How to Lower Your Medicare Part B Premiums in Retirement

In 2026 a retired couple with a modified adjusted gross income of just $206,000 will pay an extra $5,580 a year in Medicare premiums because of the income related monthly adjusted amount surcharge. That is real money taken from the budget you worked so hard to build.

Medicare looks back two years to set your premiums so the income you report on your 2024 tax return decides what you pay in 2026. The good news is that several legal steps can bring your modified adjusted gross income under the thresholds and cut those surcharges.

Jane Bryant Quinn here with concrete ways to protect your wallet from these surprise costs.

What Triggers the Medicare IRMAA Surcharge

Medicare uses your modified adjusted gross income from two years earlier to set Part B and Part D premiums. For 2026 the base Part B premium is $185 a month for individuals with income of $106,000 or less and for couples with income of $212,000 or less.

Once income crosses those lines the surcharges start. A single person with income between $106,001 and $133,000 pays $74 extra per month in 2026. The highest tier adds $419.30 per month for incomes above $500,000.

Couples face the same brackets but at double the income levels. These surcharges apply even if you receive Social Security. The Social Security Administration sends you a letter each fall telling you what your premium will be the next year.

You have the right to appeal if your income dropped because of certain life changing events such as retirement, divorce, or death of a spouse.

Roth Conversions Done Early Can Save Thousands

Converting traditional IRA money to a Roth IRA in your 60s can keep future required minimum distributions from pushing you into higher IRMAA brackets. Suppose you are 63 and expect to start Social Security and required minimum distributions at 73.

A series of partial Roth conversions over the next few years can fill the lower tax brackets now and reduce the taxable income Medicare will see later. Each conversion counts as taxable income in the year you make it so you must plan the amounts carefully.

For example converting $40,000 in a year when your other income is low may keep you under the $106,000 single threshold. After age 73 you no longer control the size of your distributions so acting before then matters.

The five year clock on Roth withdrawals also starts earlier giving you more flexibility.

Qualified Charitable Distributions Reduce Countable Income

Once you reach age 70 and a half you can direct up to $105,000 a year from your traditional IRA straight to a charity. That amount counts toward your required minimum distribution but does not show up in adjusted gross income.

Because modified adjusted gross income starts with adjusted gross income these gifts can drop you below an IRMAA bracket. In 2024 the limit was $105,000 and it usually rises with inflation.

You must ask your IRA custodian to send the check directly to the qualified charity. The custodian will send you a Form 1099 R but you will not report the distribution as income if it went to charity.

This move works only for traditional IRAs not for 401(k) plans or Roth IRAs. Many retirees use it to support their church or favorite nonprofit while protecting their Medicare premiums.

Timing Capital Gains and Taxable Account Withdrawals

Large sales of stocks or mutual funds can create a one year income spike that raises premiums for two years. If you plan to sell a big block of appreciated shares consider spreading the sales over several years.

You can also harvest losses in the same year to offset gains. Withdrawals from taxable brokerage accounts do not count as income but the dividends and interest they throw off do.

Moving some of those holdings into tax free municipal bonds can cut your modified adjusted gross income. A couple who normally earns $180,000 from pensions and Social Security might add $50,000 from a stock sale and jump into the first surcharge tier.

By selling half in one year and half the next they may stay under the $212,000 line both years.

Life Changing Event Appeals

If your income has fallen because of retirement, marriage, divorce, or the death of a spouse you can ask Medicare to use your current income instead of the two year old figure. You file Form SSA 44 with the Social Security Administration and provide proof such as a retirement letter or divorce decree.

