Complete 2026 Medicare IRMAA premium surcharge brackets for MFJ and Single filers. How a big capital-gains sale year creates a 2-year-forward IRMAA hit, and how to structure to avoid it.
IRMAA (Income-Related Monthly Adjustment Amount) is the Medicare premium surcharge tied to your income from two years prior. If your modified adjusted gross income (MAGI) in 2026 lands above certain thresholds, you'll pay higher Part B and Part D premiums in 2028. For California sellers age 63+, a single big-gain year can push you into the maximum IRMAA tier for one year — costing $5,000-$14,000 per couple on Medicare.
| 2026 MAGI (MFJ) | Part B surcharge/mo | Part D surcharge/mo | Annual cost/couple |
|---|---|---|---|
| Under $218,000 | $0 | $0 | $0 |
| $218,000 – $274,000 | +$81.20 | +$14.50 | ~$2,295 |
| $274,000 – $342,000 | +$203.00 | +$36.20 | ~$5,740 |
| $342,000 – $410,000 | +$324.00 | +$58.30 | ~$9,175 |
| $410,000 – $750,000 | +$446.00 | +$80.00 | ~$12,620 |
| Over $750,000 | +$487.00 | +$91.00 | ~$13,870 |
The IRS uses your MAGI from 2 years prior to set your current-year Medicare premium. So:
The SIS spreads your gain recognition across 5-40 years. Each year's recognition is small — often staying below the $218K MFJ no-surcharge threshold entirely. On a $4M sale spread over 30 years, annual MAGI per year might be $90K ordinary + $130K gain + $40K interest = $260K → Tier 2 instead of Tier 6. The IRMAA cost difference can be $100,000+ over the term.
For a 63+ California seller with a $1M+ gain, IRMAA is often the silent killer of the cash-sale option. The 2-year lookback means the bill arrives long after the seller stops thinking about the tax consequences.
The SIS calculator on this site models the 2-year IRMAA lookback automatically — comparing your cash-sale IRMAA hit against the spread-out SIS path.
Run the calculator → 213-414-2808