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.
Em 2023, mais de 60.000 pessoas utilizaram com sucesso este processo de recurso, de acordo com dados do governo. O formulário lista oito eventos de qualificação específicos. A aposentadoria só conta se você parar completamente de trabalhar ou reduzir seu horário e pagar substancialmente. |||SET||| O Medicare analisará sua solicitação dentro de 30 a 60 dias. Se aprovado, o prêmio mais baixo começa no mês seguinte à aprovação e pode ser aplicado retroativamente. |||SET||| Usando uma conta poupança de saúde na aposentadoria |||SET||| Você pode sacar dinheiro de uma conta poupança de saúde sem impostos para despesas médicas em qualquer idade. Essas retiradas não contam para a renda bruta ajustada modificada. O pagamento dos prêmios do Medicare diretamente da conta só é permitido após os 65 anos e o pagamento em si não reduz sua renda para fins do IRMAA. |||SET||| No entanto, usar a conta para pagar outras contas médicas do próprio bolso libera outro dinheiro que, de outra forma, poderia vir de contas tributáveis. Alguns reformados retiram deliberadamente a sua conta poupança de saúde nos anos em que pretendem reduzir o seu rendimento para os cálculos do Medicare. |||SET||| O casal médio que se reforma aos 65 anos precisa de cerca de 315.000 dólares para custos de cuidados de saúde, de acordo com a Fidelity Investments, para que a conta possa desempenhar um papel útil. |||SET||| Juntando tudo aos 60 anos |||SET||| Os anos entre 62 e 70 oferecem a melhor janela para agir. Você pode atrasar o Seguro Social para aumentar seu benefício mais tarde, enquanto gerencia a renda para evitar o IRMAA. Muitas pessoas solicitam o Medicare aos 65 anos, mesmo que atrasem o Seguro Social. |||SET||| Nesse ponto, você tem dois anos antes da primeira distribuição mínima exigida de 73. Use esse tempo para converter para contas Roth, fazer doações de caridade de IRAs e reduzir a receita tributável de investimentos. |||SET||| Acompanhe sua renda bruta ajustada modificada a cada ano com um software tributário para ver o quão perto você está da próxima faixa. As faixas de 2026 são de US$ 106.000 e US$ 133.000 para solteiros e US$ 212.000 e US$ 266.000 para casais. |||SET||| Pequenas mudanças podem mantê-lo do lado direito dessas linhas. |||SET||| custo anual extra para um casal no primeiro nível IRMAA em 2026 |||SET||| prêmio mensal padrão do Medicare Parte B em 2026 |||SET||| sobretaxa mensal mais alta da Parte B em 2026 |||SET||| anos de declarações fiscais, análises do Medicare para definir seu prêmio |||SET||| distribuição anual máxima de caridade qualificada de um IRA |||SET||| recursos bem-sucedidos da IRMAA apresentados em um ano recente |||SET||| Suportes IRMAA do Medicare Parte B 2026 |||SET||| Solteiro: $ 106 mil ou menos |||SET||| US$ 0 extras |||SET||| Solteiro: $ 106 mil - $ 133 mil |||SET||| US$ 74/mês |||SET||| Solteiro: $ 133 mil - $ 167 mil |||SET||| US$ 185/mês |||SET||| Casal: $ 212 mil ou menos |||SET||| Casal: $ 212 mil - $ 266 mil |||SET||| Casal: $ 266 mil - $ 334 mil |||SET||| Fonte: Centros de Serviços Medicare e Medicaid, anúncio de 2025 |||SET||| Sobretaxas mensais IRMAA para 2026 |||SET||| Renda Solteira |||SET||| Renda Conjunta |||SET||| Parte B Extra |||SET||| Parte D Extra |||SET||| US$ 106.000 ou menos |||SET||| US$ 212.000 ou menos |||SET||| Acima de US$ 500.000 |||SET||| Acima de US$ 750.000 |||SET||| Reduzir os prêmios do Medicare exige planejamento, mas a economia dura anos. Comece retirando suas duas últimas declarações fiscais e estimando a receita do próximo ano. Analise os números com um software fiscal ou com um consultor financeiro que conheça as regras do Medicare. |||SET||| Pequenos passos, como uma conversão de Roth ou uma distribuição de caridade qualificada, podem mantê-lo sob controle e proteger vários milhares de dólares por ano. Não espere até que chegue a carta da Segurança Social com más notícias. |||SET||| Aja enquanto você ainda controla sua renda aos 60 e início dos 70. Seu futuro eu agradecerá pelo dinheiro extra em seu orçamento de aposentadoria. |||SET||| Fontes |||SET||| Centros de serviços Medicare e Medicaid, 'Prêmios Medicare e suportes IRMAA para 2026' (2025) |||SET||| Administração da Segurança Social, 'Formulário de Instruções SSA-44' (2024) |||SET||| Fidelity Investments, 'Estimativa de custos de cuidados de saúde para aposentados' (atualização de 2025) |||SET||| Internal Revenue Service, 'Publicação 590-B sobre distribuições IRA' (2024) |||SET||| Medicare.gov, página oficial de 'IRMAA e eventos de mudança de vida' (2025) |||SET||| Vá mais fundo |||SET||| O que exatamente é a renda bruta ajustada modificada do Medicare?
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.
IRMAA Monthly Surcharges for 2026
| Income Single | Income Joint | Part B Extra | Part D Extra |
|---|---|---|---|
| $106,000 or less | $212,000 or less | $0 | $0 |
| $106,001 - $133,000 | $212,001 - $266,000 | $74.00 | $13.70 |
| $133,001 - $167,000 | $266,001 - $334,000 | $185.00 | $35.10 |
| $167,001 - $200,000 | $334,001 - $400,000 | $295.50 | $56.20 |
| $200,001 - $500,000 | $400,001 - $750,000 | $419.30 | $77.40 |
| Above $500,000 | Above $750,000 | $419.30 + $81.00 | $77.40 + $15.20 |
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)