA
| (if Single or Divorced): | (if Married & Filed Joint): | (if Married & Filed Separate): | Part D Premium |
| $103,000 or less | $206,000 or less | $103,000 or less | your plan premium |
| $103,001–$129,000 | $206,001 – $258,000 | —- | $12.90 + your plan premium |
| $129,001–$161,000 | $258,001 – $322,000 | — | $33.30 + your plan premium |
| $161,001–$193,000 | $322,001 – $386,000 | — | $53.80 + your plan premium |
| $193,001–$499,999 | $386,001 – $749,999 | $103,001–$396,999 | $74.20 + your plan premium |
| $500,000 or above | $750,000 or above | $397,000 or above | $81.00 + your plan premium |
Note that there is no total premium column listed above since your total would depend on how much your Part D drug plan premium is if you have one. The above table only shows the additional premium payment.
Is Part D IRMAA paid directly to Medicare?
Your 2024 Medicare IRMAA payments are paid directly to Medicare, although they are collected by Social Security. If you’re already receiving Social Security retirement income, your IRMAA amounts, both Part B and Part D, are withheld from your monthly checks. If you’re not yet receiving Social Security Retirement benefits, you will receive a bill from Social Security for your Medicare premiums, including Part B and D IRMAA amounts.
Does IRMAA apply to Medicare Advantage plans?
If you’re subject to IRMAA rates, you will pay those amounts even if you enroll in a Medicare Advantage Plan, and even if that plan has a $0 monthly premium. In this case, as well, those additional premium amounts will be paid to Medicare through the Social Security Administration.
Medicare Income Related Monthly Adjustment Amounts can dramatically increase the premiums you pay for your coverage. Because they have such a large impact, it’s important to understand how they work. It can also be to your advantage to plan your income at or near retirement to reduce the likelihood of paying these amounts.
Article updated on October 16, 2023.
