Why Some Federal Retirees Pay Higher Medicare Premiums (and What You Can Do About It)

Updated October 22, 2026, with the 2026 income thresholds and a worked example of how pension, Social Security and Thrift Savings Plan income combine.

Many federal retirees are surprised when they receive a letter from the Social Security Administration (SSA) informing them that their Medicare Part B premium will be higher than the standard monthly amount. The increase often comes as a shock, especially after carefully planning for retirement.

In most cases, the higher premium is the result of the Income-Related Monthly Adjustment Amount (IRMAA). IRMAA is an additional premium that applies to Medicare Part B and Medicare Part D for beneficiaries whose income exceeds certain thresholds.

Federal retirement itself does not automatically trigger IRMAA. Instead, the surcharge is based on your Modified Adjusted Gross Income (MAGI), generally reported on the federal income tax return from two years earlier. Because many federal employees experience unusually high taxable income during the year they retire, they may temporarily become subject to IRMAA even if their income later declines.

Understanding how IRMAA works, when it applies, and when you may qualify for a reconsideration can help you avoid unnecessary surprises and potentially reduce your Medicare costs.

Key Takeaways

• IRMAA is an income-based surcharge added to Medicare Part B and Part D premiums.
• SSA generally uses your federal income tax return from two years earlier to determine whether IRMAA applies.
• Receiving a Federal Employees Retirement System (FERS) or Civil Service Retirement System (CSRS) pension does not automatically result in higher Medicare premiums.
• A pension, Social Security and retirement account withdrawals add together, and one larger withdrawal can push total income over a threshold.
• One-time retirement income events can temporarily increase your income enough to trigger IRMAA.
• If your income has significantly decreased because of a qualifying life-changing event, you may request a new IRMAA determination.
• Careful retirement income planning may help reduce future IRMAA surcharges.

One of the biggest surprises many federal retirees encounter is discovering they owe more for Medicare than friends or neighbors. After enrolling in Medicare Part B, they receive a notice stating their monthly premium will be considerably higher than the standard premium. The answer is usually IRMAA.

Although IRMAA affects millions of Medicare beneficiaries every year, many people don’t learn about it until after they retire. Understanding how Medicare determines these higher premiums can help you better prepare for retirement and know your options if your income changes.

What Is IRMAA?

IRMAA stands for Income-Related Monthly Adjustment Amount. It is an additional monthly premium paid by Medicare beneficiaries whose income exceeds annual limits established by law. The surcharge applies to:

• Medicare Part B
• Medicare Part D

Congress created IRMAA to require higher-income beneficiaries to pay a larger share of Medicare costs. IRMAA does not replace your Medicare premium. Instead, it is added to your standard premium.

Why Federal Retirees Often Encounter IRMAA

Federal retirees frequently experience unusually high taxable income during the year they retire.

That increased income may come from several sources, including:

• Lump-sum annual leave payments
• Traditional Thrift Savings Plan (TSP) withdrawals
• Individual Retirement Account (IRA) distributions
• Roth IRA conversions
• Capital gains from investments
• Required Minimum Distributions (RMDs)
• Other one-time taxable events

While these events may occur only once, they can increase your income enough to place you above an IRMAA threshold. Because SSA generally looks back two years when calculating Medicare premiums, a one-time spike in income can affect your Medicare costs years after retirement.

How SSA Determines Whether You Owe IRMAA

SSA receives income information from the Internal Revenue Service. For Medicare premiums, SSA generally reviews your federal tax return from two years earlier. For example:

SSA looks at your MAGI. For IRMAA purposes, MAGI generally consists of:

• Adjusted Gross Income (AGI)
• Tax-exempt interest income

SSA compares that amount with the annual IRMAA income brackets published for each Medicare year. If your income exceeds a threshold, an IRMAA surcharge is added to both your Medicare Part B and, if applicable, your Medicare Part D premium.

