IRMAA — the Income-Related Monthly Adjustment Amount — is a surcharge added to Medicare Part B and Part D premiums for individuals whose income exceeds certain thresholds. Because United Airlines pilots typically earn $250,000 or more annually during their final working years, many may face significant IRMAA surcharges in the years immediately after retirement. Medicare determines premiums using income from the previous two tax years, which means a pilot who retires at 65 in 2026 may have premiums based on 2024 peak earnings. Filing Form SSA-44 lets you request a reduction.