Medicare Surcharges (IRMAA): How the Wealthier Pay MORE for Coverage

If you have enough wealth, your Medicare costs – specifically your premiums – might be more than you had bargained for. Not everyone knows this, but there are Medicare surcharges (officially called Income Related Monthly Adjustment Amount, or IRMAA) that correspond to income brackets.

These additional costs can really add up. It is the highest-earning 5% of Medicare recipients who pay more for their health coverage.

What Does Medicare Cost?

There are many different costs associated with Medicare. You may pay monthly premiums, IRMAA (see below), coinsurance, as well as co-pays and deductibles.

Your total out-of-pocket costs for Medicare will vary tremendously depending on the types of coverage you select, your income, where you live, your health status, and healthcare usage.

For a personalized estimate of your Medicare costs, use the NewRetirement Planner. It will help you estimate your total lifetime out of pocket medical spending – including calculating your premiums based on your income.

What is IRMAA?

IRMAA stands for Income Related Monthly Adjustment Amount. Medicare.gov explains that, if your modified adjusted gross income (MAGI) as reported on your IRS tax return from two years ago is above a certain amount, you’ll pay the standard premium amount and IRMAA.

IRMAA is an extra cost added to your premiums – specifically parts B and D. Keep reading below to learn about Medicare premiums and just how significantly they rise for those with higher income.

Current Medicare Premiums, Including IRMAA

The amounts below come from Medicare.gov. The premium amounts for Medicare Part A and C are mostly standardized – varying by the type of coverage. However, as you will see, the premiums you pay for Medicare Parts B and D will depend on your income level with the highest earners paying up to $5,201 in surcharges.

Medicare Part A Premiums

The monthly premiums for Medicare Part A range from $0–$506.

Most people don’t pay a monthly premium for Part A because you paid adequate Medicare taxes while working . If you are required to buy Part A, you’ll pay between $278 and $506 each month.

Medicare Part B Premiums – Surcharges Could Cost Up to $5,000 Each Year

If you are not required to pay IRMAA, Medicare Part B premiums in 2023 are $164.90 each month.

If you have a higher income, your costs for Medicare Part B premiums can be significantly higher. People in the highest brackets will pay $4,747 more in 2023 than those in the lowest brackets.

You can review the premium amounts for B for the different income tiers below. Or, once your financial plan is set up in the NewRetirement Planner, you can assess your Medicare costs and see your eligibility for IRMAA surcharges and what those surcharges will be each year. Look for the IRMAA and Income and Expenses charts in the Insights section of the Planner.

Lowest Bracket: People in the lowest income bracket will pay $164.90/month. The lowest bracket is for those:

• Filing jointly with income of 194,000 or less/year
• Filing as an individual with income of $97,000 or less/year

Second Tier: $230.80/month for those:

• Filing jointly with income above $194,000 up to $246,000/year
• Filing as an individual with income above $97,000 up to $123,000/year

Third Tier: $329.70/month for those:

• Filing jointly with income above $246,000 up to $306,000/year
• Filing as an individual with income above $123,000 up to $153,000/year

Fourth Tier: $428.60/month for those:

• Filing jointly with income above $306,000 up to $366,000/year
• Filing as an individual with income above $153,000 up to $183,000/year

Fifth Tier: $527.50/month for those:

• Filing jointly with income above $366,000 up to $750,000/year
• Filing as an individual with income above $183,000 up to $500,000/year
• Married, but filing separately with income above $183,000 and less than $500,000/year

Sixth Tier: $560.50/month for those

• Filing jointly with income above $750,000/year
• Filing as an individual with income above $500,000/year

Medicare Part C Premiums

The Part C – more commonly known as Medicare Advantage – monthly premium varies by plan.

Medicare Part D Premiums

Medicare Part D – prescription drug coverage – premiums also vary depending on what plan you choose.

However, there is a standardized IRMAA surcharge over and above your premium for higher income earners. The highest earners will pay $916.00 more than the lowest earners as a premium surcharge.

Lowest Bracket: People in the lowest income bracket will pay their plan’s premium with no Medicare surcharge. The lowest bracket is for those:

• Filing jointly with income of 194,000 or less/year
• Filing as an individual with income of $97,000 or less/year

Second Tier: Those with the following income levels will pay their plan premium, plus an additional $12.20/month:

• Filing jointly with income above $194,000 up to $246,000/year
• Filing as an individual with income above $97,000-up to $123,000/year

Third Tier:Those with the following income levels will pay their plan premium, plus an additional $31.50/month:

• Filing jointly with income above $246,000 up to $306,000/year
• Filing as an individual with income above $123,000 up to $153,000/year

Fourth Tier: Those with the following income levels will pay their plan premium, plus an additional $50.70/month:

• Filing jointly with income above $306,000 up to $366,000/year
• Filing as an individual with income above $153,000 up to $183,000/year

Fifth Tier: Those with the following income levels will pay their plan premium, plus an additional $70.00/month:

• Filing jointly with income above $366,000 up to $750,000/year
• Filing as an individual with income above $183,000-up to $500,000/year

Sixth Tier: Those with the following income levels will pay their plan premium, plus an additional $76.40/month:

• Filing jointly with income above $750,000/year
• Filing as an individual with income above $500,000/year

When Did These Surcharges on Medicare Premiums Become Law?

According to Kaiser, the surcharges were a provision in the Medicare Modernization Act of 2003, a law passed to change how Medicare pays physicians. The law went into effect in 2007 and was updated in 2015.

How Can You Reduce a Medicare Surcharge?

With some planning, there are steps you can take to avoid or reduce IRMAA.

Here are 5 ideas:

1. Find Out in Which Future Years You Will Pay a Medicare Surcharge, IRMAA

You can use the NewRetirement Planner which now provides you with an IRMAA analysis. You can see your projected annual income and assess when you might be assessed for IRMAA and how much for every year from now through your (and your spouse’s) longevity.

NOTE: Your IRMAA payments are determined by your MAGI from two years earlier. So, the IRMAA you would owe in 2030 is dictated by your 2028 earnings.

2. Take Steps to Minimize Taxable Income

If you can lower your taxable income below an IRMAA bracket, you can save hundreds if not a thousand or more on the surcharges. However, minimizing your retirement income can be tricky, especially if you are already taking your Required Minimum Distributions (RMDs) from your tax deferred accounts.

Planning ahead is key. You may be able to shelter income in certain years, manage capital gains, utilize Medicare Savings Accounts, take charitable distributions and consider other strategies. Working with a tax accountant or a Certified Retirement Planner may be helpful.

3. Consider a Roth Conversion

You can convert money from your taxable retirement savings accounts into a Roth account to avoid having to take RMDs. This can be a great way to reduce taxable income and enable you to avoid IRMAA.

Use the Roth Conversion Explorer in the NewRetirement Planner to see your potential opportunity for reducing your tax and IRMAA liability.

5. Let Medicare Know if Your Circumstances Have Changed

Your IRMAA is based on your income from two years ago. If your circumstances have changed since that time, you can file an appeal with Medicare to let them know about a reduction in income.

Events that might make Medicare reassess your IRMAA include: marriage, divorce, spouse’s death, loss of a job, loss of income generating property, loss of your pension and more.

6. Create and Maintain Your Overall Retirement Plan

Healthcare is a major consideration when planning a secure retirement, but there are hundreds if not thousands of different elements that impact your current and future wealth and security.

Make sure that you have a comprehensive plan and that you keep it updated.

Use the NewRetirement Planning Platform to feel in control of your money today and secure about your future. The tools will help you do better with your time, taxes, income, investments, and more.