Search
Medicare

IRMAA Explained: Why Your Medicare Premium Is Higher Than Your Neighbor's — and How to Appeal

Papers and envelopes spread on a wooden table, with a sticky note reading “2024 return?”.
Photo by Annie Spratt on Unsplash

Most people on Medicare pay $202.90 a month for Part B in 2026. At the top of the income scale, it's $689.90, for the same card and the same coverage. The difference is set by a tax return that's usually two years old. So someone who retired last year can be billed as if the paycheck never stopped. There's a form to ask for a new decision, but it accepts only a short list of reasons.

See which life changes let you appeal

Continues on the next page · opens in a new tab

By Margaret Linwood · Updated Sep 29, 2026 · Reviewed against SSA, CMS, IRS

Also worth reading

An hourglass against a textured gray wall, with a sticky note reading “For life?”. Medicare COBRA does not count as employer coverage when you turn 65 A blank sheet on a black clipboard with a yellow pencil on a wooden desk, with a sticky note reading “7 checks?”. Medicare Your Medicare plan can change January 1. Seven checks, in order

The surcharge runs on more than wages. IRA and 401(k) withdrawals, Roth conversions, capital gains and the taxable part of your Social Security all count toward the income figure it uses. The brackets work like cliffs, too: one dollar over a line and you owe that tier's whole charge, and each spouse on Medicare pays it separately.

The letter usually shows up late in the year. Plenty of people who retired the year before qualify for a new decision and never ask. A one-time sale is a different story, though. Social Security won't lower the surcharge just because the income was a one-off.

See how to plan income two years out

Continues on the next page · opens in a new tab

Questions to bring to a tax pro before your next return

The return you file for 2026 sets the Part B and Part D premiums you'll pay in 2028. These are the questions people tend to bring to a CPA or an advisor who does retirement tax planning.

  1. How big a Roth conversion? Converting $80,000 in one year might push you over a threshold. Doing $40,000 in each of two years might not, depending on where your other income sits.
  2. When to sell. A home, a rental or a block of stock can sometimes be sold before Medicare starts. With a two-year lookback, income at 63 can show up in your premium at 65.
  3. Which account to draw from. Traditional IRA and 401(k) withdrawals count toward the income figure. Qualified Roth withdrawals don't, and mixing the two can keep you under a threshold.
  4. Giving to charity. After age 70½, a qualified charitable distribution sends IRA money straight to a charity and keeps it out of your adjusted gross income.
  5. How the advisor gets paid. Ask that, and ask whether their tax projections include Medicare premiums.

None of these is right for everyone, and all of them shape future returns. For a premium that's already set, the article covers the life changes that let you ask for a new decision, and how to file.

Walk through Form SSA-44 step by step

Continues on the next page · opens in a new tab

Also on this topic

A stack of U.S. quarters on a white surface, with a sticky note reading “$202.90 a month?”. Medicare Your state may pay your Part B premium. Check one income line An empty hospital bed under a wall of medical equipment, with a sticky note reading “Admitted?”. Medicare Your parent was "under observation," not admitted. That changes who pays rehab Two people in silhouette sitting under a tree at sunset, with a sticky note reading “25% if missed”. Retirement Your first IRA withdrawal deadline is April 1, and it has a catch A pen and a teal calculator on a white desk, with a sticky note reading “Under $75,000?”. Taxes Your Social Security is still taxable. The new $6,000 deduction explains why A blank sheet of paper and a pen on a kitchen counter, with a sticky note reading “$75?”. Medicare Your 2027 raise is 3.6%. See what Part B leaves A red envelope on a yellow background, with a sticky note reading “Plan G +26%?”. Medicare Your Plan G premium jumped again. Check your state's switching window

Up next on this topic

Picked to go with this article. Each one opens in a new tab.

A dirt path splitting in two through a green forest, with a sticky note reading “Hard to undo?”. Medicare You can leave Medigap any fall. Coming back is a different story A desk calendar showing December 30 and 31 with an orange highlighter, with a sticky note reading “Ends Dec. 31?”. Medicare If your Medicare Advantage plan ends, you get a 63-day Medigap right A stethoscope, a reflex hammer and a blood pressure cuff on a white surface, with a sticky note reading “$63,840?”. Insurance Your 2027 subsidy stops at $63,840. Here's how the line is drawn Letter tiles spelling MORTGAGE on a wooden table, with a sticky note reading “+$325?”. Home & Mortgage Your fixed-rate payment has two parts that are not fixed at all An orange rotary phone on a wooden table, with a sticky note reading “Code word?”. Debt & Credit The one question to ask when a grandchild calls needing money Two steaming mugs on a small wooden table, with a sticky note reading “Covered at 62?”. Insurance Your spouse goes on Medicare. You're 62. Where your coverage comes from Two hands holding a blank white card over a dark wooden table, with a sticky note reading “65 days”. Medicare Your plan said no. Most appeals filed were at least partly reversed A hand signing a paper with a pen, with a sticky note reading “Bills: $6,300”. Insurance The adjuster wants to record your call. What you can say Colorful pills spilling from an orange prescription bottle on a blue background, with a sticky note reading “+$300?”. Medicare Your Part D deductible can reach $700 in January. Check this line A white house and fir trees covered in snow, with a sticky note reading “Heat bill up?”. Home & Mortgage This winter's heating bill forecast: gas down 9%, oil up 21% Rows of electric meters on a wall, with a sticky note reading “Same usage?”. Home & Mortgage Divide your electric bill by the kilowatt-hours. Compare it with last year A white house with a front porch among autumn trees, with a sticky note reading “No claims?”. Insurance Your home insurance rose with no claims. Check these four lines.