Why your Medicare Part B premium might be higher than your neighbor’s
Two people on the same street, both 68, both on original Medicare, and one of them is paying nearly three times what the other pays for exactly the same coverage. Nothing is wrong. That is how the system is built.
The standard Part B premium for 2026 is $202.90 a month. Most people pay that. But if your income is above a threshold, you pay a surcharge on top, and the surcharge is not small.
It is called the income related monthly adjustment amount. Everyone shortens it to IRMAA, and I have never met a single person who liked hearing the word.
The two year lag
Here is the part that makes people genuinely angry, and I think fairly.
The income they use is not your current income. It is the income on the tax return you filed two years ago. So your 2026 premium is based on what you reported for 2024.
Think about who that catches. Somebody who worked a full year in 2024, retired in 2025, and is now living on a pension and a Social Security check. Their income has collapsed. Their premium is calculated as though it never did.
It catches people who sold a house in 2024. It catches anyone who took a large one time withdrawal from a retirement account to pay off a mortgage. It catches a widow whose last joint return with her husband showed two incomes, and who is now filing alone on one.
I dealt with that last situation more than once and it is a miserable letter to receive.
How the brackets work
The surcharge is not a percentage. It is a set of steps.
You are in a bracket based on your modified adjusted gross income, and each bracket has a fixed dollar add-on. Cross a threshold by one dollar and you pay the entire next step. There is no gradual taper, no partial amount. It is a cliff.
That matters if you have any control over the timing of income. A retirement account withdrawal in December versus January can move you across a line and cost you a full year of a higher premium, and the effect does not show up for two years, by which point nobody remembers the decision.
There is a matching surcharge on Part D prescription coverage, billed separately and easy to overlook.
The exact thresholds and amounts change every year and I am not going to quote figures I cannot stand behind. Look them up at medicare.gov before you plan anything around them, and look them up for the right year.
The form almost nobody files
This is the useful part of the article, so I will be direct about it.
If your income has dropped because of a specific life event, you can ask them to use your current income instead of the return from two years ago. The form is SSA-44, and it is called a life changing event request.
The events that qualify are defined narrowly. Marriage, divorce or annulment. Death of a spouse. You or your spouse stopping work or reducing hours. Loss of income producing property through something outside your control. Loss or reduction of a pension. A settlement from an employer because of closure or bankruptcy.
Read that list again. Retirement is on it. Death of a spouse is on it.
Those are the two most common reasons anyone's income falls at that age, and they are both covered, and I would guess most people paying an unnecessary surcharge right now have no idea the form exists.
What is not on the list matters too. Selling a house is not a life changing event. Taking a one off withdrawal from an IRA is not one. A capital gain is not one. In those cases the surcharge stands, and it will drop off by itself two years later when the high income year falls out of the calculation.
How to file it
Fill in SSA-44, state which event applies, give the date, and estimate your current year income. Attach proof. For retirement that means a letter from the employer or something showing the last date worked. For a death it means the death certificate.
Send it or take it to the local office. You can file it as soon as the event happens, and you do not have to wait for the letter telling you about the surcharge to arrive.
If it is refused and you think they are wrong, that decision can be appealed like any other.
One thing I would watch
The surcharge is normally deducted straight from your Social Security payment along with the standard premium, which means it is easy to miss. People see a net figure in the bank and never look at the breakdown.
Read the annual benefit statement. Find the Medicare deduction line. If the number is well above the standard premium and your income has fallen since the year they are using, you have something to file.
At the plant I used to keep a copy of SSA-44 in my desk drawer, because the people who needed it were never the people who had heard of it. That is still true, and it is a poor way to run a program that takes money out of a pension every month.
