How IRA Withdrawals Can Raise Your Medicare Premiums

Withdrawing money from a traditional IRA can raise your Medicare premiums, because the distribution counts as taxable income and feeds into the Income-Related Monthly Adjustment Amount, or IRMAA, that Social Security uses to set your Part B and Part D costs. Qualified Roth IRA withdrawals do not have that effect. The catch that surprises most retirees is the timing: Medicare uses your tax return from two years earlier, so an IRA withdrawal today shows up in your premiums two years later.¹

Why the Account Type Matters More Than the Amount

Every dollar withdrawn from a traditional IRA is included in your gross income because the money went in untaxed.² A $50,000 distribution adds $50,000 to your adjusted gross income for the year, and that AGI flows straight into the modified adjusted gross income (MAGI) figure Social Security uses to determine your Medicare premiums.

Qualified distributions from a Roth IRA are not included in gross income.² They don’t appear on your tax return as income, so they don’t factor into MAGI and don’t trigger IRMAA. A distribution qualifies as long as you’re at least 59½ and the Roth has been open at least five years.

Roth conversions are a different story. Moving money from a traditional IRA into a Roth is a taxable event in the year of the conversion. A $100,000 conversion adds $100,000 to that year’s AGI and can raise your IRMAA two years later, even though the resulting Roth balance won’t cause any premium problems when you eventually withdraw it.

How IRMAA Turns Income Into Higher Premiums

Everyone on Medicare pays the standard Part B premium, which is $202.90 per month in 2026. Beneficiaries above certain income thresholds pay an added monthly surcharge on both Part B and Part D.³ That surcharge is IRMAA, calculated from your MAGI two years back. Your 2026 premiums are based on the income you reported on your 2024 return.

IRMAA brackets are cliffs, not slopes. A single dollar over a threshold triggers the full surcharge for that tier. Going from $109,000 to $109,001 in MAGI as a single filer adds $81.20 per month in Part B costs plus $14.50 in Part D costs — an extra $1,148.40 over the year for one dollar of income.³

2026 IRMAA Brackets for Single Filers

$109,000 or less: no surcharge
$109,001 to $137,000: $81.20 Part B + $14.50 Part D
$137,001 to $171,000: $202.90 Part B + $37.50 Part D
$171,001 to $205,000: $324.60 Part B + $60.40 Part D
$205,001 to $499,999: $446.30 Part B + $83.30 Part D
$500,000 or more: $487.00 Part B + $91.00 Part D

2026 IRMAA Brackets for Married Filing Jointly

$218,000 or less: no surcharge
$218,001 to $274,000: $81.20 Part B + $14.50 Part D
$274,001 to $342,000: $202.90 Part B + $37.50 Part D
$342,001 to $410,000: $324.60 Part B + $60.40 Part D
$410,001 to $749,999: $446.30 Part B + $83.30 Part D
$750,000 or more: $487.00 Part B + $91.00 Part D

At the top tier, a single filer pays $689.90 per month for Part B alone (the $202.90 standard plus $487.00 surcharge) and an additional $91.00 for Part D, which works out to $6,936 more per year than someone below the first threshold.³

MAGI for IRMAA is your AGI plus any tax-exempt interest income.¹ Municipal bond interest that many retirees assume is invisible for premium purposes gets added back in. IRA distributions do too, in full.

Required Minimum Distributions Force the Issue

Once you reach age 73, the IRS requires annual withdrawals from your traditional IRA whether you need the money or not.⁴ Under the SECURE 2.0 Act, those born in 1960 or later won’t face RMDs until age 75, but anyone reaching 73 between now and 2032 is on the current schedule. Every dollar of an RMD is taxable, and RMD amounts grow each year because they’re calculated by dividing your account balance by an IRS life expectancy factor. A larger balance means a larger mandatory withdrawal, which means a bigger MAGI bump and a greater chance of crossing an IRMAA line.

The First-Year RMD Trap

Your first RMD can be delayed until April 1 of the year after you turn 73, but taking the delay stacks two RMDs into one tax year: the delayed first-year distribution plus the regular distribution due by December 31.⁵ Both count as income in that single year, potentially doubling the MAGI increase and pushing you into a higher IRMAA bracket two years later. Taking the first RMD in the year you actually turn 73 avoids the pileup.

Ways to Blunt the IRMAA Effect

Roth Conversions in Low-Income Years

The years between retirement and age 73, before Social Security or RMDs start, are often a window of unusually low taxable income. Converting portions of a traditional IRA to a Roth during that window lets you pay income tax at a lower rate and move money into an account that won’t affect future Medicare premiums.

Size conversions carefully. Because IRMAA brackets are cliff-based, a conversion that pushes MAGI just past a threshold costs far more in Medicare surcharges than one that stops just below it. Because of the two-year lookback, conversions done before age 63 won’t affect premiums at all if you enroll in Medicare at 65.

Qualified Charitable Distributions

If you’re 70½ or older and planning to give to charity anyway, a Qualified Charitable Distribution lets you send up to $111,000 per year directly from your traditional IRA to a qualifying charity.⁶ The transferred amount satisfies your RMD for the year but is not included in your gross income.⁷ Because it never touches AGI, it never touches MAGI or IRMAA.

The transfer must go directly from your IRA custodian to the charity. If the money passes through your hands, even briefly, it becomes a regular taxable distribution. QCDs are only available from traditional IRAs, not from employer plans like 401(k)s.

Spreading Distributions Across Tax Years

Rather than one large lump-sum withdrawal, splitting a planned distribution across two calendar years divides the income between two future IRMAA assessments. If you need $80,000, taking $40,000 in December and $40,000 in January puts the income on two tax returns and can keep MAGI below a bracket boundary in each year.

Appealing an IRMAA Determination After a Life Change

If your income has dropped substantially since the tax year Social Security is using, you can ask for a reduction by filing Form SSA-44.⁸ You have to show that the drop came from one of eight qualifying life-changing events:

Marriage
Divorce or annulment
Death of a spouse
Work stoppage, meaning full retirement or job loss
Work reduction, meaning a move to part-time or reduced hours
Loss of income-producing property from a disaster, fraud, or other involuntary loss
Loss of pension income
Employer settlement payment tied to employer bankruptcy

You’ll need documentation matching the event along with a recent return or income estimate. Filing is by mail or through your local Social Security office; the general number is 1-800-772-1213.⁸

A common scenario: you retired in 2024, your income fell sharply, but your 2026 IRMAA still reflects your pre-retirement earnings. Retirement counts as a work stoppage, so you can ask Social Security to use your current, lower income instead. Simply choosing to take a smaller IRA distribution than you did in the lookback year is not a qualifying event. The reduction has to come from one of the eight categories.

1
Social Security Administration. Modified Adjusted Gross Income (MAGI)
2
Office of the Law Revision Counsel. 26 U.S. Code 408A – Roth IRAs
3
Centers for Medicare & Medicaid Services. 2026 Medicare Parts B Premiums and Deductibles
4
Internal Revenue Service. Retirement Plan and IRA Required Minimum Distributions FAQs
5
Internal Revenue Service. IRS Reminder to Many Retirees – Last Day to Start Taking Money Out of IRAs and 401(k)s Is April 1
6
Internal Revenue Service. 2026 Amounts Relating to Retirement Plans and IRAs
7
Internal Revenue Service. Seniors Can Reduce Their Tax Burden by Donating to Charity Through Their IRA
8
Social Security Administration. Medicare Income-Related Monthly Adjustment Amount – Life-Changing Event