How to Avoid the Medicare IRMAA Premium Hit

If you’re a high earner approaching the Medicare age of 65 or are already receiving these benefits, you may have to pay a surcharge on your Medicare Part B and Medicare Part D premiums.

This is known as the income-related monthly adjustment amount (IRMAA). And it could mean you’d pay more than twice as much for Medicaid than the average citizen.

That’s because the Social Security Administration (SSA) determines who pays IRMAA and by what amount based on their modified adjusted gross income (MAGI) from two years prior.

So you may owe IRMAA in 2026 if your 2024 MAGI exceeded $109,000 as an individual filer or if it breached $218,000 as a couple filing a joint federal tax return.

The standard monthly premium for Medicare Part B in 2026 is $202.90. The actual IRMAA for high earners is determined by how much 2024 MAGI exceeded those thresholds we mentioned. For Medicare Part B premiums, the 2026 IRMAA can range from $284.10 to $689.90.

But IRMAA also can increase your Medicare Part D premiums. If eligible, you must pay an IRMAA on your Medicare Part D premiums whether you get it through a Medicare Advantage plan or as a stand-alone Part D plan.

Medicare Part D premiums vary depending on your plan. The 2026 IRMAA on your Medicare Part D is also determined by how much your 2024 MAGI exceeded those thresholds we mentioned. It can range from an extra $14.50 to $91.00.

So as you can see, you need to keep your MAGI low to avoid IRMAA down the road. You can take action today to reduce or avoid IRMAA in 2028.

So it may be a good idea to maximize these accounts. Contribution limits vary across accounts and can change each year.

For 2026, the contribution maximum for traditional IRAs is $7,500 or $8,600 if you’re 50 or older.

And for 2026, the employee contribution maximum for a traditional 401(k) is $24,500. Those age 50 or older can make an additional $8,000 catch-up contribution for a total maximum of $32,500.

And in 2026, your employer may allow for a “super” catch-up contribution for those age 60–63. In this case, you can make a “super” catch-up contribution of $11,250 instead of the standard $8,000 catch-up contribution. This super catch up contribution would bring the traditional 401(k) maximum contribution to $35,750 for those aged 60–63.

But you don’t need to take RMDs from a Roth IRA. And you can convert part or all of the funds in a traditional IRA to a Roth IRA. However, you’d owe regular income taxes on the amount converted.

That’s why many advisers recommend you engage in a Roth conversion during your gap years. This is the period between retirement and age 73, when RMDs begin. Most likely, you’d find yourself in a low tax bracket during this time frame. So you could potentially owe a small amount of tax on the conversion, and it wouldn’t be likely for it to increase your MAGI to IRMAA territory.

But this doesn’t always work for everyone, so be sure to work with a qualified financial advisor when taking this approach.

So let’s say your RMD this year is $111,000. You’d need to take it and it would increase your MAGI, potentially triggering an IRMAA down the road. But you can instead donate it via a QCD and it won’t count toward your MAGI.

If your appeal is denied, you can reach out to the Office of Medicare Hearings and Appeals (OMHA) within 60 days of the date of your reconsideration denial. In this case, you may want to hire a lawyer.