Retirement Planning · Tax Planning
Avoid IRMAA Surcharges: A 2026 Medicare Premium Playbook for Retirees
IRMAA can add thousands of dollars to your Medicare bill — often triggered by a single financial decision made two years earlier. Here is how to avoid IRMAA surcharges in 2026, with the real bracket numbers and the planning strategies that actually work.
Gerry Barrasso, CPA, CFP®, PFS
President & Founder, United Financial Planning Group
May 7, 2026 · 12 min read
What Is IRMAA?
The Medicare Surcharge Most Retirees Don't See Coming
IRMAA — the Income-Related Monthly Adjustment Amount — is an additional charge on top of standard Medicare Part B and Part D premiums, applied to beneficiaries whose income exceeds certain thresholds. According to the Centers for Medicare and Medicaid Services (CMS), the 2026 base Medicare Part B premium is $185.00 per month. For retirees whose Modified Adjusted Gross Income (MAGI) crosses specific bracket boundaries, that number rises — significantly.
What makes IRMAA particularly disruptive is its two-year look-back: your 2026 Medicare premiums are determined by your 2024 tax return. A Roth conversion, a large capital gain, or an unexpectedly high RMD taken in 2024 can push your 2026 premiums into a higher tier — with no warning until your Medicare statement arrives.
The good news: IRMAA is largely a planning problem. When your CPA and financial planner are modeling income decisions together — before you act — crossing a bracket boundary is avoidable far more often than most retirees realize.
Key 2026 IRMAA Facts
- 1 2024 income determines 2026 premiums. The SSA uses your 2024 MAGI from your federal tax return filed in 2025.
- 2 Five surcharge tiers exist for both Part B and Part D, with thresholds starting at $106,000 (individual) or $212,000 (MFJ).
- 3 Maximum additional Part B cost: $443.90 per person per month at the highest tier — over $5,300 per year, per person.
- 4 IRMAA is recalculated annually. A one-year income spike — from a large conversion or asset sale — can trigger a surcharge that goes away the following year.
- 5 You can appeal an IRMAA determination if your income has dropped due to a qualifying life-changing event.
2026 IRMAA Brackets
The Exact Thresholds and Surcharges for 2026
Source: Centers for Medicare and Medicaid Services (CMS), 2026. Figures shown are monthly amounts per person. Part D surcharges vary by plan.
| 2024 MAGI — Individual | 2024 MAGI — Married Filing Jointly | Monthly Part B Premium | IRMAA Added (Part B) |
|---|---|---|---|
| Up to $106,000 | Up to $212,000 | $185.00 | $0 (base rate) |
| $106,001 – $133,000 | $212,001 – $266,000 | $259.00 | + $74.00/mo |
| $133,001 – $167,000 | $266,001 – $334,000 | $370.00 | + $185.00/mo |
| $167,001 – $200,000 | $334,001 – $400,000 | $444.90 | + $259.90/mo |
| $200,001 – $500,000 | $400,001 – $750,000 | $555.90 | + $370.90/mo |
| Above $500,000 | Above $750,000 | $628.90 | + $443.90/mo |
Note: A separate set of IRMAA brackets applies to Medicare Part D. Married Filing Separately filers face a compressed bracket structure. Figures sourced from CMS 2026 Medicare fact sheet. Individual circumstances vary.
The Root Cause
IRMAA Is Not a Medicare Problem. It Is a Tax Coordination Problem.
Most retirees who get hit with an unexpected IRMAA surcharge were not careless. They made reasonable financial decisions — a Roth conversion recommended by their financial advisor, a portfolio rebalance that triggered capital gains, or an RMD that landed larger than expected. What they lacked was a planning team that saw all three of those decisions together, in the same conversation, before they were executed.
Here is why this happens so often: your financial advisor recommends a Roth conversion in October. It makes mathematical sense in isolation. Your CPA files your tax return in April and dutifully reports the conversion. Nobody checked whether that conversion amount, stacked on top of your other income, crossed an IRMAA threshold. Eighteen months later, your Medicare statement shows a surcharge you never planned for.
At United Financial Planning Group, our CPA and CFP® work together on the same client team. Before we recommend a Roth conversion, we model its impact on your MAGI — including the Medicare premiums it may trigger two years from now. That is not a bonus service. It is how integrated planning is supposed to work.
The Roth Conversion Blind Spot
Advisor recommends $80,000 Roth conversion. Social Security income, RMD, and investment income already put MAGI at $100,000. The conversion pushes MAGI to $180,000 — crossing two IRMAA brackets. Additional Medicare cost: over $3,100 per year, per person.
