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Your Medicare surcharge letter, explained
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WHAT THE LETTER SAYS
The letter tells you that you will pay more than the standard amount for Medicare Part B, and often Part D.
That extra amount is the income-related monthly adjustment amount, or IRMAA. Social Security calls this letter an initial determination.
It is not a bill from a hospital and it is not a mistake. It is a decision based on your income.
WHY THE FIGURE IS TWO YEARS OLD
Social Security sets the surcharge from your tax return two years back. Your 2026 premium uses your 2024 return.
They use the modified adjusted gross income on that return. For most people that is close to their total income.
The two-year gap is the point that trips people up. Your income today can be far lower than the figure the letter used.
IF YOUR INCOME HAS SINCE CHANGED
There are two different routes, for two different situations. Do not mix them up.
A life-changing event. If your income fell because of one of eight events Social Security recognizes, such as retirement, use Form SSA-44. It asks them to use your real, lower income. It is a new initial determination, not an appeal, and it is free to file.(/free/irmaa-event-check).
You think the figures are wrong. If instead you disagree with the decision itself, that is a reconsideration, on Form SSA-561-U2, a separate form. You have 60 days from receiving the notice. If that window has passed, Social Security may still consider a late request when you show good cause, such as a serious illness, a family emergency, or records lost.
Whichever fits, the evidence is the part people get wrong. Gather your proof before you file.
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