IRMAA increases Medicare Part B and Part D premiums when modified adjusted gross income exceeds set thresholds. The surcharge is determined using a two-year lookback, so income in the conversion year affects premiums in a later year. A couple retiring at 64 stops working and performs a one-time $300,000 traditional IRA to Roth conversion. Their conversion-year MAGI becomes $380,000, placing them in a higher IRMAA tier for the premium year. IRMAA uses income “stair steps,” where being one dollar above a threshold moves both spouses into the next tier for the full year. The result is thousands of dollars in additional premiums per year.
"IRMAA is the surcharge Medicare adds to Part B and Part D premiums when modified adjusted gross income exceeds certain thresholds. The catch is the lookback: premiums in 2028 are priced off the 2026 tax return. The year you do the conversion is the year that haunts you, and you do not see the bill until two birthdays later."
"IRMAA works as a staircase with cliffs. One dollar over a threshold moves both spouses into the next tier for the full year. For married filing jointly in 2026, the tiers look like this: $218,000 or less means no surcharge; $218,001 to $274,000 costs roughly $2,297 per couple; $274,001 to $342,000 costs about $5,772; $342,001 to $410,000 costs about $9,240; $410,001 to $749,999 costs about $14,000 per couple per year."
"They move $300,000 from a traditional IRA into a Roth in one clean transaction, pay the federal tax bill, and feel good about locking in tax-free growth. Eighteen months later, the Social Security Administration sends a letter saying their Medicare Part B premium will jump several hundred dollars per month, per spouse. They never saw it coming."
"At $380,000 MAGI, our couple lands squarely in the $342,001 to $410,000 tier. Their combined Part B and Part D surcharge runs about $9,240 for the affected premium year, on top of the federal income ta"
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