Medicare
How to Avoid IRMAA: 9 Moves That Actually Work
Nine proven ways to avoid IRMAA, from QCDs and Roth conversion timing to gain harvesting and Form SSA-44, ranked by how much they save on Medicare premiums.
Checked against primary sources from Social Security, Medicare and the IRS. How we check our numbers
IRMAA — the income-related monthly adjustment amount — is a surcharge on Medicare Part B and Part D premiums for people whose income passes set thresholds. It isn't a tax you can deduct your way out of at the end of the year. It's decided by your tax return from two years earlier, which is exactly why it can be planned for.
How does IRMAA work?
Social Security looks at your modified adjusted gross income (MAGI) — AGI plus tax-exempt interest — from two years back. For 2026 premiums, single filers with 2024 MAGI above $109,000 and joint filers above $218,000 pay more (SSA POMS).
The surcharge works like a cliff, not a ramp. One dollar over the first line adds $81.20 a month to Part B and $14.50 to Part D in 2026, per person, for the whole year (CMS). For a married couple that's well over $2,000 a year from one extra dollar.
The 2026 IRMAA tiers at a glance
Each tier adds a fixed amount per person to Part B and Part D. These are the 2026 figures, based on 2024 tax returns (CMS):
| Tier | Single MAGI above | Joint MAGI above | Part B add-on | Part D add-on |
|---|---|---|---|---|
| 1 | $109,000 | $218,000 | $81.20 | $14.50 |
| 2 | $137,000 | $274,000 | $202.90 | $37.50 |
| 3 | $171,000 | $342,000 | $324.60 | $60.40 |
| 4 | $205,000 | $410,000 | $446.30 | $83.30 |
| 5 | $500,000 | $750,000 | $487.00 | $91.00 |
The 9 moves, ranked
Ranked by how much they typically save for people near a line. Most are about controlling which year income lands in.
- Give through QCDs. From age 70½, a qualified charitable distribution sends IRA money straight to charity and keeps it out of AGI entirely. If you give anyway, it's the cleanest IRMAA tool there is — run it on the QCD calculator (IRS).
- Do Roth conversions before 63. Income at 63 sets premiums at 65. Conversions in your early 60s never touch IRMAA; later ones should stop just under a line — size them on the Roth conversion calculator.
- Time big capital gains. Spread a large sale over two tax years, or realize gains in a year with less other income. Selling a rental or a business in an installment sale can do this automatically.
- Harvest losses to offset gains in the same year. Up to $3,000 of net losses can also reduce ordinary income, and unused losses carry forward.
- Use Roth money for big one-time expenses — a roof, a car, a wedding — instead of extra IRA withdrawals.
- Spend from an HSA for medical costs, including Medicare premiums, instead of IRA money. HSA withdrawals for qualified costs never count as income.
- Shrink future RMDs with conversions now or a QLAC, so 73 doesn't push you over.
- Watch the line, not the bracket. Check projected thresholds two years out on the 2028 IRMAA brackets page before any discretionary income.
- File Form SSA-44 after a life-changing event such as retirement, divorce or a spouse's death.
A worked example
A married couple, both on Medicare, expects joint MAGI of $222,000 in 2026 — $4,000 over the first line that applied for 2026 premiums. In tier 1 they'd each pay the Part B and Part D add-ons, a little over $2,290 a year for the two of them at 2026 rates. They give $5,000 to their church every year by check.
Making that gift as a QCD instead drops MAGI to $217,000, under the line, and saves the whole surcharge — for a gift they were going to make anyway.
The same couple could get the same result by moving $5,000 of a planned Roth conversion into the next year, or by realizing a capital gain in January instead of December.
How to Reduce IRMAA After You Have Been Hit
If you've already received an IRMAA letter, three routes can lower it. The best one depends on why your income was high.
- Your income dropped because of a life-changing event — you stopped working, lost a pension, divorced or were widowed. File Form SSA-44 with your newer income or an estimate (SSA).
- Social Security used the wrong return, or you've filed an amended one: ask for a reconsideration.
- It was a one-time spike, like selling a house: there's no appeal, but IRMAA is recalculated every year, so it will drop off once that tax year rolls out of the two-year window.
The IRMAA timeline by age
Because of the two-year lookback, the decisions that matter most happen before Medicare even starts. Knowing which tax year feeds which premium year turns IRMAA from a surprise into a schedule. Here's the sequence most retirees face:
- Age 63: the first tax year that counts. A large severance, a home sale or a big Roth conversion at 63 shows up in your premiums at 65.
- Ages 63–72: the "gap years" for Roth conversions, ideally sized to stop under a line.
- Age 70½: QCDs become available — the best tool for anyone who gives to charity.
- Age 73 or 75: required minimum distributions begin and can push a large IRA over a threshold for the rest of your life.
- The year after a spouse dies: the survivor files single, and the single thresholds are half the joint ones.
Should you ever accept IRMAA?
Sometimes, yes. If a Roth conversion saves you 10 percentage points of tax on $100,000 over the following decades, paying one year of a tier-1 surcharge — well under $1,200 per person at 2026 rates — can be the better deal. The point is to cross a line on purpose, for a reason, not by accident. The Roth conversion calculator shows both sides.
What doesn't work
Some popular ideas don't help. Tax-free municipal bond interest is added back into MAGI for IRMAA. Giving cash to charity doesn't lower AGI, even if you itemize. And switching to Medicare Advantage doesn't avoid IRMAA — the Part B and Part D surcharges apply either way.
Two subtler ones: the taxable part of your Social Security is in MAGI, so a larger benefit can nudge you over a line, and moving money into a deferred annuity only postpones the income — the gains count in the year you take them out. Neither is a reason to change course, but both belong in the projection.
Our take
The cheapest IRMAA fix is a calendar. Know your two-year-ahead line, schedule discretionary income around it, and leave a few thousand dollars of cushion because the next year's thresholds aren't final until the fall. Start with your current tier on the IRMAA calculator. For conversions specifically, see our Roth conversion strategy for retirees.