What Is IRMAA and How Can Columbus Retirees Avoid the Medicare Surcharge?

What Is IRMAA and How Can Columbus Retirees Avoid the Medicare Surcharge?

A guide to Medicare’s income-related premiums from a fee-only fiduciary in Columbus, Ohio.

Quick Answer

IRMAA stands for Income-Related Monthly Adjustment Amount. It’s a surcharge added to your Medicare Part B and Part D premiums when your income rises above set thresholds.

• How income is measured. Medicare uses your modified adjusted gross income (MAGI) from two years earlier, so your 2024 tax return sets your 2026 premiums.
• The 2026 thresholds. The surcharge starts above $109,000 for single filers and $218,000 for married couples filing jointly.
• The surcharge is avoidable for many people. Common ways to stay under a threshold include sizing Roth conversions carefully, using Qualified Charitable Distributions and timing capital gains.
• You can appeal. If your income dropped because of retirement or another life-changing event, you can ask Social Security to use a more recent year.

Key Takeaways

• The two-year lookback. IRMAA is based on income from two years earlier. Your 2026 income will set your 2028 premiums.
• The range of premiums. In 2026, the standard Part B premium is $202.90 a month. With IRMAA, it ranges from $284.10 to $689.90 per person, and Part D adds its own surcharge.
• Each tier is a cliff. Going $1 over a threshold applies the higher premium for the entire year.
• MAGI for IRMAA includes tax-exempt interest. That means municipal bond income counts.
• New retirees often qualify for a lower premium. Form SSA-44 lets you ask Social Security to use your lower post-retirement income.
• Couples and surviving spouses face different thresholds. A surviving spouse who moves to single filing status can be pushed into IRMAA even when income stays the same.

Table of Contents

1. What is IRMAA, and who pays it?
2. What are the 2026 IRMAA brackets?
3. How does the two-year lookback work?
4. What income counts toward IRMAA?
5. What commonly pushes Columbus retirees into IRMAA?
6. How can you reduce or avoid IRMAA?
7. Can you appeal an IRMAA determination?
8. How do I factor IRMAA into a retirement plan?
9. Frequently Asked Questions

What is IRMAA, and who pays it?

Most people on Medicare pay the standard Part B premium. If your income is above certain thresholds, Social Security adds an Income-Related Monthly Adjustment Amount to both your Part B premium and your Part D prescription drug premium. The surcharge applies even if you’re enrolled in a Medicare Advantage plan.

IRMAA is easy to miss for two reasons:

• It never appears on your tax return.
• It’s usually deducted straight from your Social Security deposit, so many retirees first notice it as a smaller check. I explain that mechanic in Why Medicare Premiums Reduce Social Security Checks.

For married couples, IRMAA applies per person. If both spouses are on Medicare, a household in the second tier pays the surcharge twice.

What are the 2026 IRMAA brackets?

Here are the 2026 figures, based on 2024 MAGI. Each premium is per person, per month.

Married couples who file separately face much narrower brackets that start immediately above $109,000. For most couples, filing separately to avoid IRMAA backfires.

The thresholds are indexed to inflation. CMS typically announces the next year’s premiums and brackets in the fall, so the 2027 figures should be released soon. All figures here are illustrative and may change.

How does the two-year lookback work?

Social Security uses the most recent tax return the IRS gives it, which is usually from two years before the premium year:

• 2026 premiums are based on 2024 income.
• 2027 premiums will be based on 2025 income.
• 2028 premiums will be based on 2026 income.

This timing matters most in two situations:

• The years right around retirement. Your final working year, often your highest-earning year, can set your Medicare premiums two years later. That’s true even after your paycheck has stopped.
• Planning moves you make this year. Roth conversions, large IRA withdrawals and capital gains realized in 2026 affect premiums in 2028, not now.

If you’re approaching 65, my guide to when to enroll in Medicare covers the enrollment timeline that runs alongside this.

What income counts toward IRMAA?

For IRMAA, MAGI is your adjusted gross income plus any tax-exempt interest. In practice, that includes:

• Pension income, including OPERS and STRS benefits.
• Wages and self-employment income.
• Traditional IRA, 401(k), 403(b) and 457 withdrawals, including required minimum distributions.
• Roth conversions.
• The taxable portion of Social Security.
• Interest, dividends and capital gains, including gains distributed by mutual funds.
• Tax-exempt municipal bond interest.
• Taxable gain from selling a home above the $250,000 or $500,000 exclusion.

What generally does not count:

• Qualified Roth IRA withdrawals.
• HSA withdrawals for qualified medical expenses.
• Return of principal from a taxable account.
• Qualified Charitable Distributions, which are excluded from income.

What commonly pushes Columbus retirees into IRMAA?

In my work with retirees around Upper Arlington, Dublin, Worthington and Westerville, these are the most common triggers:

• The final working year. A last full salary, a bonus and a sick-leave or vacation payout can all land in the same year.
• Roth conversions that weren’t sized for IRMAA. A conversion can make good sense for income tax but cross an IRMAA threshold by a few thousand dollars.
• Selling a long-held home or rental property. Gains above the home-sale exclusion can create a one-time spike.
• Required minimum distributions. Larger pre-tax balances can push RMDs, and with them MAGI, steadily upward. See How Do RMDs Affect Your Taxes in Retirement?
• Pension plus Social Security plus a working spouse. For OPERS and STRS households, a solid pension combined with other income can sit close to the first threshold. I cover how those pensions are taxed in How Are OPERS and STRS Pensions Taxed in Ohio?

