Medicare IRMAA Surcharge 2026: Plan Roth Conversions to Avoid Tax
Quick Answer
Medicare IRMAA: surcharge on Part B + Part D if MAGI >$97k (single) / $194k (MFJ) in 2026. Surcharge can double/triple your premium ($165/month → $300+/month). Control MAGI via Traditional withdrawals, Roth conversions (pre-65), qualified charitable distributions (QCD), tax-loss harvesting.
IRMAA Thresholds 2026
| MAGI Single | MAGI MFJ | Part B Premium | Part D |
|---|---|---|---|
| ≤$97k | ≤$194k | $165 | Normal |
| $97k-$122k | $194k-$244k | $229 | +$12 |
| Over $147k | Over $294k | $370+ | $40+ |
Controlling MAGI
- Traditional 401(k)/IRA: Withdrawals don't increase MAGI
- Roth conversion (pre-age 65): Convert early, pay tax now, avoid surcharge later
- Qualified charitable distribution (QCD): Age 70.5+, direct IRA to charity (no income)
- Tax-loss harvesting: Capital losses reduce MAGI
- Municipal bonds: Tax-free interest (may not count toward MAGI)
Example Impact
Age 66, MAGI $150k
- Base Part B: $165/month
- IRMAA surcharge: +$130/month
- Total: $295/month (79% increase)
- Annual extra: $1,560
- 20-year cost: $31k