One dollar over a Medicare line can cost a couple $2,296.80 a year.Here are all the lines.
Medicare premiums are set by your tax return from two years back, and the income lines are cliffs, not ramps: $1 over and the higher premium applies for the whole year, for each spouse. The printable one-pager has the full 2026 table (every line, Part B and Part D), the one-dollar math, and the SSA form that can get a surcharge removed when life changes. From Jim Swiech, CPA.
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Quick answers
- What is IRMAA?
- IRMAA is the Income-Related Monthly Adjustment Amount, a surcharge added to Medicare Part B and Part D premiums when your income crosses set lines. It is a cliff, not a slope. In 2026, being one dollar over a line can cost a married couple $2,296.80 more for the year than a couple one dollar under it.
- Which year's income does Medicare use for IRMAA?
- Your tax return from two years earlier. Your 2026 premium is based on your 2024 return. That is why a Roth conversion, a home sale or a large IRA withdrawal this year sets your Medicare premium two years from now, and why the timing of those moves matters as much as the amount.
- Can you appeal an IRMAA surcharge?
- Yes, if a life-changing event lowered your income since the tax year Medicare looked at. Retirement, a reduction in work hours, marriage, divorce or the death of a spouse all qualify. You file Form SSA-44 with Social Security and they reset the premium to your current income. Most people who qualify never file it.
Updated . Reviewed by Jim Swiech, CPA.
This one-pager is educational and general in nature, it is not tax, legal, or investment advice. Figures are official 2026 CMS amounts based on 2024 modified adjusted gross income; married-filing-separately uses different lines; outcomes depend on your specific facts. Go Beyond Tax is a brand of Swiech Consulting LLC.