How can you reduce or avoid IRMAA?

IRMAA is one of the few retirement costs you can influence directly. The approaches I use most often:

1. Size Roth conversions to the threshold. Instead of converting a round number, I calculate how much room remains below the next IRMAA tier. Sometimes crossing a tier is worth it for the long-term tax savings. When it is, I want that to be a deliberate decision, not a surprise. My posts on when Ohio retirees should consider a Roth conversion and whether to do Roth conversions in retirement explain the trade-offs.
2. Give through Qualified Charitable Distributions. If you’re 70½ or older and charitably inclined, a QCD can satisfy part or all of your RMD without adding to MAGI.
3. Manage capital gains. Harvesting losses, spreading large sales across tax years and choosing tax-efficient funds can keep gains from stacking on top of other income. See How Are Capital Gains Taxed in Retirement?
4. Coordinate which accounts you draw from. Blending pre-tax, Roth and taxable withdrawals lets you control MAGI year by year. My post on building a tax-efficient withdrawal strategy walks through the approach.
5. Use your HSA for medical costs. Qualified HSA withdrawals don’t count toward MAGI. See How Do HSAs Work in Retirement?
6. Plan ahead for the surviving spouse. When one spouse passes away, the survivor generally files as single starting the year after the death. That can mean similar income measured against roughly half the threshold. Doing Roth conversions while both spouses are living can reduce that future exposure.

Can you appeal an IRMAA determination?

Yes. If your income dropped because of a qualifying life-changing event, you can file Form SSA-44 with Social Security and ask it to use a more recent year’s income. Qualifying events include:

• Work stoppage or work reduction, which covers retirement.
• Marriage, divorce or annulment.
• Death of a spouse.
• Loss of income-producing property.
• Loss or reduction of certain pension income.
• An employer settlement payment.

A Roth conversion, an IRA withdrawal or a capital gain doesn’t qualify. Those are treated as voluntary income choices.

For many Columbus-area retirees leaving OSU, the State of Ohio or a school district, “work stoppage” is the most common reason to file. I help clients gather the documentation, but you’re the one who files the form with Social Security.

How do I factor IRMAA into a retirement plan?

I treat IRMAA as one input in a client’s full tax picture, not a standalone rule:

• Review the actual tax return. I use Holistiplan to review the return line by line and find how close a household sits to each threshold. See how a Holistiplan tax summary improves financial planning.
• Project future years. In eMoney, I project income several years forward so Roth conversions, RMDs and gains can be planned two years ahead of the premiums they affect.
• Revisit at year-end. I check IRMAA on the year-end review list in What Should Columbus Retirees and Pre-Retirees Do Before December 31?

For broader context, see my guides to planning for healthcare in retirement in Ohio and planning a tax-efficient retirement in Ohio.

As a fee-only fiduciary, I’m not compensated for recommending a conversion, an annuity or any product. My role is to help you see the trade-offs clearly and choose deliberately.

Frequently Asked Questions

What does IRMAA stand for?
Income-Related Monthly Adjustment Amount. It’s a surcharge added to Medicare Part B and Part D premiums for beneficiaries whose income is above set thresholds.

What is the IRMAA threshold for 2026?
In 2026, IRMAA begins when 2024 MAGI is above $109,000 for single filers or above $218,000 for married couples filing jointly.

Does a Roth conversion count toward IRMAA?
Yes. The converted amount is added to your MAGI for that year and can affect your Medicare premiums two years later.

Do Roth IRA withdrawals count toward IRMAA?
Generally no. Qualified Roth IRA withdrawals aren’t included in MAGI.

Can I appeal IRMAA after I retire?
Often, yes. Retirement counts as a “work stoppage,” which is a qualifying life-changing event. You can file Form SSA-44 to ask Social Security to use your lower, current-year income estimate.

Is IRMAA permanent?
No. Social Security redetermines IRMAA each year based on your most recent tax return, so the surcharge can rise, fall or disappear as your income changes.

Does Ohio have its own version of IRMAA?
No. IRMAA is a federal Medicare rule. Ohio’s flat state income tax affects your overall tax bill but plays no part in how Medicare premiums are calculated.

Let’s Look at Your Medicare Costs Together

If you’re approaching Medicare or already retired in Columbus, Upper Arlington or anywhere in Central Ohio, I can help you see how close you are to each IRMAA threshold. I can also help you plan Roth conversions, RMDs and withdrawals with those thresholds in view. I’m a fee-only CFP® professional, and you’ll work directly with me. [Schedule a complimentary introductory call here.]([Calendly link])

James E. Blue II, CFP®, Blue Advisors, Upper Arlington, Ohio

Disclosure: This article is for educational and informational purposes only and should not be considered individualized investment, tax or legal advice. Figures cited are 2026 Medicare amounts published by CMS, are illustrative, and are subject to change; 2027 amounts had not been released at the time of writing. Tax and Medicare outcomes depend on your individual circumstances; please consult a qualified tax professional before acting. Blue Advisory LLC d/b/a Blue Advisors is a registered investment adviser. Registration does not imply a certain level of skill or training. Past performance is not indicative of future results.