Medicare · 9 min read
The IRMAA Cliff: One Dollar Over $218,000 Can Add About $2,300 a Year to a Couple’s Medicare Premiums
The IRMAA cliff is the all-or-nothing edge of each Medicare surcharge tier. In 2026, joint MAGI of $218,000 keeps standard premiums; $218,001 adds $81.20 a month on Part B and $14.50 on Part D for each spouse. ($81.20 + $14.50) × 12 × 2 = $2,296.80, about $2,300 a year, set by the 2024 return.
Most of the tax system charges a little more for each added dollar. Medicare’s income-related monthly adjustment amount, IRMAA, charges nothing until income passes a threshold and then charges the full tier. The first of those thresholds, $218,000 of joint income in 2026, is where many retired couples meet it, often through a Roth conversion, a property sale or a year of large required distributions. Because the income is measured two years before the premium is billed, the cost can arrive long after the decision that caused it. We refer to each threshold as an IRMAA cliff.
What follows is educational. IRMAA determinations are made by the Social Security Administration from IRS data; how they apply to a specific household should be reviewed with a tax professional.
Chart
2026 Medicare Part B premium by joint income
Monthly premium per person for married couples filing jointly, by modified adjusted gross income from two years earlier. Part B only; Part D surcharges are separate.
Source: CMS · 2026 Medicare Parts A & B premiums and deductibles fact sheet · joint-return brackets
View the data
| Joint income (MAGI) | Monthly Part B premium | Surcharge (IRMAA) |
|---|---|---|
| Up to $218,000 | $202.90 | $0.00 |
| $218,001–$274,000 | $284.10 | $81.20 |
| $274,001–$342,000 | $405.80 | $202.90 |
| $342,001–$410,000 | $527.50 | $324.60 |
| $410,001–$749,999 | $649.20 | $446.30 |
| $750,000 and up | $689.90 | $487.00 |
What the Cliff Question Is Really Asking
A household asking about the IRMAA cliff usually wants to know how much more income it can recognize before Medicare costs more, and what crossing the line would cost if it did. Answering takes four facts: which year’s income is measured, what counts as income, where the thresholds sit, and how many people in the household are enrolled. The charge applies to each enrolled person, so a married couple pays it twice.
The Arithmetic at $218,000
The standard 2026 Part B premium is $202.90 a month. A married couple filing jointly pays that rate while modified adjusted gross income (MAGI) is at or below $218,000. Above it, each enrolled spouse pays the first-tier amounts: (CMS, 2026 Medicare Parts A & B premiums and deductibles fact sheet)
| Per person, per month | MAGI $218,000 | MAGI $218,001 | Change |
|---|---|---|---|
| Part B premium | $202.90 | $284.10 | +$81.20 |
| Part D income-related adjustment | $0.00 | $14.50 | +$14.50 |
| Total added | +$95.70 |
For a couple with both spouses enrolled in Part B and Part D coverage:
$81.20 + $14.50 = $95.70 a month per person
$95.70 × 12 months = $1,148.40 a year per person
$1,148.40 × 2 spouses = $2,296.80 a year, about $2,300
The Part D amount is added to whatever the drug plan charges, so it applies whichever plan the couple chooses. If only one spouse is enrolled, the added cost is $1,148.40. And nothing is prorated: at $218,001 the full amount applies for all twelve months.
At $218,000 of joint MAGI, a couple pays standard premiums. At $218,001, it pays $2,296.80 more for the year. The first dollar over the line costs as much as the last dollar in the tier.
All Five Cliffs in 2026
The same structure repeats at four more thresholds. The last two columns are our arithmetic from the CMS figures, for a couple with both spouses enrolled in Parts B and D. (CMS 2026 fact sheet)
| MAGI, single | MAGI, joint | Part B per month | Part D adjustment per month | Couple’s annual surcharge | Added cost of crossing into this tier |
|---|---|---|---|---|---|
| $109,000 or less | $218,000 or less | $202.90 | $0.00 | $0 | — |
| Above $109,000 to $137,000 | Above $218,000 to $274,000 | $284.10 | $14.50 | $2,296.80 | $2,296.80 |
| Above $137,000 to $171,000 | Above $274,000 to $342,000 | $405.80 | $37.50 | $5,769.60 | $3,472.80 |
| Above $171,000 to $205,000 | Above $342,000 to $410,000 | $527.50 | $60.40 | $9,240.00 | $3,470.40 |
| Above $205,000, under $500,000 | Above $410,000, under $750,000 | $649.20 | $83.30 | $12,710.40 | $3,470.40 |
| $500,000 or more | $750,000 or more | $689.90 | $91.00 | $13,872.00 | $1,161.60 |
Two features stand out. The first cliff is not the largest: each of the next three adds about $3,470 for a couple. And the surcharge tiers are wide: the first three span $56,000 to $68,000 of joint income each, which matters for planning, as the example below shows.
