Ask the Editor, March 13: Questions on Medicare Premiums and IRMAA

Each week in our Ask the Editor series, Joy Taylor, The Kiplinger Tax Letter editor, answers questions on topics submitted by readers. This week she's looking at five questions on monthly Medicare premiums, IRMAA and tax-deductible medical expenses. (Get a free issue of The Kiplinger Tax Letter or subscribe.)

1. How do I calculate MAGI?

Question: How do I calculate modified adjusted gross income (MAGI) to determine whether I owe an income-related monthly adjustment amount (IRMAA) on top of my basic monthly Medicare Part B and D premiums? Is the untaxed portion of Social Security benefits added back in for this purpose?

Joy Taylor: True to the complexity of the federal tax code, the definition of MAGI often differs, depending on what it is used for. MAGI for purposes of determining IRMAA for Medicare purposes is your adjusted gross income shown on line 11 of your Form 1040 or 1040-SR, plus any tax-exempt interest income. As a result, the untaxed portion of your Social Security benefits is not included in MAGI.

2. What tax return year is used for determining MAGI?

Question: I am confused about the calculation of MAGI for determining monthly Medicare premiums. What year's tax return do the Centers for Medicare and Medicaid Services (CMS) and the Social Security Administration (SSA) look to for figuring out the amount of my 2026 IRMAA?

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Joy Taylor: For determining MAGI for purposes of whether a Medicare recipient must pay IRMAA, CMS and the SSA generally look at the most recently filed federal income tax return. MAGI from the 2024 tax returns was used for determining whether a Medicare recipient owes IRMAA for his or her 2026 monthly Medicare Parts B and D premiums. That's because most people filed the 2024 return in 2025, and Medicare released its 2026 premiums in late 2025.

MAGI on your 2025 federal tax return will determine whether your are subject to IRMAA in 2027. MAGI on your 2026 federal tax return will determine whether you are subject to IRMAA in 2028. And so forth.

3. What if my MAGI has gone down?

Question: I have Medicare and pay monthly premiums for Parts B and D. For many years, I have been subject to IRMAA, so my monthly Medicare premiums are high. My husband just retired this year, so we will be reporting much less income on our tax returns for 2026 and later years than we had in prior years. Can I get a waiver from IRMAA for next year's monthly Medicare premiums?

Joy Taylor: Possibly. Your 2026 IRMAA premium surcharges are based on MAGI from your 2024 Form 1040. And your 2027 IRMAA premium surcharges will be based on MAGI from your 2025 Form 1040. But since your income is lower because of your husband's retirement, the SSA may give you a waiver from IRMAA if you request it.

The SSA provides for a Medicare Part B and D premium-surcharge waiver. People whose financial circumstances have changed because of divorce, retirement, death of a spouse or other major life-changing event may apply for relief to lower their IRMAA payments. You can request this easing by filing Form SSA-44 with the SSA. I think you might also be able to request the relief through your online Social Security account, if you have one.

4. Are Medicare premiums tax-deductible medical expenses?

Question: My spouse and I each pay monthly premiums for our Medicare coverage. Are the premiums we pay deductible medical expenses?

Joy Taylor: Yes, but you must itemize and not claim the standard deduction. Taxpayers who itemize on Schedule A of Form 1040 can deduct qualifying medical expenses to the extent that the total amount exceeds 7.5% of adjusted gross income. You can claim medical expenses that are not reimbursed by insurance for yourself, your spouse and your dependents.

To qualify as a deduction, the expense must be incurred primarily to alleviate or prevent a physical or mental disability or illness. The broad list of eligible expenses includes out-of-pocket payments for medical services rendered by doctors, dentists, optometrists and other medical practitioners; mental health services; health insurance premiums (including Medicare Parts B and D); annual physicals; amounts paid for in vitro fertilization; prescription drugs and insulin (but not over-the-counter drugs); hearing aids; transportation to and from the doctor’s office; the unreimbursed costs of long-term care; and many home improvements to accommodate a disability or illness.

For more information about what qualifies, see IRS Publication 502, “Medical and Dental Expenses.”

5. Can a self-employed person deduct Medicare premiums without itemizing on Schedule A?

Question: I am self-employed and single. I recently enrolled in Medicare and am now paying monthly Medicare premiums. I heard that self-employed individuals can deduct their monthly Medicare premiums without having to itemize on Schedule A. Is this correct?

Answer: Yes. Although most people must itemize on Schedule A to deduct their medical expenses, there is an important exception for self-employed individuals who pay health insurance premiums (including monthly Medicare premiums). They can deduct the health insurance premiums they pay on line 17 of Schedule 1 of the Form 1040. And the 7.5%-of-AGI haircut doesn't apply.

About Ask the Editor, Tax Edition

Subscribers of The Kiplinger Tax Letter, The Kiplinger Letter and The Kiplinger Retirement Report can ask Joy questions about tax topics. You'll find full details of how to submit questions in each publication. Subscribe to The Kiplinger Tax Letter, The Kiplinger Letter or The Kiplinger Retirement Report.

We have already received many questions from readers on topics related to tax changes in the One Big Beautiful Bill, retirement accounts and more. We will continue to answer these in future Ask the Editor roundups. So keep those questions coming!

More Reader Questions Answered

• All Ask the Editor Q&As
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• Ask the Editor: Modified Adjusted Gross Income
• Ask the Editor: QCDs and Tax-Planning
• Ask the Editor: Tax Questions on Roth IRA Conversions
• Ask the Editor: What Medical Expenses are Deductible?
• Ask the Editor: Questions on Inherited IRAs