Understanding the IRMAA “Cliff”

One aspect of IRMAA that surprises many retirees is that it works using income brackets rather than a gradual phase-in. If your income exceeds an IRMAA threshold by even a small amount, you move into the next premium tier. That means an additional dollar of income can increase your Medicare premiums for the entire year.

For retirees whose income is close to one of the thresholds, careful year-end tax planning may help avoid crossing into a higher premium bracket.

2026 IRMAA Income Thresholds and Premiums

For 2026, Medicare looks at MAGI from the 2024 tax return. The standard Part B premium is $202.90 per month, and each tier below adds a surcharge to that amount. The Part D surcharge is separate from the drug plan’s own premium and is paid directly to Medicare.

Amounts are per person, so a married couple with both spouses enrolled pays each surcharge twice. Married retirees who file separately and lived with their spouse during the year use a different, narrower set of brackets, which the SSA premiums page lists. The official 2027 thresholds and premiums have not been published yet; see the projected 2027 Medicare premiums page for the current estimates.

Retirement Events That Commonly Trigger IRMAA

Many retirees assume IRMAA only affects wealthy households. In reality, several common retirement transactions can temporarily increase taxable income.

Lump-Sum Annual Leave Payments

Federal employees often receive a significant payment for accumulated annual leave when they retire. This payment is taxable income and may contribute to crossing an IRMAA threshold.

Thrift Savings Plan Withdrawals

Withdrawals from a traditional TSP account are generally taxable. Large distributions taken in a single year can substantially increase your income.

Roth IRA Conversions

Converting assets from a traditional retirement account to a Roth IRA creates taxable income in the year of conversion. Although many retirees convert funds for long-term tax planning, the conversion may temporarily trigger IRMAA.

Capital Gains

Selling appreciated investments can increase taxable income and potentially move you into a higher IRMAA bracket.

Required Minimum Distributions

Beginning at the applicable age, required minimum distributions from traditional retirement accounts increase taxable income and may affect Medicare premiums.

Does Your Federal Pension Cause IRMAA?

No. Many federal retirees believe that simply receiving a FERS or CSRS pension automatically results in higher Medicare premiums.

Your federal pension counts as taxable income, but IRMAA applies only if your total income exceeds the applicable threshold.

How Pension, Social Security and TSP Income Stack Up

A federal pension alone rarely crosses an IRMAA threshold. The more common path is several steady income sources combined with one larger withdrawal. A FERS annuity is taxable income, up to 85 percent of Social Security benefits can become taxable once total income passes the IRS thresholds, and every dollar withdrawn from a traditional TSP account counts in full.

The example below is illustrative. It assumes a married couple filing jointly, both enrolled in Medicare, with a FERS annuity of $58,000 (treated as fully taxable), combined Social Security benefits of $44,000, and traditional TSP withdrawals. Scenario B adds a one-time $40,000 TSP withdrawal, such as for a home repair.

Nothing in Scenario A looks like high income, yet the couple sits within $32,600 of the first threshold. The extra $40,000 withdrawal lands $7,400 over the line, and that overage triggers $2,296.80 in surcharges, on top of the income tax owed on the withdrawal itself. Because Medicare looks back two years, the bill arrives for the second year after the withdrawal and covers all twelve months.

Spreading the same $40,000 over two tax years, $20,000 more each year, would hold MAGI at $205,400 in both years, below the $218,000 line. Income tax brackets and other income would still need to be checked, but the surcharge cliff is avoided.

A withdrawal taken by choice is generally not one of the life-changing events SSA accepts on Form SSA-44, so a couple in Scenario B would typically have no appeal. Retirement itself, divorce and the death of a spouse are the types of events that do qualify. The Medicare premium appeal guide covers how that process works.

How IRMAA Affects Medicare Part D

IRMAA is not limited to Medicare Part B. If your income exceeds the applicable threshold, you may also owe an additional premium for Medicare Part D prescription drug coverage. Unlike Part B, where the surcharge is added directly to your Medicare premium, the Part D IRMAA amount is generally billed separately by Medicare. Some retirees are surprised to learn they owe higher premiums for both parts of Medicare.

