IRMAA is determined by income from your income tax returns two years prior. This means that for your 2022 Medicare premiums, your 2020 income tax return was used. This amount is recalculated annually. The IRMAA surcharge is added to your 2022 premiums if your 2020 income was over $91,000 (or $182,000 if you’re married). But as discussed below, there’s an appeals process if your financial situation has changed.