How to Avoid IRMAA in 2026: The Income Cliffs and the Roth-Conversion Ceiling

What IRMAA is and why it hits harder than you expect

IRMAA is a surcharge on your Medicare Part B and Part D premiums. In 2026, the standard Part B premium is $202.90 per month (annual deductible $283). If your modified adjusted gross income from two years earlier — your 2024 MAGI — exceeds the first threshold, you pay more. How much more depends on which tier you land in. The surcharges apply to both Part B and Part D, and they are not small.

The critical mechanic most retirees miss: IRMAA brackets are cliffs, not marginal rates. Cross the threshold by $1 and you pay the full surcharge for the entire year. There is no gradual phase-in. This makes IRMAA the most punitive “tax” in the retirement income code — a single dollar of excess income can cost over $1,100.

The 2026 IRMAA brackets: your exact surcharge by income

These brackets are finalized. They use your 2024 MAGI (the tax return you filed by April 2025). Source: CMS 2026 Medicare Parts B Premiums & Deductibles fact sheet; Federal Register 2025-20251.

“Extra cost / yr” is the combined Part B premium increase plus Part D surcharge above the base, per person. For a married couple both on Medicare, double it. A couple at $218,001 MFJ pays $2,296 more per year than a couple at $218,000 — for $1 of income.

The two-year lookback: the income year that controls your bill

Social Security uses your most recently filed federal tax return to calculate IRMAA. For 2026 premiums, that is your 2024 return (filed by April 2025). For 2027, it is your 2025 return. For 2028, it is 2026.

This means two things. First, your 2026 IRMAA is already set — you cannot change it through income management now (though you may appeal via Form SSA-44 if a qualifying life-changing event has lowered your income). Second, the income decisions you make this year — Roth conversions, capital-gains harvesting, RMD timing — determine your 2028 Medicare bill. The planning window is always two years forward.

The cliff math: why $1 costs over $1,100

Most retirees think of IRMAA as “higher earners pay more for Medicare.” That framing misses the structural problem. Federal income tax brackets are marginal — only the income inside the bracket is taxed at that rate. IRMAA is a cliff — cross the line by any amount and your premium jumps to the next tier for all 12 months.

Here is what that cliff costs in practice, per person:

For a married couple both on Medicare, every cliff cost doubles. The Tier 1 cliff at $218,001 MFJ costs $2,296 a year. The Tier 2 cliff at $274,001 costs $3,473 more than Tier 1. This is not academic — a single unexpected capital gain, a poorly sized Roth conversion, or even one extra RMD distribution can push you over.

Decision tree: which IRMAA avoidance strategy fits your situation

There is no single “best” way to avoid IRMAA. Your strategy depends on where your income naturally falls, what levers you control, and how many years you have before Medicare kicks in. Start with the branch that matches you.

Branch 1: You are 60–64 and not yet on Medicare

This is the golden window. You are likely retired or semi-retired, your earned income is low, and you are not yet drawing Social Security or taking RMDs. Your MAGI is naturally depressed — which means you can Roth-convert aggressively in the 12% and 22% federal brackets (MFJ income up to $100,800 at 12%, up to $211,400 at 22% per IRS Rev. Proc. 2025-32) without any IRMAA concern because you are not on Medicare yet.

Your move: convert as much as the bracket math supports each year from 60 to 64. Every dollar you move to Roth now is a dollar that will never appear in MAGI once you are on Medicare. A couple with a $1.5M Traditional IRA who converts $100,000 a year for five years at the 22% bracket pays ~$22,000 per year in tax — but removes $500,000 from future RMDs and the IRMAA calculation entirely.

Branch 2: You are 65+ and already on Medicare, MAGI near a cliff

You can still Roth-convert, but you need to size the conversion to stay below the next IRMAA tier. The math:

1. Start with your IRMAA ceiling for the tier you want to stay in (e.g., $218,000 MFJ for Tier 0).
2. Subtract your baseline MAGI: taxable Social Security + pensions + required minimum distributions + investment income + earned income.
3. The remainder is your Roth-conversion headroom — the maximum you can convert without tripping the next cliff.