The RMD Bracket Push
Required minimum distributions are taxable as ordinary income and count toward MAGI. As IRA balances grow through retirement, annual RMDs can push retirees across IRMAA thresholds they never anticipated — even without any active financial decisions in a given year.
The Capital Gain Surprise
A portfolio rebalance, the sale of a second home, or the exercise of stock options can generate a one-year MAGI spike that triggers IRMAA for the following two years — even if your income returns to normal immediately after. Timing these events matters enormously.
The scenarios above are hypothetical illustrations for educational purposes only. They do not represent actual client outcomes. Individual results vary based on personal circumstances.
How to Avoid IRMAA Surcharges
Five Strategies That Actually Work in 2026
Each of these strategies requires visibility into your complete income picture. The most effective ones involve decisions made in the calendar year two years before your next Medicare anniversary — not after the fact.
Size Your Roth Conversions Against Your IRMAA Bracket — Not Just Your Tax Bracket
Roth conversions are one of the most powerful retirement planning tools available, but they directly increase MAGI in the year of conversion. Before converting, your planning team should model your total projected MAGI for the year — including Social Security income, RMDs, dividends, capital gains, and any other sources — and determine how much conversion room exists before crossing the next IRMAA tier. Converting $1 too many dollars could cost thousands in surcharges over the following year. Sized correctly, conversions reduce long-term tax liability while staying IRMAA-neutral.
Individual tax situations vary. Roth conversions involve trade-offs and may not be appropriate for all retirees. Consult a qualified tax professional.
Use Qualified Charitable Distributions (QCDs) to Reduce Taxable RMD Income
If you are age 70½ or older and charitably inclined, Qualified Charitable Distributions allow you to transfer up to $105,000 per person directly from an IRA to a qualifying charity in 2026 — satisfying all or part of your RMD without the distribution being counted in your MAGI. Because QCDs bypass your taxable income entirely, they can reduce your MAGI dollar-for-dollar compared to taking the RMD as taxable income and donating separately. For retirees near an IRMAA threshold, a well-sized QCD can keep Medicare premiums at the base rate.
Coordinate Capital Gains Realizations and Investment Income Timing
Capital gains — whether from selling securities, real estate, or business interests — count toward MAGI. In years when your other income already sits near an IRMAA threshold, realizing a large gain can push you into a higher surcharge tier. Strategies to consider include spreading asset sales across multiple years, harvesting capital losses to offset gains, or deferring a sale to a year when other MAGI components are lower. Bond interest, dividend income, and partnership distributions also contribute to MAGI and should be factored into threshold modeling before year-end.
Draw Down Pre-Tax Accounts Earlier to Reduce Future RMD Burden
Large pre-tax IRA and 401(k) balances compound a long-term IRMAA problem: as balances grow, required minimum distributions increase, and so does MAGI — often past IRMAA thresholds that were comfortably manageable earlier in retirement. A multi-year strategy of drawing down pre-tax accounts through Roth conversions or additional distributions in lower-income years can meaningfully reduce future RMDs and, with them, future IRMAA exposure. This strategy requires projecting income and Medicare costs 10 to 20 years forward — the kind of modeling that integrates tax planning and retirement income planning in a single coordinated analysis.
Appeal a Surcharge When Your Income Has Dropped Due to a Life-Changing Event
If your income has declined significantly since the year Medicare is using to calculate your IRMAA — due to retirement, the death of a spouse, divorce, loss of income-producing property, or employer settlement — you may be eligible to have your surcharge recalculated using more recent income. File SSA Form SSA-44 ("Medicare Income-Related Monthly Adjustment Amount — Life-Changing Event") with the Social Security Administration, along with documentation of your changed circumstances and a reasonable estimate of your current income. Successful appeals can eliminate or substantially reduce the IRMAA surcharge for the current year.
The Cost of Disconnected Advice
What IRMAA Can Cost a Couple Over a 20-Year Retirement
These are illustrative scenarios, not guaranteed outcomes. Individual results depend on income, tax situation, and Medicare enrollment. Results vary.
$888
Additional annual Part B cost at Tier 1
(per person, $74/mo surcharge)
$8,902
Additional annual Part B cost at Tier 5
(per person, $443.90/mo surcharge)
$178K+
Potential 20-year cost for a couple both at Tier 5
(hypothetical illustration only)
Proactive IRMAA planning — particularly Roth conversion sizing and RMD management — may help reduce this exposure over time, depending on individual circumstances. Outcomes are not guaranteed.