Meet IRMAA. This is not a senior’s dating site, but every senior on Medicare should be intimately familiar with IRMAA — the initials that stand for “income-related monthly adjustment amount.”
It’s the amount by which your Medicare Part B and Part D premiums increase each year, based on your recent modified adjusted gross income (MAGI). The more you earn while on Medicare, the higher your monthly premiums for the insurance!
(Modified adjusted gross income is your adjusted gross income plus tax-exempt interest and dividends from municipal bonds. Your AGI is your total income from all sources minus certain adjustments such as student loan interest, alimony payments and retirement contributions.)
I used the term “recent” income, because there is a two-year look-back period for this income adjustment. So even if you’ve been retired for a year and your income has dropped, you’ll still pay the higher monthly premiums. Your 2025 IRMAA adjustment is based on the income shown in your 2023 tax return.
IRMAA brackets
Basically, if you earn above certain levels — there are five brackets — your monthly premiums for Medicare increase substantially. Nearly 5 million people, roughly 7% of Medicare beneficiaries, pay higher monthly Medicare premiums based on their adjusted gross income. Although Medicare is individual, if you file a joint return there is a separate IRMAA calculation.
In 2025, here are the income thresholds that will trigger IRMAA surcharges for Medicare beneficiaries:
Single tax filers: $106,000
Joint tax filers: $212,000
Married filing separately: $106,000
For Medicare beneficiaries whose income surpasses these benchmarks, total Monthly Part B premiums will range from $259.00 to $628.90.
IRMAA brackets for 2025 can be found here, or just by Googling “IRMAA brackets 2025.”
IRMAA and income spikes
If you’re about to retire or are already retired, you’ll want to be careful of one-time spikes in income that could affect your monthly Medicare premiums in two years. For example, if you do a Roth conversion of your IRA (or a series of annual conversions), that money is not only taxable in the year of the conversion, but it adds to the (MAGI) income considered for the IRMAA adjustment.
Your Roth conversion will give you years of tax-free future growth of your IRA, without annual minimum distribution requirements, but that benefit could be offset by significantly higher Medicare premiums starting in two years. On the other hand, taking the IRMAA penalty for one year means future tax-free Roth withdrawals won’t impact your MAGI in future years, which will help you avoid IRMAA!
Similarly, if you sell the family home that you’ve owned for many years, you’ll be able to exclude $250,000 of capital gains for each owner, or $500,000 if the property is held jointly. But if your home has an even higher gain, it will be subject to capital gains taxes — and the IRMAA adjustment.
Taking a lump sum payout of a pension benefit, which becomes taxable income, could also impact the IRMAA adjustment, at least temporarily. Those are all considerations that should go into your financial planning. Consult your tax adviser!
Appealing IRMAA
Once you’ve been subject to IRMAA, it’s entirely possible that in future years your Medicare B and D premiums will automatically be increased for IRMAA — until they catch up on your lower income years. However, if your income spike was a one-time thing, or if you have recently lost a substantial portion of your income, you can appeal the IRMAA adjustment.
Medicare defines the basic qualification for an IRMAA appeal as: “life-changing events include marriage, divorce, the death of a spouse, loss of income, and an employer settlement payment.”
There is a specific form (SSA-44) you can use to file an appeal, or you can call Social Security (which governs Medicare) at 800-772-1213. However, many find it helpful to get IRMAA appeal help from private consultants who specialize in these appeals.
One such consultant is www.IRMAA.com, where you can pay a small fee to use their professional services to help get your premiums lowered and get repayment of unjust past IRMAA deductions.
When you consider that your monthly Medicare premium could be higher by more than $500 a month — $6,000 per year — based on IRMAA, you’ll understand why it is so important to factor this adjustment into your financial planning decisions. And that’s The Savage Truth.
(Terry Savage is a registered investment adviser and the author of four best-selling books, including “The Savage Truth on Money.” Terry responds to questions on her blog at TerrySavage.com.)