Medicare IRMAA Rules & Flowchart

Last Reviewed: August 2026

Will You Avoid IRMAA Surcharges on Medicare Part B and Part D?

Higher-income retirees may pay more for Medicare Part B and Part D through the Income-Related Monthly Adjustment Amount (IRMAA). These surcharges are based on your modified adjusted gross income from two years earlier and can significantly increase your healthcare costs. Understanding the IRMAA rules before making major financial decisions can help you reduce or avoid these additional premiums.

This flowchart helps you determine whether you may be subject to IRMAA surcharges. It walks through the most common income thresholds and planning considerations that affect your Medicare premiums.

How to Use This Flowchart

Start at the top of the flowchart and answer each question based on your current financial situation. Follow the arrows until you reach a recommendation.

The flowchart reviews your modified adjusted gross income, filing status, and expected sources of taxable income. It also considers whether recent Roth conversions, capital gains, retirement account distributions, or other one-time income events could increase your Medicare premiums.

As you work through the flowchart, remember that IRMAA is calculated using your tax return from two years earlier. Decisions you make today may not affect your premiums until a future year. Planning ahead often creates more opportunities to manage your income and avoid higher Medicare costs.

Use this flowchart as an educational guide. Medicare premium thresholds are updated periodically, so review the current IRMAA limits before making major tax or retirement decisions.

Why This Decision Matters

IRMAA surcharges can add thousands of dollars to your Medicare costs over time. Many retirees trigger these higher premiums without realizing it, especially after completing large Roth conversions, selling appreciated investments, or taking sizable retirement account withdrawals.

Fortunately, careful tax planning may help reduce or avoid these surcharges. Spreading taxable income across multiple years, managing retirement withdrawals, and coordinating investment sales may help keep your income below important IRMAA thresholds.

Reviewing your income before the end of each year can help you avoid unexpected Medicare premium increases. A proactive tax strategy often reduces both your lifetime taxes and your long-term healthcare costs.