If you have heard the term IRMAA and wondered whether it applies to you, you are not alone. It is one of the most common surprises for people in Charlotte and across North Carolina who retire from higher-paying careers — banking, healthcare, engineering — and then open their first Medicare premium notice. Here is what IRMAA is, how it works in 2026, and what you can do if it does not reflect your real financial situation today.

What is IRMAA for Medicare?

IRMAA stands for Income-Related Monthly Adjustment Amount. It is not a separate tax or a penalty — it is an extra amount added on top of your regular Medicare Part B (medical insurance) and Part D (prescription drug) premiums when your income is above a certain level. Most people never pay it. Medicare eligibility itself has nothing to do with income; everyone who qualifies gets the same program. IRMAA only changes what higher-income enrollees pay for it. IRMAA is one reason Medicare is not truly free for everyone — our guide to whether Medicare is free breaks down the costs.

The Social Security Administration — not Medicare, and not your insurance company — decides whether you owe IRMAA. It looks at the modified adjusted gross income (MAGI) reported on your federal tax return and compares it to that year's thresholds.

The 2026 income thresholds

In 2026, IRMAA begins when your MAGI is above:

  • $109,000 for an individual tax filer
  • $218,000 for a married couple filing jointly

If your income is at or below those amounts, you pay the standard premiums — in 2026, the standard Part B premium is $202.90 per month — a figure we cover in our guide to the Medicare Part B premium — plus whatever your chosen Part D or Medicare Advantage plan charges.

For individual and joint filers in the first bracket above those thresholds, the 2026 Part B total is $284.10 per month for Part B and an additional $14.50 per month for Part D. The Part B total includes the $202.90 standard premium plus an $81.20 income-related surcharge; do not add $284.10 again. The Part D surcharge is added to the drug plan premium. Each eligible enrollee pays their own adjustment. Married people who lived together but file separately use a different bracket schedule.

The two-year lookback — the part that surprises people

Here is the detail that catches most new retirees off guard: Social Security generally uses your MAGI from two years prior. Your 2026 premiums are based on your 2024 tax return.

That means someone who retired from a Charlotte-area employer in 2025 could be living on a much smaller retirement income in 2026 — and still get an IRMAA bill, because Social Security is looking at their last full working year. The system is not wrong on purpose; it simply uses the most recent complete tax data the IRS has. A qualifying life-changing event or other correctable information may support a new determination; a reduction is not automatic.

How you find out, and how you pay

If IRMAA applies to you, Social Security mails you a letter explaining the determination, what income year it used, and what your adjusted premiums will be. You do not have to calculate anything yourself.

The Part B amount, including any IRMAA, is typically deducted from your Social Security benefit if you receive one, or billed to you directly if you do not. Our companion guide on how Medicare and Social Security work together explains that connection. The Part D IRMAA works the same way — importantly, it is paid to Medicare, not to your drug plan, so it shows up alongside your Part B amount rather than on your plan's bill. This is true whether you have a stand-alone Part D plan with Original Medicare or drug coverage built into a Medicare Advantage plan.

What if your income has dropped? You can ask for a new decision

Because of the two-year lookback, Social Security has a process for people whose income has fallen due to a life-changing event. Common qualifying events include:

  • Stopping work or reducing your hours (retirement is the big one)
  • Marriage, divorce, or the death of a spouse
  • Loss of income-producing property due to circumstances beyond your control (for example, a disaster or fraud), or loss of a pension

If one of these applies, you can ask Social Security to use your more recent, lower income instead of the two-year-old figure. You will need documentation — for example, proof of retirement and an estimate of your current income. Contact Social Security at ssa.gov, by phone at 1-800-772-1213, or at a local office to start the request. If you retired recently, it is worth checking whether you qualify — this request is one many people never think to file.

One important note: a one-time spike in income — say, selling an investment property in the Charlotte market, a large Roth conversion, or cashing out stock — generally does not count as a life-changing event. If your 2024 return was high because of a one-time gain, you may owe IRMAA for 2026 even though the event will not repeat. That is why income timing is worth discussing with your tax professional in the years before and after you turn 65.

Why IRMAA matters when you plan for Medicare

IRMAA changes the math of your total Medicare cost, but it should not drive your coverage choice by itself. A few things worth knowing:

  • IRMAA follows you, not your plan. The applicable Part B adjustment is based on income rather than choosing between Original Medicare with a Medicare Supplement, or a Medicare Advantage plan. Part D IRMAA applies when you have Part D drug coverage, including through an Advantage plan. Switching plan types does not by itself remove an income-related adjustment.
  • It is recalculated every year. A high-income year triggers it; a normal year later can remove it. It is not permanent the way the Part B late enrollment penalty is.
  • It applies per person. There is no couples rate — each spouse's Medicare stands on its own, based on the household's tax filing.

How The Jordan Insurance Agency helps

The Jordan Insurance Agency is an independent, full-time, licensed insurance agency in Charlotte, North Carolina, serving clients across the state. Because we are independent, we represent multiple carriers rather than one company's lineup, and we help explain current Medicare cost information. Social Security determines IRMAA; an agent’s carrier certification does not authorize the agent to change that determination.

When we sit down with someone approaching 65, IRMAA is part of the conversation — we help you understand whether the two-year lookback is likely to affect you, flag when a life-changing-event request to Social Security may be worth filing, and factor your true total cost (premiums plus any IRMAA) into comparing Medicare Advantage, Medicare Supplement, and Part D options. Then we review your coverage every year at renewal, because both your income situation and the plans themselves change. Our guidance costs you nothing extra — the carrier pays us, and your premium is the same whether you enroll on your own or with our help. If you are in Charlotte or anywhere in North Carolina and want a plain-English walkthrough of what Medicare will really cost you, reach out to The Jordan Insurance Agency.

IRMAA surcharges land on higher-income households, which comes up often in Charlotte’s more affluent suburbs. For one of them, a large-lot town with no hospital of its own, see our Medicare page for Weddington, NC.

Next step: Turning 65, or helping a parent sort out Medicare in Charlotte? The Jordan Insurance Agency is an independent, full-time agency that compares Medicare Advantage, Medicare Supplement, and Part D options across multiple carriers — at no cost to you. Get honest, plain-English guidance. For coverage details, explore our Medicare guidance and plan support.

Check CMS’s 2026 premium and IRMAA tables against your filing status and notice. For a qualifying income reduction, use Social Security’s IRMAA review guidance and the applicable evidence, including Form SSA-44 when appropriate. Follow the review instructions and deadlines on your notice; plan premiums and late-enrollment penalties are separate charges.