Who sends it: Social Security, often near the end of the year, to people with Medicare whose income is above set limits.
What this letter is
IRMAA stands for income-related monthly adjustment amount. It is an extra charge added to your Medicare Part B premium and to your Part D drug coverage when your income is above certain limits.
Social Security decides who pays it, using income information from the IRS. The extra amount for Part D is paid to Medicare, not to your drug plan, so your plan's own premium does not change. If your premiums are taken from your Social Security check, the extra amount is taken too. If not, Medicare bills you.
Why you got it
It is usually based on your tax return from two years earlier. For example, the 2027 premium is usually based on your 2025 tax return. A large one-time income in that year, such as selling a house or property, a big retirement withdrawal, or a final year of work, can push you over the limit.
The income limits and the extra amounts change every year. The current figures are posted at medicare.gov and ssa.gov.
What to check
- The tax year and income figure used. Do they match your return?
- Your filing status, such as single or married filing jointly
- Whether you filed an amended return for that year
- Whether your income has dropped since then because of a life-changing event
What to do: ask for a lower amount
You can file the SSA-44 online through your my Social Security account, mail or fax it to your local office, or bring it to an appointment.
- Your income dropped because of a life-changing event: use form SSA-44. Events that count are marriage, divorce or annulment, death of a spouse, stopping work, cutting back work, loss of income-producing property, loss of a pension, and an employer settlement payment. You will need proof, such as a letter from your employer, and an estimate of this year's income.
- The income figure is wrong, or you amended your return: call Social Security at 1-800-772-1213 and say you want to lower your IRMAA.
- You disagree with the decision itself: you can ask for a reconsideration. The letter gives the deadline, generally 60 days from when you get it.
How to tell a real one from a fake
A real IRMAA letter comes by mail from Social Security and explains how your Medicare premiums were figured. Social Security does not ask you to pay this charge by phone, gift card or wire. If anyone calls about your Medicare surcharge and asks for payment or your Social Security number, hang up and call 1-800-772-1213 yourself.
Who can help
A tax preparer can help you see how a one-time income affected you, and plan for future years. A SHIP counselor can answer Medicare questions at no cost. Find one at shiphelp.org.
Have one in front of you?
Take a clear photo and text it to Uncle at +1 208 214 0093. He tells you in plain words what it says, what it wants from you, and anything that looks wrong. How to take a clear photo.
This page explains what this kind of letter usually means. Your letter is the final word on your dates and amounts. For a decision about taxes, health coverage or a legal matter, call the office that sent it, using the number on its official website, or ask a professional you trust.
Read next
- Social Security COLA notice
- Required minimum distribution letter
- Medicare Annual Notice of Change
- Social Security scam
- See all letters explained
Written by the Textuncle team. Last updated October 3, 2026.
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