Worked example: A married couple, both 68, with $72,000 Social Security (about $61,200 taxable at 85% inclusion), $24,000 pension, and $8,000 in investment income. Baseline MAGI: ~$93,200. IRMAA Tier 0 ceiling: $218,000. Roth-conversion headroom: $124,800. They can convert up to $124,800 and stay at the base Part B premium of $202.90 per month. Convert $125,000 and they cross into Tier 1 — costing $2,296 per year in surcharges for the extra $200 of conversion.

Branch 3: You are 73+ and RMDs are pushing you over

Once RMDs start (age 73 for those born 1951–1959, age 75 for those born 1960+ under SECURE 2.0 § 107), you lose control of a chunk of your MAGI. A $1.8M IRA at age 73 has an RMD of ~$67,924 ($1.8M ÷ 26.5 divisor). Add $72,000 of Social Security and you are already at $140,000+ before any other income — past the Tier 1 cliff for a single filer and within striking distance for MFJ.

Your moves at this stage:

• QCDs (Qualified Charitable Distributions). If you give to charity, route it through your IRA as a QCD instead of writing a check and itemizing. A QCD satisfies your RMD but is excluded from gross income entirely — it does not appear in MAGI. The 2026 limit is $111,000 per person ($222,000 for a married couple where each spouse owns an IRA) per IRC § 408(d)(8). A $20,000 QCD that would have been part of your RMD drops MAGI by $20,000 — potentially enough to drop a tier.
• Tax-loss harvesting in taxable accounts. Net capital losses offset gains dollar-for-dollar, plus up to $3,000 of ordinary income per year. Harvest losses in the same tax year whose MAGI will set your premiums two years later.
• Income timing. If you have discretion over when to realize gains (selling a rental property, exercising stock options, taking a lump-sum distribution), shift the income to a year where it causes the least IRMAA damage. One large capital gain in a single year can spike MAGI into Tier 3 or 4; spreading it over two years might keep both years in Tier 1.

Branch 4: You had a life-changing event — appeal with Form SSA-44

If your income dropped significantly due to a qualifying event — retirement or work stoppage, marriage, divorce, death of a spouse, loss of income-producing property, or loss of pension income — you can ask Social Security to use a more recent (lower) income year instead of the standard two-year lookback. File Form SSA-44 with documentation. This does not change the rules; it lets you show that your current income is materially lower than the year SSA is using.

Common scenario: you retired in 2024, your 2024 W-2 income was high through your last day of work, but your 2025 and 2026 income is only Social Security plus small IRA withdrawals. Without an appeal, your 2026 IRMAA reflects the high-income 2024. With an SSA-44 filing, SSA can use your 2025 or projected 2026 income instead.

The Roth-conversion ceiling: how to size conversions around IRMAA

Roth conversions are the single most powerful IRMAA avoidance tool — but only if you size them correctly. Convert too little and you leave money in your Traditional IRA to become RMDs that push you into higher IRMAA tiers later. Convert too much and you trip the cliff now. The goal is to find the conversion ceiling: the maximum annual conversion that fills your federal tax bracket without crossing the next IRMAA tier.

Here is how to calculate it for a married couple on Medicare:

In this example, the couple can convert up to $120,800 and pay zero IRMAA surcharge. At the 22% federal bracket (MFJ income up to $211,400), the tax on $120,800 is roughly $26,576. That is real money — but it is buying them future years of base-rate Medicare premiums and reduced RMDs, which is typically worth far more over a decade.

The trade-off worth modeling: sometimes it is rational to accept Tier 1 IRMAA ($2,296/yr for a couple) to convert a larger amount that fills the 22% or even 24% bracket. The Tier 1 surcharge for one or two years can be far less than the decade of higher RMD-driven IRMAA and federal tax you would pay by not converting. Run the numbers both ways.

