Which types of retirement account withdrawals count toward IRMAA in 2025?
Executive summary
Medicare’s IRMAA is calculated from your Modified Adjusted Gross Income (MAGI) reported on tax returns two years earlier; for 2025 IRMAA that means MAGI from 2023 (including AGI plus tax‑exempt interest) and retirement‑account distributions that increase AGI generally count toward those IRMAA thresholds (e.g., the individual 2025 threshold begins at $106,000) [1] [2]. Qualified Roth distributions are generally not counted in MAGI, while withdrawals from traditional IRAs, 401(k)s and RMDs typically increase MAGI and therefore can trigger IRMAA [3] [4].
1. How IRMAA is computed and why retirement withdrawals matter
Medicare sets IRMAA based on your MAGI from two years prior; that MAGI is your adjusted gross income plus tax‑exempt interest, so any taxable retirement distributions that raise AGI (traditional IRA/401(k) withdrawals, required minimum distributions, taxable pension distributions, and taxable portions of Roth conversions) push MAGI higher and can move you into an IRMAA bracket [1] [4]. Multiple outlets explain that one large withdrawal in a single year can create a temporary bracket jump: the surcharge is assessed, then reassessed year‑to‑year as MAGI changes [5] [6].
2. Which types of retirement withdrawals are cited as counting toward IRMAA
Sources repeatedly list distributions from tax‑deferred accounts — traditional IRAs, 401(k)s, 403(b)s and other tax‑deferred retirement accounts — and required minimum distributions as income that is added to taxable income and therefore to MAGI used for IRMAA [3] [4]. Financial guidance pieces also explicitly call out large IRA withdrawals and lump‑sum distributions from retirement accounts as common triggers for IRMAA bracket increases [7] [8].
3. Withdrawals that are generally not counted (Roth and certain accounts)
Several sources highlight that qualified Roth withdrawals (Roth IRA and qualified Roth 401(k) distributions) do not increase AGI and therefore do not count toward MAGI for IRMAA; that makes Roth accounts a commonly recommended tool to limit IRMAA exposure [4] [8]. Tax‑exempt interest (for example, municipal bond interest) is added to MAGI for IRMAA — the calculation explicitly includes tax‑exempt interest even though it’s not taxed on the return itself [1].
4. Common planning strategies and the tradeoffs reporters emphasize
Coverage repeatedly recommends timing and tax planning to avoid a one‑year spike in MAGI: stagger withdrawals, use Roth conversions in low‑income years, spread capital gains and distributions across years, or prioritize withdrawals from Roths or taxable accounts where withdrawals may be return of basis rather than taxable income [7] [8] [5]. These pieces also warn the tradeoffs: deferring RMDs or Social Security can shift future IRMAA exposure and Roth conversions themselves can raise MAGI in the conversion year if not timed carefully [7] [9].
5. Appeals and relief when income falls due to life events
Sources note that if your income has fallen because of retirement, divorce, death of a spouse or other qualifying life event, you can file Form SSA‑44 to request a re‑determination of IRMAA so premiums reflect more current income rather than the two‑year‑old tax return [7] [2]. Reporters stress that this is a documented appeals process; it does not automatically erase prior assessments but can change future IRMAA amounts [7] [2].
6. What the sources don’t specify or where they differ
Available sources consistently identify traditional tax‑deferred withdrawals and RMDs as counted and qualified Roth distributions as not counted, and they agree on the two‑year lag [1] [4] [5]. Sources vary on tactical recommendations and emphasis — some push Roth conversions aggressively while others emphasize spreading distributions — reflecting different planning philosophies rather than disagreement on the basic rule [7] [9]. Detailed edge cases (for example, the treatment of certain partial rollovers or the tax characterization of complex pension‑settlement payments) are not exhaustively covered in the provided reporting; those specifics are not found in current reporting.
7. Bottom line for retirees planning withdrawals in 2025
If you take taxable distributions from traditional IRAs, 401(k)s, or similar tax‑deferred accounts in 2023, those amounts will have contributed to the MAGI that determined your 2025 IRMAA — and similar logic applies going forward: withdrawals that increase AGI count toward IRMAA while qualified Roth distributions do not [1] [3] [4]. Financial writers and advisers in the sources urge retirees to run projections and consider staggered withdrawals, Roth strategies, or use of Form SSA‑44 when life events lower income to avoid avoidable IRMAA surcharges [5] [7].