Which Income, and From Which Year
The year. Social Security uses MAGI from the tax year two years before the premium year, so 2026 premiums generally reflect 2024 returns. If the IRS has not yet supplied that year, the agency uses the return from three years before and corrects the figure once the later year is available. (20 CFR §418.1135) A person first enrolling at 65 is therefore measured on income from about age 63.
The measure. For IRMAA, MAGI is adjusted gross income plus tax-exempt interest and a short list of excluded foreign and territorial income. (20 CFR §418.1010) Municipal bond interest, untaxed on the return, still counts here. Qualified Roth IRA withdrawals and qualified charitable distributions are not part of adjusted gross income and do not.
The items that most often carry a couple across $218,000 are one-time or mechanical:
- Roth conversions, which add every converted dollar to income in the conversion year.
- Capital gains from selling a home above the exclusion, a rental property, a business or a concentrated stock position. Long-term gains taxed at preferential rates still count in full toward MAGI.
- Required minimum distributions, which rise with account balances and age whether or not the money is needed.
- A final year of salary or a severance payment in the year a spouse retires.
A Hypothetical Couple, Worked Through
This illustration is hypothetical and simplified. It is not based on any client, and it uses 2026 thresholds and premiums to stand in for later years, which have not been published. It is not a recommendation.
A married couple, both 66, file jointly and are enrolled in Parts B and D. Their projected 2026 income before any conversion:
| Source | Amount |
|---|---|
| Pensions | $60,000 |
| Taxable Social Security (85% of $64,000) | $54,400 |
| Traditional IRA withdrawals | $40,000 |
| Taxable interest and dividends | $12,000 |
| Adjusted gross income | $166,400 |
| Tax-exempt municipal interest | $5,000 |
| MAGI for IRMAA | $171,400 |
They are weighing a Roth conversion this year. Under the two-year look-back, 2026 income will set their 2028 premiums. The distance to the first cliff is $218,000 − $171,400 = $46,600.
| 2026 conversion | MAGI | Position | Couple’s surcharge (2026 rates) | Surcharge per dollar above $218,000 |
|---|---|---|---|---|
| $40,000 | $211,400 | $6,600 below the cliff | $0 | — |
| $46,600 | $218,000 | Exactly at the cliff | $0 | — |
| $55,000 | $226,400 | $8,400 over | $2,296.80 | $2,296.80 ÷ $8,400 ≈ 27 cents |
| $102,600 | $274,000 | Top of the first tier | $2,296.80 | $2,296.80 ÷ $56,000 ≈ 4 cents |
| $102,601 | $274,001 | Second tier | $5,769.60 | — |
Three conclusions follow, before any income tax on the conversion, which is a separate calculation.
- A narrow miss is the expensive outcome. Converting $55,000 instead of $46,600 buys $8,400 more of conversion for $2,296.80 in premiums, about 27 cents per dollar on top of income tax.
- Converting to the edge leaves no margin. Year-end fund distributions, an unplanned sale or a larger dividend can add a few thousand dollars after the conversion is done. The $40,000 option keeps a $6,600 cushion.
- Once over, the tier is wide. Converting $102,600 costs the same surcharge as $55,000, so the per-dollar premium cost falls to about 4 cents. If a couple crosses a cliff deliberately, the width of the tier is part of the decision.
How We Approach This in a Plan
We treat each IRMAA threshold as one line on a household’s income map, alongside the tax brackets and the Social Security thresholds. Premiums are one cost of income among several, and the plan looks at all of them in the same year.
- Roth conversions. Conversion size is set against the bracket, the IRMAA line two years out, and the long-term value of the converted dollars. Our guide to when Roth conversions pay off covers the bracket side.
- Social Security. At lower incomes, the same added dollar can also make more of the benefit taxable; the Social Security tax torpedo explains that zone. By the time a couple nears $218,000, 85 percent of benefits is usually already taxable.
