Most higher-earning seniors know they have to pay taxes on their Social Security benefits. But they may not know that they could get hit with a special surcharge on their Medicare premiums—the Income-Related Monthly Adjustment Amount (IRMAA). Depending on your adjusted gross income (AGI), you may be subject to IRMAA whether you use traditional Medicare or a Medicare Advantage plan. If you go even $1 over the IRMAA income limits in any year, you may have to pay hundreds or even thousands of dollars in IRMAA.

IRMAA is based on your income from two years ago, so whether you face surcharges in 2024, for example, depends on your 2022 income. Over the last decade, the number of Medicare recipients owing IRMAA has doubled to 5.2 million.

What it means for you: In 2024, Medicare recipients will pay a standard premium of $174.70 per month for Part B (for doctors), as well as a premium for the Part D plan they select (for drug coverage). If you are single and your AGI is greater than $103,000 and less than or equal to $129,000 (for married couples, greater than $206,000 and less than or equal to $258,000), the Medicare premium rises to $244.60 per month per person and can go as high as $594 per month per person for those in the highest income bracket. For Medicare Part D, monthly IRMAA surcharges range from $12.90 to $81 per person above the cost of your drug-plan premium. You can find 2024 IRMAA brackets at

What to do…

Tap retirement accounts for maximum tax efficiency. Know when your income is approaching a level that triggers IRMAA surcharges. You may want to take tax-free withdrawals from a Roth IRA to meet expenses or look for stocks you can sell at a loss to offset taxable income for the year. Check with your accountant for the best strategies.

Appeal the surcharge. Medicare will reconsider an IRMAA surcharge if one of seven qualifying life-changing events has reduced your current income. Example: If you retired at age 65 and no longer have a salary, the government won’t make you pay more for Medicare based on your income at age 63 when you were still employed. Other common situations that may qualify you to avoid IRMAA: Death of a spouse, marriage, divorce, work reduction, loss of income from income-producing property and loss or reduction of certain pension income. To appeal an IRMAA surcharge: Go to, and download Form SSA-44.

Caveats: One-time surges in annual income, such as a Roth IRA conversion or taxable gains on the sale of a home, do not qualify for an appeal of an IRMAA surcharge. But if you have unusual circumstances—say you filed an amended tax return that lowered your annual income below IRMAA limits—visit a Social Security office to speak with a counselor about an appeal. And if you file a joint tax return with your spouse and you both are subject to IRMAA, you should file separate appeals.


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