QCDs: the IRMAA lever most retirees overlook

If you are 70½ or older, give to charity, and own a Traditional IRA, the Qualified Charitable Distribution is the most efficient tool in the IRMAA playbook. Here is why:

• A QCD counts toward your RMD but is excluded from gross income. It does not appear in MAGI.
• It is better than an itemized deduction because it reduces AGI directly (deductions only reduce taxable income below AGI — IRMAA is calculated on MAGI, which is based on AGI).
• The 2026 limit is $111,000 per person. A one-time QCD to a split-interest entity (charitable remainder trust or charitable gift annuity) of up to $55,000 is also permitted under SECURE 2.0 § 307.

Worked example: A single filer, age 74, has a $900K IRA with an RMD of ~$33,962 ($900K ÷ 26.5). Her other income (SS + pension) is $80,000. Without a QCD, MAGI = $80,000 + $33,962 = $113,962 — Tier 1 IRMAA, costing $1,148/yr. She gives $10,000 a year to her mosque. If she routes that $10,000 as a QCD, her MAGI drops to $103,962 — below the $109,000 Tier 1 cliff. The QCD saves her $1,148 per year in IRMAA, on top of the charitable tax benefit she was already getting.

Tax-loss harvesting: the taxable-account lever

If you hold investments in a taxable brokerage account, realized capital gains add to MAGI. Selling losers to offset those gains — and taking up to $3,000 per year in net losses against ordinary income — directly reduces the MAGI number IRMAA uses. The key is timing: harvest in the tax year whose MAGI will affect your premiums two years from now.

Common mistake: harvesting losses in 2026 to “help with 2026 IRMAA.” It does not. Your 2026 IRMAA is already set by 2024 income. Losses harvested in 2026 help with 2028 premiums.

Income timing: the one-time-event defense

One-time income events — selling a rental property, exercising stock options, taking a lump-sum pension — can spike MAGI into the upper IRMAA tiers for a single year. Since IRMAA uses a single year’s income, not an average, a $300,000 capital gain in one year is worse than two $150,000 gains in consecutive years (which might each stay in a lower tier).

Where you have control over timing:

• Installment sales (IRC § 453): spread the gain from a property or business sale across multiple years.
• Roth conversion splitting: instead of converting $200,000 in one year, convert $100,000 in two consecutive years to stay below a cliff in both.
• Deferring bonus or consulting income into a year where your other income is lower.

The IRMAA appeal: Form SSA-44

If your income has dropped due to a qualifying life-changing event, you do not have to accept the IRMAA determination based on your two-year-old tax return. File Form SSA-44 with Social Security. Qualifying events per SSA:

• Marriage, divorce, or annulment
• Death of a spouse
• Work stoppage or reduction (retirement counts)
• Loss of income-producing property (involuntary — e.g., casualty, not a voluntary sale)
• Loss of pension income
• Employer settlement payment (added in recent guidance)

SSA will recalculate your IRMAA using a more recent or projected income year. This is not a loophole — it is the designed mechanism for people whose current income does not match the lookback year.

Your next step depends on which branch matched you

If you are 60–64 and not on Medicare: this is your Roth-conversion runway. Convert aggressively in the 12% and 22% brackets. Every dollar you move now is invisible to IRMAA later. Check the bracket-fill math and your standard deduction ($32,200 MFJ, $16,100 single in 2026, plus the additional age-65 deduction of $1,650 per MFJ spouse or $2,050 single).

If you are 65+ and near a cliff: calculate your Roth-conversion ceiling using the table above. Convert up to that ceiling annually. Use QCDs ($111,000 limit per person in 2026) to reduce MAGI if your RMDs are pushing you over. Harvest losses in taxable accounts in the years whose MAGI will affect your premiums two years out.

If you are 73+ and RMDs control your income: QCDs and tax-loss harvesting are your primary levers. The conversion window is narrower (each conversion adds to the RMD-driven MAGI), but even small conversions can reduce future-year RMDs. Model the multi-year impact, not just this year.

If a life event changed your income: file Form SSA-44 immediately. You may be overpaying right now.