Family Wealth blog

Meet IRMAA from Medicare

A manicured hand grabs a handful of bills from a stack of cash with a stethoscope on it. The title reads: Meet IRMAA from Medicare

When it comes to Medicare, one term you might not be familiar with is IRMAA, or Income-Related Monthly Adjustment Amount. While it might sound complex, it’s a crucial concept that can significantly impact healthcare costs for those enrolled in Medicare.

Understanding IRMAA and its impact on your Medicare costs is a crucial aspect of retirement planning and managing your healthcare expenses in your senior years. By being aware of how your income affects your IRMAA surcharges, you can make informed decisions about your retirement income strategy, potentially reduce your Medicare expenses, and ensure that you are financially prepared for healthcare costs during your retirement years.

Who or What is IRMAA?

IRMAA is a surcharge added to your Medicare Part B and Part D premiums if your income exceeds a certain threshold.1 It’s a way for the government to collect additional funds from higher-income Medicare beneficiaries to help support the Medicare program.

IRMAA primarily affects Medicare Part B (which covers doctor visits, outpatient services, and medical equipment) and Medicare Part D (which covers prescription drugs) premiums and Medicare Advantage plans (which is typically a grouping of B and D, offered by private companies). The Social Security Administration (SSA) determines your IRMAA based on your modified adjusted gross income (MAGI) from two years prior. For example, this means that your IRMAA for 2023 (if any) would be based on your income from 2021.

Increased Healthcare Costs

IRMAA isn’t just an additional fee; it’s a potential game-changer for your healthcare expenses during retirement. If you fall into a higher income bracket, you will pay a surcharge on top of your standard Medicare premiums. In fact, you could be looking at hundreds or even thousands of dollars added to your annual Medicare costs.

IRMAA’s Sliding Scale

Unlike a flat fee, IRMAA operates on a sliding scale based on your income. The more you earn, the higher your IRMAA surcharge. But even if you’re already retired, your MAGI (Modified Adjusted Gross Income) is what IRMAA cares about, and it’s a lot:

IRA Withdrawals: IRAs allow individuals to save for retirement with traditional IRAs being taxed upon withdrawal and Roth IRAs offering generally tax-free withdrawals; retirees with traditional IRAs must start RMDs at age 73.

Capital Gains: Retirees may incur capital gains from selling assets, with short-term gains taxed as regular income and long-term gains potentially benefiting from lower tax rates.

Dividends: Corporations distribute dividends to shareholders from profits, which can be taxed as qualified (at long-term capital gains rates) or non-qualified (at standard income rates).

Interest from CDs: Retirees often use Certificates of Deposit (CDs) for a fixed interest rate over a determined period, and the interest is taxable as ordinary income.

Taxable Portion of Social Security: Not all Social Security benefits are taxable, but depending on a retiree’s combined income, up to 85% of these benefits might be subject to tax.

Real Estate Sales: These can have a big impact as well.

As you can see, when you factor in all the sources of income that MAGI includes—and IRMAA bases its calculations on—this tiered system can have a substantial impact on your retirement budget.

IRMAA’s Role in Retirement Planning

Understanding IRMAA is crucial for accurate retirement planning. It’s not just about estimating your living costs; it’s about factoring in these potential surcharges to get a realistic picture of your healthcare expenses—and how they might affect your plans for travel and the other more pleasant aspects of retirement.

IRMAA and Tax Planning

Since IRMAA is based on your Modified Adjusted Gross Income (MAGI), it’s intertwined with your tax planning. Strategies like Roth conversions or managing your retirement account withdrawals can help reduce your MAGI, potentially lowering your IRMAA.

IRMAA is Annual

IRMAA isn’t set in stone. It’s assessed annually, meaning your total Medicare premiums can fluctuate from year to year based on your income. Being aware of these potential changes can help you make informed decisions during every Medicare Open Enrollment Period.

This is Appealing

Sometimes, the amount you're asked to pay for IRMAA doesn't seem right. After all, the amount is based on information from two years ago. Any so-called “Life-Changing” events can form the basis of an appeal.2 Here’s the list:  

• Marriage

• Divorce/Annulment

• Death of a Spouse

• Work Stoppage or Reduction

• Loss of Income-Producing Property

• Loss of Pension Income

• Employer Settlement Payment

If anything on this list pertains to you, then you can fill out and submit the Life-Changing Event form and then set up an appointment with the Social Security office.

An alternative would be to write and send in a formal appeal.

If you're still not happy with the outcome of your appeal, you can ask for more checks on the decision. This could even lead to a hearing with a judge from OMHA, the Office of Medicare Hearings and Appeals. If you go this route, don't delay, as there are strict timelines involved. As you might expect, the whole IRMAA process can be tricky, especially when it involves appeals. It's smart to get some legal and financial advice and keep all related paperwork handy.

The Takeaway

Navigating the financial landscape of retirement can be complex, but understanding the intricacies of Medicare and IRMAA is a crucial step. IRMAA, while lesser-known, has a significant impact on your healthcare costs during retirement. It's not just an additional fee; it's a variable cost that can fluctuate based on your income and tax planning strategies.

By understanding how IRMAA works and its connection to your MAGI, you can better strategize for retirement, manage your tax obligations, and prepare for potential changes in your Medicare premiums. We’ve only touched the tip of the iceberg with IRMAA here, without going into any detail on Medicare Part B and Part D that it affects. As with all things financial and tax-related, it’s best to consult with your financial advisor and tax professional about your particular situation.




Understanding IRMAA and Why it Really Matters: For those in Medicare, IRMAA can have a big impact on healthcare costs Copyright © 2023 FMeX. All rights reserved. Distributed by Financial Media Exchange.

Disclosure: This information is for educational and informative purposes and shall not be considered a specific recommendation. Readers are advised to speak with their advisor at JL Bainbridge to determine their specific recommendations that meet their investment objectives and to review their portfolios. The material being provided is thought to be accurate. However, the information is compiled from multiple resources and may become outdated or otherwise rendered incorrect by new research or corrections without notice. J.L. Bainbridge & Co., Inc., is not a broker dealer and does not offer tax or legal advice. Please consult your tax or legal advisor for assistance regarding your individual situation. It should neither be assumed that future results will be as profitable or that a loss could not be incurred. For more information related to our firm, please see our disclosure brochures at and

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