IRMAA: The Medicare Surcharge Most Tampa Bay Retirees Don't See Coming

IRMAA stands for Income-Related Monthly Adjustment Amount. It is an extra amount added to Medicare Part B and Medicare drug coverage premiums when tax-return income is above the annual thresholds. People enrolled in Medicare Advantage still pay their Part B premium, and an income-related Part D adjustment can also apply when the plan includes drug coverage.

For 2026, the standard Part B premium is $202.90 per month. IRMAA begins when 2024 modified adjusted gross income is above $109,000 for an individual return or $218,000 for a joint return. Medicare.gov lists five higher-income tiers. At the highest tier, the 2026 Part B premium is $689.90 and the Part D adjustment is $91.00 per month in addition to the plan premium.

Why the two-year lookback matters. Medicare generally uses the most recent federal tax return the IRS provides to Social Security, which is usually from two years earlier. That means a Roth conversion, capital gain, business sale, or other income recognized in 2024 can affect 2026 Medicare premiums.

A Roth conversion increases taxable income in the conversion year. Whether that income crosses an IRMAA threshold depends on the full tax return, filing status, and other income. IRMAA is one planning input, not proof that a conversion is good or bad. The tax cost, future required distributions, estate goals, and Medicare effect should be evaluated together.

A lower current income does not automatically change IRMAA. Social Security identifies eight life-changing events that may support a request for a new decision: marriage; divorce or annulment; death of a spouse; work stoppage; work reduction; loss of income-producing property; loss of pension income; or an employer settlement payment. A routine investment loss or voluntary sale of income-producing property does not automatically qualify.

Form SSA-44 is the government form for reporting a qualifying life-changing event and estimating the reduced income. Social Security asks for evidence of both the event and the reduction in income. If the issue is not a listed life-changing event, the IRMAA notice explains other review and appeal rights.

Planning ahead can make the Medicare effect visible before a tax decision is final. Model the projected modified adjusted gross income, compare it with the correct premium-year thresholds, and remember that the thresholds and premiums are updated annually.

For Tampa Bay retirees, the federal IRMAA rules are the same as they are elsewhere in the country. The useful local planning question is how a property sale, business transaction, retirement date, or Roth conversion fits with the household’s broader income plan.

IRMAA should be described as a cost to plan for, not a penalty to avoid at any price. Crossing a threshold may increase Medicare premiums, but the underlying transaction may still improve the long-term plan. The decision should be based on total after-tax and after-premium results.

The official Medicare.gov cost table and Social Security Form SSA-44 are linked below. Check the applicable premium year before acting because the dollar amounts change.