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Tax Planning

IRMAA Surprises: The Medicare Tax Most Retirees Never See Coming

By Gerard Ladalardo·Aug 13, 2026· 5 min read

IRMAA — the Income-Related Monthly Adjustment Amount — is a surcharge on Medicare Part B and Part D premiums for higher-income retirees. It's calculated from your tax return two years prior, which is why so many retirees get blindsided.

The Cliff, Not a Slope

IRMAA brackets are cliffs, not gradual ramps. One dollar of extra income above a threshold can cost a couple over $2,000 a year in extra premiums. Cross the top bracket and the surcharge exceeds $6,000 per person.

Triggers to Watch

Large Roth conversions, lump-sum IRA withdrawals, capital gains from selling a home or business, and even inherited IRA distributions can all push you over an IRMAA line.

How We Plan Around It

We model income two years forward, sequence withdrawals to stay just under bracket lines, and use tax-free buckets (Roth, cash-value life insurance) for spending spikes. If you've had a life event that lowered your income, Form SSA-44 can reverse the surcharge.

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