Do tax-free retirement account withdrawals affect IRMAA for Medicare Part B/D premiums?

1. How IRMAA is calculated and why “two years ago” matters

IRMAA is a surcharge added to Medicare Part B and Part D premiums based on Modified Adjusted Gross Income (MAGI) reported on tax returns from two years prior, so 2026 IRMAA looks at 2024 MAGI; the lag means a tax-free or taxable withdrawal’s effect on premiums may show up only after this delay and can’t be undone immediately except by an appeal for a life‑changing event ^{[3] [4] [2]}.

2. Taxable retirement withdrawals definitely raise MAGI and can trigger IRMAA

Distributions from traditional IRAs, 401(k)s and Required Minimum Distributions (RMDs) are generally taxable and therefore increase AGI and MAGI, which can push beneficiaries into higher IRMAA brackets and produce significant premium surcharges — even a single large withdrawal or conversion can spike MAGI and create a cliff effect where $1 more income can move someone into a materially higher surcharge tier ^{[5] [6] [4]}.

3. Roth withdrawals: the safe harbor for IRMAA — mostly

Qualified Roth IRA withdrawals (and distributions of converted Roths after meeting the seasoning rules) are generally not counted in MAGI and therefore do not raise IRMAA the way taxable withdrawals do, making Roth assets a powerful tool to manage future IRMAA exposure according to multiple retirement‑planning guides ^{[1] [5]}. That said, timing of conversions and whether distributions are “qualified” matter; some sources warn that large Roth conversions done within the two‑year window before Medicare can temporarily increase MAGI and IRMAA ^[6].

4. Tax‑free strategies with caveats: QCDs, HSAs, and tax‑exempt interest

Qualified Charitable Distributions (QCDs) can reduce the taxable impact of RMDs and thus limit MAGI and IRMAA exposure when used properly, and Health Savings Account withdrawals for qualified medical expenses are tax‑free and can be used to avoid tapping taxable income — both are repeatedly recommended as planning tools ^{[1] [7]}. Counterpoint: some forms of “tax‑free” income such as certain tax‑exempt interest may still be treated as part of MAGI for IRMAA purposes (sources discuss adding tax‑exempt interest into MAGI), so not every non‑taxed cashflow is excluded from the SSA’s calculation and consultation with a tax professional is advised ^{[8] [4]}.

5. Practical implications, trade‑offs, and where reporting may oversimplify

Coverage across financial outlets emphasizes that ordinary retirement withdrawals can unintentionally trigger steep IRMAA surcharges and that careful sequencing (spread conversions, timing capital gains, using QCDs) can reduce exposure, but some articles oversimplify by suggesting an absolute “Roth fixes IRMAA” rule; in reality, Roth assets remove future withdrawals from MAGI only when withdrawals are qualified and earlier Roth conversions themselves are taxable events that can temporarily raise MAGI two years later ^{[6] [2]}. Another implicit agenda in vendor and advisory pieces is to promote services or products (Roth conversions, managed strategies) as solutions, so recommendations should be weighed against fees and individual circumstances ^{[9] [10]}.

6. Bottom line and limits of available reporting

Bottom line: truly tax‑free withdrawals that are excluded from MAGI (qualified Roth distributions, properly executed QCDs, qualified HSA distributions) do not raise IRMAA the way taxable IRA/401(k) withdrawals do, but exceptions exist (tax‑exempt interest treatment, Roth conversion timing) and the SSA’s two‑year lookback means planning and possible appeals are essential; the sources reviewed consistently recommend working with tax or financial advisors for personalized planning and note that appeals are available for life‑changing income drops — the reporting consulted does not replace confirmation from SSA or a tax advisor for specific cases ^{[1] [3] [7]}.