IRMAA Two-Year Look-Back Calendar: When Your Income Sets Your Medicare Premiums

Medicare doesn't look at what you're earning today to set your premiums — it looks at what you earned two years ago. That two-year gap is the central mechanic behind IRMAA planning. Understanding exactly which income year determines each premium year, and which windows are still open, is where every meaningful IRMAA strategy starts.

The full look-back calendar

Each row shows which income tax year sets which Medicare premium year, and the planning status as of September 2026.

Who this matters most for right now

If you are 62–63 in September 2026 and will enroll in Medicare in 2028, your income for the rest of 2026 directly sets your very first Medicare premium. That is the highest-leverage planning window in your Medicare lifetime — your starting IRMAA tier may persist for years if your income stays stable. A Roth conversion that is $10,000 too large in 2026 could cost you $1,148 or more per year in extra Part B and Part D surcharges for as long as your income remains in that tier.

If you are already on Medicare, the look-back calendar explains why your premiums changed. If your 2024 income included a one-time event — a business sale, a large Roth conversion, a deferred compensation payout — that income is inflating your 2026 premiums even though the event is over. The SSA-44 can help if a qualifying life event reduced your income.

What you can still do before December 31, 2026

As of September 2026, the 2026 tax year is still open. Each strategy below reduces your 2026 MAGI and therefore your 2028 Medicare premiums:

• Calibrate a Roth conversion to stay below a bracket cliff. If your projected 2026 MAGI puts you near an IRMAA threshold, convert less — or stop before the cliff. The gap between no IRMAA and Tier 1 for a single filer is $109,000; between Tier 1 and Tier 2 is $137,000. Crossing Tier 1 adds $1,148/year per person permanently. A conversion that skips a cliff can pay for itself in 2–3 years of premium savings. See: Roth conversion and IRMAA bracket planning.
• Make a qualified charitable distribution (QCD) of up to $111,000. If you are 70½ or older and have a traditional IRA, a QCD paid directly to a qualifying charity never enters your AGI — reducing IRMAA MAGI dollar for dollar. The 2026 annual limit is $111,000 per person.² This is one of the few strategies available late in the year without advance planning.
• Harvest capital losses to offset 2026 gains. Long-term capital gains count fully toward IRMAA MAGI even at the 0% federal tax rate. If you have unrealized losses in taxable accounts, realizing them before year-end reduces your net gain income. See: Capital gains and IRMAA.
• Defer self-employment or business income into 2027. Cash-basis self-employed individuals and consultants can defer year-end invoices or December receipts into January 2027, shifting that income out of 2026 MAGI entirely.
• Maximize deductible retirement plan contributions. Pre-tax contributions to a Solo 401(k), SEP-IRA, or SIMPLE IRA reduce your AGI dollar for dollar. The 2026 Solo 401(k) employee deferral limit is $24,500 ($8,000 catch-up at age 50+; $11,250 super catch-up at ages 60–63).³ SEP-IRA contributions can be made as late as the tax filing deadline with extension.
• Self-employed health insurance deduction. If you are already on Medicare and have net self-employment income, Part B and Medigap premiums are deductible above the line under IRC §162(l), reducing AGI and IRMAA MAGI for 2026.

Strategies that required earlier setup and are no longer available for 2026: 409A deferred compensation payment elections (must be made 12+ months in advance), new cash balance plan installments (plan must exist), and installment sale gross profit percentage elections on property already sold. If these apply to your 2027 or 2028 income, now is the time to structure them.

Estimate your 2028 Medicare premiums based on 2026 income

Enter your projected 2026 MAGI below. The calculator uses 2026 IRMAA brackets as a planning baseline — 2028 thresholds will be inflation-adjusted and are not yet published.

The SSA-44 exception: bypassing the look-back

The two-year look-back has one statutory exception. If you experienced a qualifying life-changing event that significantly reduced your income, you can file SSA Form SSA-44 to request that SSA use your current-year (lower) income instead of the look-back year's income.⁴

The seven qualifying life-changing events:

1. Marriage
2. Divorce or annulment
3. Death of a spouse
4. Work stoppage (retirement or cessation of employment)
5. Work reduction (significant reduction in hours or pay)
6. Involuntary loss of income-producing property (fire, flood, theft)
7. Loss or reduction of certain pension income (employer settlement, plan termination)

How SSA-44 maps to the look-back calendar: If you retired in 2025 and your 2025 income was much lower than your 2024 income, the SSA will still use 2024 MAGI to set your 2026 premiums — unless you file SSA-44 showing that your 2025 income dropped due to retirement. The appeal uses your most recent year's income (projected or filed) as the new basis. A retirement in 2026 lets you request that SSA use 2026 income to set 2028 premiums immediately, rather than waiting for the look-back to self-correct in 2028.

What SSA-44 cannot do: The appeal is not available for voluntary business sales, large Roth conversion years, capital gain realizations, or RMD spikes. Those are not qualifying life-changing events. If your 2024 or 2025 MAGI was elevated by one of these, the path forward is income reduction strategies for 2027 and 2028. See: IRMAA appeal guide and SSA-44 walkthrough.

The 2027 premium situation: currently being set

As of September 2026, your 2027 Medicare premiums are being set based on your 2025 MAGI. The 2027 IRMAA brackets have not yet been published — the SSA typically announces them alongside the Part B premium announcement in November of the prior year. When announced, the thresholds will be inflation-adjusted from the 2026 levels. If your 2025 income was high due to a qualifying life event you experienced in 2025 or 2026, file SSA-44 before your 2027 premiums are finalized.

1. SSA POMS HI 01101.020: IRMAA Sliding Scale Tables — statutory basis for the two-year look-back rule and the MAGI-to-tier premium mapping. All bracket values verified here for 2026. The SSA uses the MAGI from the most recently filed tax return, typically two calendar years prior. Statutory authority: 42 U.S.C. §1395r.
2. IRS: Retirement Plans FAQs — IRA Withdrawals and Distributions — qualified charitable distributions under IRC §408(d)(8); 2026 annual QCD limit of $111,000 per person per IRS Rev. Proc. 2025-67. QCDs reduce AGI directly and therefore reduce IRMAA MAGI.
3. IRS: Retirement Topics — 401(k) and Profit-Sharing Plan Contribution Limits — 2026 employee deferral limit $24,500; catch-up $8,000 at age 50+; super catch-up $11,250 at ages 60–63 per SECURE 2.0 §109. Pre-tax contributions reduce AGI and IRMAA MAGI.
4. SSA Form SSA-44: Medicare Income-Related Monthly Adjustment Amount — Life-Changing Event — the seven qualifying life-changing events and the process for requesting use of current-year income to bypass the two-year look-back.
5. CMS: 2026 Medicare Parts A & B Premiums and Deductibles — official CMS fact sheet confirming Part B base premium $202.90/month and IRMAA surcharge tiers used in this page's calculator. November 2025.

IRMAA bracket values verified as of September 2026 against SSA POMS and CMS sources. Calculator uses 2026 brackets as a planning baseline for 2028; actual 2028 thresholds will be inflation-adjusted and announced November 2028. Content is for informational purposes only and does not constitute financial, tax, or legal advice.