Medicare · IRMAA · Age 63 and up
IRMAA Tax Planning: Keep Your Medicare Premiums Down
Medicare charges more for Part B and Part D once your income crosses set thresholds, and one dollar over can cost a married couple more than $2,000 a year. We project your income before you sell, convert or withdraw, so your return lands where you planned.
Monday to Friday 10am to 6pm, weekends 11am to 5pm.
How IRMAA works
The 2026 brackets.
Medicare’s income-related monthly adjustment amount (IRMAA) adds a surcharge to Part B and Part D premiums. Most of the thresholds rise with inflation each year.
a year more for a married couple $1 over $218,000 of joint income
a year more for a married couple in the top bracket
the lookback: the return you file now sets the premiums you pay two years from now
| Single | Married filing jointly | Part B per month | Part D surcharge per month | Extra per person per year |
|---|---|---|---|---|
| Up to $109,000 | Up to $218,000 | $202.90 | None | None |
| $109,001 to $137,000 | $218,001 to $274,000 | $284.10 | $14.50 | $1,148.40 |
| $137,001 to $171,000 | $274,001 to $342,000 | $405.80 | $37.50 | $2,884.80 |
| $171,001 to $205,000 | $342,001 to $410,000 | $527.50 | $60.40 | $4,620.00 |
| $205,001 to $499,999 | $410,001 to $749,999 | $649.20 | $83.30 | $6,355.20 |
| $500,000 and up | $750,000 and up | $689.90 | $91.00 | $6,936.00 |
Part D surcharges are added to your plan’s own premium. Married filing separately and lived with your spouse during the year: up to $109,000 pays the standard premium, $109,001 to $390,999 pays $649.20 plus an $83.30 Part D surcharge, and $391,000 and up pays $689.90 plus $91.00. Medicare publishes the 2027 figures, based on 2025 income, each fall, and we update this table when it does.
Where planning pays off
Six decisions that move your Medicare premiums.
Roth conversions
Converting in the years between retirement and Medicare, or sized each year to stop just under a threshold, can lower both your tax and your premiums for life.
Selling stock, a rental or a business
A large gain in one year can push you up two or three brackets. Spreading it over two tax years, an installment sale or harvesting losses can keep you lower.
Required minimum distributions
Once you are 70½, a qualified charitable distribution from your IRA goes straight to charity, counts toward your required distribution and stays out of your income.
Fund distributions
Mutual funds pay out capital gains each December whether you sold or not. We look at what is coming before year end.
The year you stop working
Your last year of salary can set your first Medicare premiums. We plan the timing, and if it is too late to plan, we look at a life-changing event request.
Social Security
When you start benefits changes how much of them is taxable, and taxable benefits count toward IRMAA.
Income already dropped
You do not always have to wait two years.
If your income dropped because of a life-changing event, you can ask Social Security to base your premiums on a more recent year instead of the one two years back. The request is made on Form SSA-44, with proof of the event and your estimated income.
We review whether your situation qualifies, and we give you the income figures for the form. You file it with Social Security.
If the premium is based on a return that was wrong or later amended, Social Security can update it once it has the corrected return.
How it works
From the first call to the return.
Free consultation
A short call to see what you are planning and whether we are a fit.
Your last two returns
They show where your income has been and which brackets you are already in.
A projection
This year’s income and the next two, with the Medicare bracket each one lands in.
Actions with dates
How much to convert, when to sell, how much to give from your IRA, and what to pay in estimates.
A year-end check
In November and December we compare the plan to what actually happened, while there is still time to adjust.
The return
Every return is prepared, reviewed and signed by a CPA, and we confirm your income landed where we planned.
Related
Where to go next.
Common questions
Questions about IRMAA.
What income does Medicare use?
Your modified adjusted gross income from the tax return two years earlier: adjusted gross income plus tax-exempt interest. 2026 premiums are based on your 2024 return.
When should IRMAA planning start?
The year you turn 63. Medicare starts at 65 and looks back two years, so the income on the return you file for age 63 sets your first premiums.
Is it all or nothing?
Yes. One dollar over a threshold puts you in the higher bracket for the whole year. That is why the size of a Roth conversion or a sale matters down to the dollar.
Do both spouses pay it?
Yes, each spouse on Medicare pays the surcharge separately, based on the joint income on the return. A married couple pays it twice.
Does a Roth conversion count?
Yes. The taxable amount converted counts as income in the year of the conversion. Qualified withdrawals from the Roth later do not count.
Do tax-free municipal bonds help?
Not for IRMAA. Tax-exempt interest is added back when Medicare figures your income, even though it is not taxed.
My income dropped after I retired. Am I stuck with the surcharge?
Not always. A work stoppage or reduction is a life-changing event. You can ask Social Security to use a more recent year on Form SSA-44, and we give you the income figures for it.
Is IRMAA a tax?
No. It is a surcharge on your Medicare premiums, usually taken out of your Social Security benefit. Your tax return is what sets it, so tax planning is how you control it.
Turning 63, or planning a big year?
The first consultation is free. Call before you convert, sell or retire, while the numbers can still change.