When Do Both Spouses Have to Pay IRMAA?
Navigate Medicare's IRMAA for married couples. Learn how joint income impacts both spouses' premiums and potential adjustments.
The Income-Related Monthly Adjustment Amount (IRMAA) is an additional charge applied to Medicare Part B and Part D premiums for beneficiaries whose incomes exceed certain thresholds. The Social Security Administration (SSA) is responsible for determining and applying these adjustments based on reported income data.
What IRMAA Is
This additional charge applies to individuals whose Modified Adjusted Gross Income (MAGI) surpasses specific income benchmarks set by the federal government. The Social Security Administration (SSA) calculates this amount, and it varies depending on the income bracket into which a beneficiary falls. Beneficiaries receive a notice from the SSA if they are subject to IRMAA, detailing the premium amount and the income used for the determination.
The purpose of IRMAA is to ensure the sustainability of the Medicare program by requiring higher-income individuals to contribute more towards their healthcare benefits. These income thresholds are subject to annual adjustments, which means that the income level at which IRMAA begins, and the specific amounts charged, can change from one year to the next. The IRMAA is paid directly to Medicare, usually through deductions from Social Security benefits or by direct bill.
How IRMAA Applies to Spouses
When both spouses are enrolled in Medicare, the application of IRMAA primarily considers their combined income, especially if they file their taxes jointly. Even though the income is combined, each spouse who is on Medicare will receive a separate IRMAA determination and will be responsible for their own individual IRMAA amount, which is added to their respective Part B and Part D premiums. This means that if the combined income exceeds the threshold, both spouses will likely pay an IRMAA.
In situations where a married couple files their taxes separately but resided together at any point during the tax year, their individual IRMAA is still generally based on their combined income. However, if a married couple files separately and lived apart for the entire tax year, each spouse’s IRMAA determination is based solely on their individual income. This distinction is important for couples whose financial situations might be independent.
Even if only one spouse in a marriage is enrolled in Medicare, the couple’s income filing status remains relevant for that spouse’s IRMAA calculation. If they file jointly, the joint MAGI will be used to determine the IRMAA for the Medicare-enrolled spouse. Therefore, the financial circumstances of both partners can influence the Medicare costs for even a single beneficiary within the household.
Income Determination for IRMAA
The income used to determine IRMAA is known as Modified Adjusted Gross Income (MAGI). This figure is derived from your Adjusted Gross Income (AGI), as reported on your federal income tax return, with certain additions. Specifically, the MAGI for IRMAA purposes includes your AGI plus any tax-exempt interest income, such as interest from municipal bonds. Other less common additions may also be factored in, depending on specific tax situations.
The Social Security Administration (SSA) generally uses a “look-back” period to assess your income for IRMAA purposes. For example, the IRMAA for the current year (e.g., 2025) is typically based on your MAGI from your tax return filed two years prior (e.g., your 2023 tax return). This two-year lag allows the SSA to obtain finalized income data directly from the Internal Revenue Service (IRS). The IRS provides this tax information to the SSA, which then uses it to make IRMAA determinations. This look-back period means that a significant change in income in the current year may not immediately affect your IRMAA until two years later.
Challenging or Adjusting IRMAA
Beneficiaries who believe their IRMAA assessment is incorrect or whose income has significantly decreased due to certain life-changing events may request a reconsideration. The Social Security Administration (SSA) provides a process for adjusting IRMAA based on specific qualifying events. These events include marriage, divorce or annulment, the death of a spouse, work stoppage or reduction, loss of income-producing property, loss of pension income, and receipt of an employer settlement payment.
To request an adjustment or reconsideration, individuals must generally complete Form SSA-44, titled “Medicare Income-Related Monthly Adjustment Amount – Life-Changing Event.” This form requires you to provide details about the life-changing event and to estimate your income for the current year, which should reflect the impact of that event. You will need to submit supporting documentation, such as proof of the life event (e.g., a marriage certificate or divorce decree), and evidence of your new, lower income (e.g., pay stubs, pension statements, or a letter from your former employer).
The completed Form SSA-44 and all supporting documentation should be submitted directly to the Social Security Administration. The SSA will review your request and determine if an adjustment to your IRMAA is warranted. If your initial request for reconsideration is denied, you have the right to appeal the decision.