The 2026 cost-of-living adjustment came in at 2.8%, adding roughly $56 a month to the average retired worker’s benefit. Sounds fine. But Medicare took a bigger bite the same month. The standard Part B premium jumped from $185 to $202.90 — nearly 10% in a single year. The annual deductible climbed from $257 to $283. And for retirees who crossed an IRMAA threshold, the increase wasn’t measured in dollars — it was measured in thousands.

Let me lay it on the line.

The numbers behind the smaller check

For an average Utah retiree at the standard premium, the COLA adds about $56 a month, Part B goes up $17.90 and the net gain on the Social Security deposit lands a little under $40. That’s before any Part D plan increases, and inflation on groceries and utilities eats the rest.

Higher earners face a different picture. About 8% of Medicare beneficiaries pay the Income-Related Monthly Adjustment Amount, or IRMAA. The 2026 brackets begin at $109,000 of modified adjusted gross income for single filers and $218,000 for joint filers. Cross by even a dollar, and the bracket triggers in full.

Here’s what that looks like in practice. A married couple with 2024 MAGI of $217,999 pays the standard $202.90 each per month for Part B. The same couple at $218,001 pays $284.10 each — an extra $1,948 a year between them. Move up another tier, the gap grows. At the highest bracket, Part B runs $689.90 per person per month. Add the Part D surcharge, and a single bracket move can cost a couple over $4,500 a year on top of the standard increase. Every year the income stays high.

How IRMAA actually works

IRMAA is a surcharge layered on top of Part B and Part D premiums when MAGI clears a threshold. Three things make it brutal.

First, the two-year lookback. Your 2026 premium is based on your 2024 tax return. A year of high income — selling a property, a Roth conversion, a big withdrawal — comes back to bite you 24 months later, after you’ve already spent the money.

Second, the cliff effect. Cross a bracket by $1 and you owe the full surcharge. No phase-in.

Third, MAGI is broader than taxable income. The calculation starts with AGI on Form 1040 and adds back tax-exempt interest. Municipal bonds count. Many retirees who think they’re “below the line” find out too late they weren’t.

Five strategies for staying under the surcharge

The retirees who handle IRMAA well treat MAGI like a budget — something they design every year, not something that happens to them.

1. Time Roth conversions while they still help. Conversions before age 63 don’t trigger IRMAA, because the lookback hasn’t started yet. The window between retirement and Medicare enrollment is the best time to move dollars from a traditional IRA to a Roth. Once you’re on Medicare, every conversion has to be sized carefully against the next bracket.
2. Stack income years instead of spreading them. If a large IRA withdrawal or property sale is coming, consider taking it in one tax year rather than splitting it. One bad IRMAA year hurts. Two bad years hurt twice as much.
3. Use Qualified Charitable Distributions. Once you’re 70½, you can send up to $108,000 directly from your IRA to charity in 2026. The distribution counts toward your Required Minimum Distribution but never lands on your tax return as income. For retirees who tithe or give anyway, this is one of the cleanest IRMAA tools available.
4. Watch your tax-exempt interest. Municipal bond income is federally tax-free, but it counts for IRMAA. Retirees who park large positions in munis for “tax-free income” sometimes pay for it on the Medicare side without realizing the connection.
5. File Form SSA-44 when life changes. If you’ve recently retired or had another qualifying life event, Social Security will recalculate your IRMAA based on current income, not the 2024 number. This is one of the most underused appeals in retirement planning. If you stopped working in 2025, do not assume Social Security knows. Tell them.

A planning conversation worth having before December

Most IRMAA disasters are self-inflicted, and almost all are predictable. By late autumn, you generally know what your MAGI will look like. That’s the moment to act, not after the tax return is filed.

Sit down with your tax return and a retirement income projection. Find the bracket you’re closest to. Then ask three questions. How much room do I have under the next threshold? Are there one-time income items I can defer or accelerate? Is there a charitable strategy that lowers MAGI?

Thirty minutes of planning can save thousands in surcharges that recur for years.

The Medicare increases of 2026 are real. The IRMAA cliffs are real. The planning tools are real too — and the retirees who use them keep more of every dollar they spent decades building.

Lyle Boss, The REAL BOSS Financial, a native Utahn and retirement specialist who has spent decades helping families across Utah and the Mountain West build secure, income-focused retirement plans. Boss Financial, 955 Chambers St. Suite 250, Ogden, UT 84403. Telephone: 801-475-9400. https://www.safemoneylyleboss.com/.