By Matthew J. Renaud Sr., ChFC®, President and Founder, Renaud & Company Registered Investment Advisors, a fiduciary RIA in financial services since 1998. Tax preparation is available through Renaud Tax & Accounting LLC (Jeannie Renaud, CPA), a separate CPA firm in the same office. Information as of November 5, 2026.
Quick answer: IRMAA is an income-based surcharge on Medicare Part B and Part D premiums, set from your modified adjusted gross income (MAGI) two years earlier. For 2026, the first threshold is above $109,000 for single filers and $218,000 for joint filers (based on 2024 income), per Medicare.gov. As of November 5, 2026, CMS has not yet published the full official 2027 IRMAA table (it typically arrives mid-November); 2027 premiums will use 2025 income. You can sometimes reduce IRMAA by managing withdrawals, timing Roth conversions, using qualified charitable distributions, or filing Form SSA-44 after a life-changing event such as retirement. For O'Fallon and St. Charles County households approaching 65, the planning window is the two years before Medicare starts. See also our Medicare IRMAA reduction page.
How IRMAA works
- Two-year lookback. Your 2026 premium is based on your 2024 tax return. Your 2025 income sets your 2027 premium.
- MAGI, not just wages. It is adjusted gross income plus tax-exempt interest, so IRA withdrawals, Roth conversions, capital gains, and the taxable part of Social Security all count.
- Cliffs. Each bracket is a threshold. Crossing it by one dollar moves you into the next tier for the year.
In 2026 the standard Part B premium is $202.90 a month (Medicare.gov). The first IRMAA tier, above $109,000 (single) or $218,000 (joint), raises Part B to $284.10 and adds a Part D surcharge. Higher tiers go up from there.
What about 2027?
As of November 5, 2026, CMS has not published the full official 2027 Part B premium and IRMAA brackets. The Medicare & You 2027 handbook still points readers to the published income limits that apply for 2026 ($109,000 individual / $218,000 joint for Part D IRMAA). Watch Medicare.gov and CMS newsroom for the mid-November release. We will update this article when those official numbers are out. Do not rely on unofficial projections for planning decisions.
Five strategies to review
- Manage RMDs. Plan ahead for required distributions, which begin at age 73 or 75 depending on birth year.
- Time Roth conversions. Converting in a low-income year may reduce later RMDs, but a large conversion counts toward IRMAA two years later.
- Use qualified charitable distributions. At 70½ or older, a QCD from an IRA to a charity can satisfy an RMD without adding to taxable income (confirm the current annual limit for the year you give).
- Watch capital gains. Selling appreciated investments in one year can push MAGI over a line.
- Appeal after a life-changing event. Retirement, reduced work hours, marriage, divorce, the death of a spouse, or loss of income-producing property may qualify. File Form SSA-44 with Social Security at SSA.gov/medicare/lower-irmaa.
Be careful: SSA-44 requires a genuine reduction in income and is signed under penalty of perjury. A Roth conversion, business sale, or taxable inheritance is not a qualifying event.
Local note
Missouri also taxes conversions and IRA withdrawals, so one decision can affect your state return and your Medicare premium. A CPA, such as Jeannie Renaud, CPA, of the separate CPA firm Renaud Tax & Accounting LLC, can help keep the pieces consistent. For coordinated planning, start with our IRMAA reduction overview.
Frequently asked questions
What is the IRMAA income threshold for 2026?
For 2026, IRMAA applies when 2024 modified adjusted gross income is above $109,000 for single filers or $218,000 for married couples filing jointly (Medicare.gov).
Are the 2027 IRMAA brackets published yet?
Not the full official table as of November 5, 2026. CMS typically announces them mid-November. Confirm on Medicare.gov before you act.
Can I appeal an IRMAA surcharge?
Possibly. If a life-changing event such as retirement lowered your income, you can file Form SSA-44 with the Social Security Administration and ask it to use more recent income.
Does a Roth conversion affect IRMAA?
Yes. A conversion adds to your income in the year it happens, and IRMAA looks at income from two years earlier. Some people spread conversions across several years to stay below a threshold.
Which tax year does Medicare use?
Generally the return from two years earlier. Your 2024 return affects 2026 premiums, and your 2025 return affects 2027 premiums.
Questions about your own situation? Meet with Renaud & Company Registered Investment Advisors virtually from anywhere, or in person at 2112 Bryan Valley Commercial Drive, O'Fallon, MO 63366. Call (636) 240-5055 or email info@renaudco.com.
Educational purposes only. This article is general information, not individualized investment, tax, or legal advice. Rules and figures are as of November 5, 2026 and can change; confirm them on Medicare.gov or with SSA before acting. Renaud & Company, LLC is an SEC-registered investment adviser; registration does not imply a certain level of skill or training. Neither Renaud & Company, LLC nor its advisors provide tax or legal advice. Renaud Tax & Accounting LLC is a separate CPA firm with separate engagements and fees. Some of our advisors may earn commissions on certain insurance products; we explain how we are paid before you decide. Our Form ADV Part 2A and Form CRS are available at adviserinfo.sec.gov or on request. All investing involves risk, including loss of principal.