How to Reduce Your Medicare IRMAA (Legally)

IRMAA is set by one number: your Modified Adjusted Gross Income (MAGI) from two years back. That's actually good news — because MAGI is something you can plan around. Cross a bracket by a single dollar and you pay the higher surcharge for the whole year, so the goal is simple: keep MAGI just under the line that matters for you.

The levers below are ordinary, legitimate tax planning. None of this is tax advice — it's a map of what to discuss with your tax professional.

Time Roth Conversions Carefully

A Roth conversion adds to your MAGI in the year you convert, which can raise IRMAA two years later. But money already in a Roth is not counted in MAGI when you withdraw it. So conversions are a timing decision: paying tax (and possibly one year of IRMAA) now to shrink future taxable withdrawals — ideally done in lower-income years, or spread across several years to avoid jumping a bracket in any single one.

Use Qualified Charitable Distributions (QCDs)

If you're subject to Required Minimum Distributions, a QCD lets you send money directly from an IRA to a charity. It satisfies your RMD but is excluded from MAGI — so it can lower the income that drives IRMAA while meeting the distribution you owed anyway. For charitably-inclined retirees near a bracket, it's one of the cleanest tools available.

Manage Capital Gains and RMD Timing

Realized capital gains land in MAGI, so spreading a large sale across tax years, harvesting losses to offset gains, or simply choosing when to sell can keep a one-time gain from tipping you into a higher tier. The same goes for the timing of discretionary withdrawals — bunching them into a year you're already in a high bracket, and easing off in years you're near a threshold.

Plan a Property Sale

Selling a home or investment property can create a large one-year gain that spikes IRMAA — but the capital-gains exclusion on a primary residence, installment sales, and choosing the sale year deliberately can all soften the MAGI hit. If a sale is coming, model the IRMAA impact before you close, not after the determination letter arrives.

Watch the Thresholds — and the Traps

• Know your line. In 2026, IRMAA starts above $109,000 (single) or $218,000 (married filing jointly). Estimate where you land before year-end, while you can still act.
• Tax-exempt interest still counts. Municipal-bond interest is added back into MAGI for IRMAA even though it's income-tax-free.
• Married-filing-separately is a trap. It uses much lower thresholds and can trigger a high surcharge at modest income.

If Your Income Already Dropped

Planning is for future years. If your income already fell because of retirement, a spouse's death, or another life-changing event, you don't plan around it — you appeal it with Form SSA-44 right now.

IRMAA planning sits at the intersection of taxes and Medicare. Bring your tax advisor for the tax side, and call us free for the Medicare side — we'll help you see which bracket you're near and what a move actually saves.