The income that counts toward IRMAA — the surcharge Medicare adds to Part B and Part D premiums at higher incomes — is every dollar of your adjusted gross income, plus any tax-exempt interest added back on top; the total is called modified adjusted gross income, or MAGI. If a dollar appears in your AGI — a paycheck, an IRA withdrawal, a Roth conversion, a capital gain, a pension payment, the taxable share of a Social Security benefit — it counts, and municipal bond interest counts too, even though it escapes income tax.
Revised: 7/24/26
Jason Baar
Fee-Only Medicare Advisor
NPN #2033715
It shows where Medicare’s five income lines sit in 2026, what counts toward them, and the timing moves that can keep you under.
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The long answer
What stays out is mostly money the tax code never counts as income in the first place: withdrawals from a Roth IRA that meet the qualified rules, HSA dollars spent on care, an inheritance, insurance proceeds, and the principal you get back when you sell something — only the gain above what you paid is income.
Timing matters as much as the list. Medicare reads the return from two years back, so what counted on your 2024 filing is what sets your 2026 premiums. Surcharges begin above $109,000 of MAGI for a single filer and $218,000 for a joint filer, per the Social Security Administration.
The planning insight hiding in all this: the amount you spend in retirement and the income Medicare sees are two different numbers. Two households can spend identically while one pays surcharges and the other never does — because of which accounts the spending came from.
Printed from JasonKnowsMedicare.com — “What Income Counts Toward IRMAA?”. The free IRMAA Planning Guide is available at tally.so/r/81gEEA · Questions: (850) 810-1000
This page is educational information, not personal financial, tax, or legal advice. For decisions about your own situation, talk with a qualified professional.