政府のデータによると、2023 年には 60,000 人以上がこの異議申し立てプロセスを利用して成功しました。このフォームには、8 つの具体的な対象となるイベントがリストされています。退職は、仕事を完全にやめるか、時間を短縮して大幅な給与を支払った場合にのみカウントされます。 |||9月||| メディケアは、30 ～ 60 日以内にリクエストを審査します。承認された場合、より低い保険料は承認の翌月から始まり、遡って適用することができます。 |||9月||| 退職後の健康貯蓄口座の使用 |||9月||| 健康貯蓄口座からは、年齢に関係なく医療費に非課税でお金を引き出すことができます。これらの引き出しは修正調整後総収入にはカウントされません。メディケア保険料を口座から直接支払うことは 65 歳以降にのみ許可されており、支払い自体によって IRMAA の目的で収入が減少することはありません。 |||9月||| ただし、この口座を他の自己負担の医療費の支払いに使用すると、課税口座から得られる可能性のある他の現金が解放されます。退職者の中には、メディケアの計算のために収入を減らしたい場合に、意図的に医療貯蓄口座を取り崩す人もいます。 |||9月||| フィデリティ・インベストメンツによると、65歳で退職する平均的な夫婦は医療費として約31万5,000ドルが必要となるため、この口座は有用な役割を果たすことができる。 |||9月||| 60代ですべてをまとめる |||9月||| 62 年から 70 年の間が、行動を起こすのに最適な時期となります。 IRMAA を回避するために収入を管理しながら、社会保障を遅らせて後で給付額を増やすことができます。多くの人は社会保障を遅らせても65歳でメディケアを申請します。 |||9月||| その時点で、最初に必要な最低分配金（73歳）までは2年あります。その時間を利用して、Roth口座に変換し、IRAから慈善寄付をし、課税対象の投資収入を削減します。 |||9月||| 税務ソフトウェアを使用して修正後の調整総収入を毎年追跡することで、次のブラケットにどれだけ近づいているかを確認できます。 2026年の枠はシングルが106,000ドルと133,000ドル、カップルが212,000ドルと266,000ドルです。 |||9月||| 小さな変更を加えることで、これらの境界線の正しい側に留まることができます。 |||9月||| 2026 年の IRMAA の最初の段階にあるカップルの年間追加費用 |||9月||| 2026 年の標準月額メディケア パート B 保険料 |||9月||| 2026 年のパート B 月額最高割増料金 |||9月||| 長年の納税申告書に基づいてメディケアを見直して保険料を設定する |||9月||| IRA からの年間最大適格慈善寄付金 |||9月||| 近年提出されたIRMAA控訴の成功例 |||9月||| 2026 年メディケア パート B IRMAA ブラケット |||9月||| シングル: 106,000ドル以下 |||9月||| 追加料金0ドル |||9月||| シングル: >06,000～>33,000 |||9月||| $74/月 |||9月||| シングル: >33,000～>67,000 |||9月||| >85/月 |||9月||| カップル：212,000ドル以下 |||9月||| カップル: <12,000～<66,000 |||9月||| カップル: <66,000～$334,000 |||9月||| 出典: メディケアおよびメディケイド サービス センター、2025 年の発表 |||9月||| 2026 年の IRMAA 月額追加料金 |||9月||| 収入 シングル |||9月||| 収入共同 |||9月||| パートBエクストラ |||9月||| パート D 番外編 |||9月||| 106,000ドル以下 |||9月||| 212,000ドル以下 |||9月||| 500,000ドル以上 |||9月||| 750,000ドル以上 |||9月||| メディケア保険料を下げるには計画が必要ですが、節約は何年も続きます。過去 2 回の納税申告書を取得し、来年の収入を見積もることから始めます。税務ソフトウェアまたはメディケアのルールに精通した財務アドバイザーを使用して数値を計算します。 |||9月||| Roth への改宗や適格な慈善活動のような小さな一歩を踏み出すことで、枠内に留まり、年間数千ドルを守ることができます。社会保障に関する悪い知らせが届くまで待ってはいけません。 |||9月||| 60代から70代前半までは収入をコントロールできるうちに行動しましょう。将来のあなたは、退職後の予算に余分なお金が入ってくれたことに感謝するでしょう。 |||9月||| 情報源 |||9月||| メディケアおよびメディケイド サービス センター、「2026 年のメディケア保険料と IRMAA ブラケット」(2025 年) |||9月||| 社会保障局、「フォーム SSA-44 指示」(2024) |||9月||| フィデリティ・インベストメンツ、「退職者の医療費の見積もり」（2025 年更新） |||9月||| 内国歳入庁、「IRA 分配に関する出版物 590-B」(2024) |||9月||| Medicare.gov、「IRMAA と人生を変える出来事」公式ページ (2025) |||9月||| さらに深く進む |||9月||| メディケアの修正調整後総収入とは正確には何ですか?

Medicare will review your request within 30 to 60 days. If approved the lower premium starts the month after approval and can be applied retroactively.

Using a Health Savings Account in Retirement

You can withdraw money from a health savings account tax free for medical costs at any age. Those withdrawals do not count toward modified adjusted gross income. Paying Medicare premiums directly from the account is allowed only after age 65 and the payment itself does not reduce your income for IRMAA purposes.

However using the account to pay other out of pocket medical bills frees up other cash that might otherwise come from taxable accounts. Some retirees deliberately draw down their health savings account in years when they want to lower their income for Medicare calculations.

The average couple retiring at 65 needs roughly $315,000 for health care costs according to Fidelity Investments so the account can play a useful role.

Putting It All Together in Your 60s

The years between 62 and 70 offer the best window to act. You can delay Social Security to increase your benefit later while you manage income to avoid IRMAA. Many people file for Medicare at 65 even if they delay Social Security.

At that point you have two years before the first required minimum distribution at 73. Use that time to convert to Roth accounts, make charitable gifts from IRAs, and reduce taxable investment income.

Track your modified adjusted gross income each year with tax software so you can see how close you are to the next bracket. The 2026 brackets are $106,000 and $133,000 for singles and $212,000 and $266,000 for couples.

Small changes can keep you on the right side of those lines.

Lowering your Medicare premiums takes planning but the savings last for years. Start by pulling your last two tax returns and estimating next year's income. Run the numbers with tax software or a financial adviser who knows Medicare rules.

Small steps such as a Roth conversion or a qualified charitable distribution can keep you under the brackets and protect several thousand dollars a year. Do not wait until the Social Security letter arrives with bad news.

Act while you still control your income in your 60s and early 70s. Your future self will thank you for the extra money in your retirement budget.

Sources

• Centers for Medicare and Medicaid Services, 'Medicare Premiums and IRMAA Brackets for 2026' (2025)
• Social Security Administration, 'Form SSA-44 Instructions' (2024)
• Fidelity Investments, 'Retiree Health Care Cost Estimate' (2025 update)
• Internal Revenue Service, 'Publication 590-B on IRA Distributions' (2024)
• Medicare.gov, 'IRMAA and Life-Changing Events' official page (2025)