What is IRMAA and how do I avoid the surcharge?
Medicare & healthcare
IRMAA (Income-Related Monthly Adjustment Amount) is a Medicare premium surcharge for higher-income retirees. In 2026, it kicks in around $109,000 single / $218,000 married, and can add over $400/month per spouse to Medicare Parts B and D.
The two-year lookback that catches people off guard
IRMAA is based on your tax return from 2 years ago. Your 2026 IRMAA is determined by your 2024 modified adjusted gross income (MAGI). One large taxable event (Roth conversion, business sale, RMD year) can spike a year of premiums.
The cliff effect, $1 over costs hundreds
IRMAA is a hard cliff, not a phase-in. Crossing a tier by $1 costs the same as crossing it by $5,000. Tax-aware income management around the brackets is one of the highest-value moves in retirement planning.
Strategies that actually reduce IRMAA
Roth conversions in lower-income years (before 63 to avoid the lookback). Qualified Charitable Distributions (QCDs) from IRAs at 70½+ to satisfy RMDs without raising MAGI. Tax-loss harvesting. Coordinating capital gains across years. Filing Form SSA-44 after life events (retirement, spouse death) to request a redetermination.
What people often get wrong
- Doing a large Roth conversion at 63 without realizing it triggers IRMAA at 65
- Taking RMDs without using QCDs to offset
- Not filing SSA-44 after a qualifying life event
What to think about next
- Identify which IRMAA tier you're approaching for the next 2 years.
- Project your MAGI through age 75 and identify lookback windows.
- If you've had a life event that reduced income, file SSA-44.
When to consider working with a CFP®
Working with a CFP® can help when these decisions feel intertwined, taxes, investments, cash flow, and life goals tend to move together, and a planning relationship can offer structure, prioritization, and accountability over time.
Frequently Asked Questions
Can I appeal IRMAA?
Yes, for qualifying life-changing events: marriage, divorce, death of spouse, work stoppage, work reduction, loss of pension, or settlement payment from an employer.
Talk to a CFP® who works with high earners.
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