- Required distributions. Larger RMDs later can make IRMAA a recurring cost rather than a one-year one. Drawing down pre-tax accounts earlier, or giving through qualified charitable distributions, up to $111,000 per person in 2026 from age 70½, reduces that later income. (IRS Notice 2025-67) See our RMD guide for how the schedule works.
- Gains and estate. The timing of a large sale can be matched to a year with room under a threshold, and some appreciated holdings may be better held for the step-up in basis at death than sold at all.
- The wider Medicare picture. Enrollment timing, the four parts and what they cost are in our Medicare and IRMAA guide.
The result is a multi-year schedule of expected MAGI against each threshold, with a margin built in, revisited each fall when the next year’s figures are published.
Questions Worth Answering Before You Decide
- What was MAGI on the return two years ago, and which premium year does this year’s income set?
- Does projected MAGI include tax-exempt interest, fund distributions and any planned sales?
- How far is projected MAGI from the nearest threshold, and how much margin is sensible given income that is not known until December?
- If a conversion or sale will cross a threshold anyway, how much of the tier’s width is worth using this year?
- Are both spouses enrolled in Part B and Part D coverage, and in which years?
- Has there been a qualifying major life event since the look-back year that would support a request on Form SSA-44?
When the Look-Back Year No Longer Fits
The surcharge is recalculated every year from the new look-back return, so a single high-income year normally produces a single year of higher premiums. Separately, when income has fallen because of a major life event, a beneficiary can ask Social Security to use a more recent year on Form SSA-44. The qualifying events are listed in regulation: (20 CFR §418.1205)
- Death of a spouse, marriage, or divorce or annulment.
- The beneficiary or spouse stopping work or reducing hours.
- Loss of income-producing property through no choice of the owner, such as a disaster or fraud, but not a sale or an ordinary market loss.
- A scheduled end, termination or reorganization of an employer pension plan, or a settlement from an employer’s closure, bankruptcy or reorganization.
A Roth conversion, a one-time sale or a drop in investment income is not on the list. Retirement is, which is why the first IRMAA notice after leaving work is often worth a closer look.
What This Does Not Mean
- It does not mean income above a threshold is lost. A couple $20,000 over the first cliff pays $2,296.80, roughly 11 cents per dollar over the line, and keeps the rest after income tax.
- It does not mean the surcharge is permanent. Each year is determined from its own look-back return.
- It does not mean staying under is always right. A conversion or a planned gain buys something, and the surcharge is one cost in that comparison.
- It is not personalized advice. Projected income and the premium consequences should be reviewed with a tax professional.
Frequently Asked Questions
Q: How is the roughly $2,300 figure calculated?
Crossing the first 2026 threshold raises Part B from $202.90 to $284.10 a month, an increase of $81.20, and adds a $14.50 monthly Part D adjustment. That is $95.70 a month per person. Times 12 months, $1,148.40 per person; times two spouses enrolled in Parts B and D, $2,296.80 a year.
Q: Why does a single dollar over $218,000 matter?
Each IRMAA tier applies in full once income is above its threshold. Joint MAGI of $218,000 keeps the standard premium; $218,001 puts both enrolled spouses in the first tier for the whole year. The surcharge is not prorated by how far income crossed.
Q: Which year’s income sets 2026 Medicare premiums?
Generally the 2024 tax return. Social Security uses modified adjusted gross income from the tax year two years before the premium year, and falls back to three years before if the IRS has not supplied the more recent year.
Q: What counts as income for IRMAA?
Adjusted gross income plus tax-exempt interest and a few other excluded items. Municipal bond interest therefore counts. Qualified Roth IRA withdrawals and qualified charitable distributions are not in adjusted gross income and do not count.
Q: Is an IRMAA surcharge permanent?
No. It is set again each year from a new look-back return, so a single high-income year normally produces a single year of surcharges. If income has since dropped because of a qualifying major life event, such as retirement, divorce or a spouse’s death, Form SSA-44 asks Social Security to use a more recent year.
Q: How are married couples filing separately treated?
More harshly. In 2026 a married person who files separately and lived with the spouse during the year pays the standard Part B premium only at or below $109,000 of MAGI; above that, Part B is $649.20 a month, rising to $689.90 at $391,000 or more.
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General educational information, current as of 2026. Figures and rules change. For guidance specific to your situation, speak with a qualified professional.