How IRMAA Quietly Increases Retirement Costs

Henry Supinski, ChFC® · 4 min read · April 2026

The Income-Related Monthly Adjustment Amount (IRMAA) is a Medicare surcharge that most high earners have never heard of — until they get the bill. Here's how it works and what you can do about it.

What Is IRMAA?

IRMAA increases your Medicare Part B and D premiums based on your income from two years prior. If your income exceeds certain thresholds, you pay more — significantly more at the top brackets. The surcharges can add $4,000–$10,000+ per year for a couple.

The Planning Problem

Because IRMAA is based on income from two years ago, a large Roth conversion, a business sale, or an unusual income event in one year can trigger IRMAA surcharges two years later — often as a complete surprise. Understanding this dynamic is essential to retirement income planning.