Medicare IRMAA: How High Earners Pay More for Medicare and How to Appeal

The Income-Related Monthly Adjustment Amount (IRMAA) is a Medicare surcharge applied to beneficiaries whose income exceeds certain thresholds. Introduced in 2007 for Part B and 2011 for Part D, IRMAA uses your Modified Adjusted Gross Income (MAGI) from two years prior to determine your current year surcharge. This means your 2024 Medicare premiums are based on your 2022 tax return. About 7% of Medicare beneficiaries pay IRMAA, but the surcharges can be substantial — adding up to $419.30/month to Part B and $81.00/month to Part D in 2024. Understanding the brackets and your options is essential for retirement income planning.

2024 IRMAA Brackets (Part B)

• Standard: ≤$103,000 individual / ≤$206,000 joint

  Standard Part B premium: $174.70/month. No IRMAA surcharge. This covers approximately 93% of all Medicare beneficiaries.

• Tier 1: $103,001–$129,000 / $206,001–$258,000

  Total Part B premium: $244.60/month (+$69.90 surcharge). Part D IRMAA: +$12.90/month.

• Tier 2: $129,001–$161,000 / $258,001–$322,000

  Total Part B premium: $349.40/month (+$174.70 surcharge). Part D IRMAA: +$33.30/month.

• Tier 3: $161,001–$193,000 / $322,001–$386,000

  Total Part B premium: $454.20/month (+$279.50 surcharge). Part D IRMAA: +$53.80/month.

• Tier 4: $193,001–$500,000 / $386,001–$750,000

  Total Part B premium: $559.00/month (+$384.30 surcharge). Part D IRMAA: +$74.20/month. At the highest tier (>$500K individual), premium reaches $594.00/month.

Because IRMAA uses income from two years ago, it can create an unfair surcharge if your income dropped significantly — due to retirement, job loss, divorce, death of a spouse, or a reduction in work hours. SSA Form SSA-44 (Medicare Income-Related Monthly Adjustment Amount — Life-Changing Event) allows you to request a reduction using more recent income. Qualifying events include marriage, divorce or annulment, death of a spouse, loss of income-producing property, loss of pension income, and employer settlement payments. File the form at your local Social Security office or online.

For retirement income planning, be aware that Roth conversions, sale of property, and required minimum distributions (RMDs) from traditional IRAs all count toward MAGI for IRMAA purposes. Working with a financial planner to manage income in the years before Medicare enrollment can prevent unexpected surcharges. Qualified Opportunity Zone investments and strategic charitable contributions through Qualified Charitable Distributions (QCDs) from IRAs are two tools that can reduce MAGI without reducing actual wealth.