Can You Appeal Higher Part B Premiums from an IRMAA Determination?

Yes, but only under certain circumstances. Simply disagreeing with the premium amount is generally not enough.

SSA allows beneficiaries to request a new determination if they experience a qualifying life-changing event that significantly reduces their income. Examples include:

• Retirement
• Reduction in work hours
• Marriage
• Divorce or annulment
• Death of a spouse
• Loss of pension income
• Loss of income-producing property
• Certain employer settlement payments ending

Note on reduced work hours: SSA treats a full retirement and a reduction in work hours as related but separate qualifying events. If you or your spouse moved from full-time to part-time employment, rather than stopping work entirely, and your income dropped as a result, you may still qualify for an IRMAA reconsideration. This is especially relevant for retirees who take on part-time or phased work after leaving federal service.

If SSA approves your request, it may base your Medicare premium on your current income rather than the older tax return.

How to Request an IRMAA Reconsideration

Individuals who qualify may request a new determination by submitting Form SSA-44, Medicare Income-Related Monthly Adjustment Amount – Life-Changing Event. The form asks for:

• The qualifying event
• The date it occurred
• Your estimated current income
• Documentation supporting the change

Supporting documentation may include:

• Retirement paperwork
• Pension statements
• Employer records
• Tax information
• Other evidence requested by SSA

SSA reviews the information and determines whether your premium should be adjusted.

Strategies That May Help Reduce Future IRMAA

IRMAA cannot always be avoided, but careful retirement income planning may help reduce future Medicare premiums. Strategies sometimes discussed with financial or tax professionals include:

• Spreading TSP withdrawals over multiple years
• Timing Roth conversions carefully
• Managing capital gains
• Coordinating Required Minimum Distributions
• Monitoring taxable income near year-end
• Using Qualified Charitable Distributions (QCDs), when eligible
• Coordinating withdrawals from taxable, tax-deferred, and Roth accounts

These strategies are highly individual and should be evaluated in light of your overall retirement and tax situation.

Example: A Retirement-Year Income Spike

Michael retired from federal service at age 65. During his retirement year, he received a large annual leave payout, withdrew funds from his traditional TSP account to pay off his mortgage, and completed a partial Roth conversion. His taxable income increased substantially for that year.

Two years later, SSA notified him that his Medicare Part B and Part D premiums would increase because of IRMAA. Since his ongoing retirement income was much lower than during the year he retired, he submitted Form SSA-44 documenting his retirement and estimated current income. SSA reviewed the information and approved a lower premium.

Look Two Years Ahead, Not Just at This Year

Income reported on a 2026 tax return generally sets Medicare premiums for 2028. That makes the months before December 31 the last chance to adjust 2026 income: the size and timing of TSP withdrawals, the amount of any Roth conversion, and the realization of capital gains. A quick check of projected MAGI against the thresholds above, before a large withdrawal rather than after, is the most direct way to keep an IRMAA surcharge a planned decision instead of a surprise notice.

Frequently Asked Questions

Does every federal retiree pay IRMAA?

No. Most federal retirees pay the standard Medicare Part B premium because their income falls below the annual IRMAA thresholds.

Does my FERS pension automatically trigger IRMAA?

No. Your pension is included as taxable income, but receiving a pension alone does not automatically place you above an IRMAA threshold.

Does FEHB affect IRMAA?

Generally, no. However, if you disenroll from Medicare Part D and rely on Federal Employees Health Benefits (FEHB) drug coverage, you’re no longer subject to Part D IRMAA, but you can still owe Part B IRMAA if you’re enrolled in Part B.

Can I appeal simply because I think the premium is unfair?

Generally, no. SSA typically requires a qualifying life-changing event or evidence that the income information used was incorrect.

Does IRMAA last forever?

Not necessarily. IRMAA is recalculated annually using updated tax information. If your income decreases, your surcharge may also decrease or disappear.