If you’re enrolled in Medicare and have a higher income, you may be required to pay more for your Part B and Part D coverage. This extra charge is called the Income-Related Monthly Adjustment Amount, or IRMAA.

IRMAA is not a separate program — it’s a surcharge added to your regular Medicare premiums if your income exceeds certain thresholds.

Who Has to Pay IRMAA?

You may owe IRMAA if your modified adjusted gross income (MAGI) from two years ago exceeds:

1. $106,000 for individuals
2. $212,000 for those filing jointly
3. $106,000 for those married but filing separately

These thresholds apply for the 2025 benefit year, based on your 2023 tax return.

How Is IRMAA Calculated?

The Social Security Administration (SSA) uses your MAGI from your IRS tax return to determine whether IRMAA applies. This figure includes income sources such as:

1. Wages and self-employment income
2. Dividends and interest
3. Capital gains
4. Taxable Social Security benefits

If your income crosses the threshold, IRMAA is added to both your Part B (medical insurance) and Part D (prescription drug plan) premiums. The surcharge is calculated on a sliding scale — the higher your income, the higher your IRMAA.

Does IRMAA Apply to Expats or Non-Citizens?

Yes. IRMAA applies to anyone who is enrolled in Medicare Part B or Part D, regardless of their location or citizenship status. This includes:

1. U.S. citizens living abroad
2. Lawful permanent residents (green card holders)

As long as you're enrolled in Medicare and your income exceeds the IRMAA thresholds, you may be required to pay the surcharge — even if you live outside the United States. However, Medicare generally does not cover medical services overseas, which is why many U.S. expats choose to delay enrollment until they return.

How Will You Know If IRMAA Applies to You?

When you first enroll in Medicare, you’ll pay the standard premium amount. The IRS then sends your income data to the SSA. If it shows you earn above the limit, Social Security will notify you in writing.

You’ll first receive a predetermination notice, which outlines how the decision was made and explains your appeal rights. If IRMAA is confirmed, you’ll then get an initial determination notice with the official surcharge amount for your Part B and D premiums.

Keep this document for your records, especially if you think there’s been an error or your circumstances have changed.

How Do You Pay the IRMAA?

If you already have your Medicare premiums deducted from your Social Security or Railroad Retirement Board benefit, IRMAA will be deducted automatically as well.

If you’re not receiving those benefits, you’ll receive a bill for both your regular premiums and the IRMAA surcharge.

Can You Appeal an IRMAA Decision?

Yes — if you believe your IRMAA determination is incorrect, or your financial situation has changed since the tax year used, you have the right to appeal.

There are two common options:

1. Request a Reconsideration – Call the SSA at 800-772-1213 or file a Request for Reconsideration if you believe the IRS data was outdated, incorrect, or your return was amended.
2. Report a Life-Changing Event – If your income dropped due to a major life event (such as retirement, divorce, or death of a spouse), submit Form SSA-44. You’ll need documentation to support your claim.

Common acceptable life-changing events include:

1. Retirement or reduction in work hours
2. Death or divorce from a spouse
3. Loss of pension income or income-generating property

Does IRMAA Adjust Automatically Each Year?

Yes. Each year, the SSA re-evaluates your IRMAA based on your most recent tax return provided by the IRS. If your income has dropped or you filed an amended return, it’s important to notify the SSA — they don’t automatically apply changes unless they have updated information.

Need Help?

For more information about IRMAA and Medicare premiums, visit Medicare.gov or call 800-MEDICARE (800-633-4227). If you need to speak with someone about your IRMAA status or file an appeal, contact the Social Security Administration at 800-772-1213.