A 65-year-old who sold her landscaping company in 2024 opened her January 2026 Medicare notice and saw a Part B premium of $689.90. Her husband’s line showed the same number. They had not taken raises or added new income in 2026. Their 2024 tax return, the one with the sale on it, had finally reached Medicare.
This is IRMAA’s two-year lookback, and it can be especially painful for business sellers who enter Medicare soon after a large one-time gain. Roughly 8% of people with Medicare Part B pay any surcharge at all. The risk is concentrated among households whose MAGI is near or above $218,000 for joint filers or $109,000 for single filers under the 2026 brackets.
One tax return, two surcharges, both spouses
Medicare generally uses your MAGI from two years back to price both your Part B and your Part D premiums. A sale that closes in 2024 can show up on the 2026 premium notice. MAGI here is Form 1040 line 11, adjusted gross income, plus tax-exempt interest on line 2a. Municipal bond income that feels tax-free still counts toward the number Medicare uses.
The 2026 standard Part B premium is $202.90 per person, up from $185.00 in 2025. That is what each spouse pays when joint MAGI stays at or under $218,000. Above that line, the surcharges climb in five steps for joint filers, with amounts shown monthly and per person:
| Joint MAGI (2024) | Part B Total Premium | Part D Surcharge |
|---|---|---|
| ≤ $218,000 | $202.90 | $0.00 |
| $218,001 to $274,000 | $284.10 | $14.50 |
| $274,001 to $342,000 | $405.80 | $37.50 |
| $342,001 to $410,000 | $527.50 | $60.40 |
| $410,001 to $749,999 | $649.20 | $83.30 |
| ≥ $750,000 | $689.90 | $91.00 |
At the top tier, each spouse pays $487.00 per month in Part B IRMAA plus $91.00 in Part D IRMAA, in addition to the standard Part B premium and any Part D plan premium. For a couple, that is $13,872 in added Medicare cost for the year, driven entirely by a single 2024 line item.
The “twice over” in the title lives here: Part B and Part D each carry their own surcharge, and both spouses on Medicare each pay both. One sale, four surcharge lines on the household budget.
The appeal path most sellers get wrong
Form SSA-44 covers eight specific life-changing events: marriage, divorce or annulment, death of a spouse, work stoppage, work reduction, certain losses of income-producing property, loss of pension income, and employer settlement payment. A business sale by itself does not qualify. A Roth conversion does not qualify. A voluntary home sale does not qualify. Voluntary income spikes do not get you out of IRMAA, no matter how large.
The lever that may work for many sellers is work stoppage. If you closed the business or ended self-employment when the sale closed, SSA may allow a more recent tax year to determine IRMAA. When 2026 looks like a normal retirement year, filing SSA-44 with transfer, wind-down, or dissolution paperwork can reduce or erase the 2026 surcharge that the 2024 sale created.
Two second-order traps catch sellers later:
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The survivor bracket. When one spouse dies, the survivor may eventually file as single. The single IRMAA brackets are roughly half the joint brackets, so a widow or widower can have less room before surcharges apply. Death of a spouse is a qualifying SSA-44 event, but the lower single thresholds can still matter after the transition.
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Muni interest still counts. Sale proceeds parked in tax-exempt bonds may feel tax-free on the 1040, yet the interest lands in MAGI for IRMAA on line 2a. Tax-exempt interest from a sizable muni portfolio can add thousands of dollars to the number Medicare reads.
What to do
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If you sold in 2024 and stopped working the same year, consider filing SSA-44 under work stoppage with retirement, transfer, or dissolution paperwork attached. This is the main lever that can reduce a 2026 surcharge already appearing on your notice.
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If a sale is scheduled for 2026 or 2027, model the MAGI in advance. Splitting proceeds across two tax years through an installment sale may keep one or both years below a higher IRMAA tier, but the tax and legal structure needs to work apart from Medicare.
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If combined MAGI lands within $20,000 of a bracket edge, a fee-only advisor who models IRMAA alongside Roth conversions and Social Security taxation may be worth the cost. The interaction can produce high effective marginal rates on the last dollars of the sale.
A business sale closes once, but the Medicare bill it triggers can run for a full premium year. For a 2024 seller already seeing the charge in 2026, the next question is not whether the sale happened. It is whether a qualifying work stoppage or other allowed update lets SSA use a better income year.
Source note: 2026 Part B and Part D premium and IRMAA figures come from the CMS “2026 Medicare Parts A & B Premiums and Deductibles” fact sheet. SSA-44 qualifying events and evidence requirements come from Social Security Administration Form SSA-44 and SSA’s Program Operations Manual System guidance on IRMAA work stoppage.
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