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.