What steps can Medicare beneficiaries take to reduce or avoid IRMAA in 2026, including income planning and Roth conversions timing?
Executive summary
Medicare uses your MAGI from two years earlier to set 2026 IRMAA; for 2026 the Social Security Administration will use your 2024 tax return and the first surcharge threshold is $109,000 single / $218,000 married filing jointly [1]. Strategies that advisers and planners emphasize include reducing 2024 MAGI by timing Roth conversions, using Qualified Charitable Distributions (QCDs), delaying taxable events, or filing an SSA-44 appeal after a life-changing event [2] [3] [4].
1. How IRMAA actually works — the two‑year lookback and the 2026 triggers
Medicare’s Income‑Related Monthly Adjustment Amount for Part B and Part D is set using Modified Adjusted Gross Income from two years prior, so 2026 surcharges are based on your 2024 MAGI; the baseline 2026 thresholds start at $109,000 for single filers and $218,000 for joint filers [1]. CMS and SSA publish the brackets each year and add the IRMAA surcharges to the standard Part B and Part D premiums [5] [6].
2. Cut your 2024 MAGI to avoid a surcharge — common, tested levers
Financial writers and advisers repeatedly point to reducing MAGI in the relevant tax year as the direct way to avoid IRMAA: accelerate deductions, shift taxable income, harvest capital losses to offset gains, or use QCDs from IRAs to satisfy charitable intent without raising MAGI [7] [2] [8]. Practitioners recommend modeling scenarios because the IRMAA relationship is “cliff‑like”: a $1 excess over a threshold can trigger a materially higher premium bracket [9].
3. Roth conversions: benefit and risk depending on timing
Roth conversions remove future RMD pressure and can lower long‑term IRMAA exposure, but conversions increase MAGI in the year of conversion and can therefore trigger IRMAA two years later. Advisors urge “strategic” conversions — spread over multiple years and sized to fill a desired tax bracket — and to model the IRMAA ripple effect before executing large conversions [3] [10] [11]. Several planning sources stress that converting “just enough” to stay within a given MAGI window is a common tactic [11] [12].
4. Non‑conversion tactics that lower taxable MAGI now
Qualified Charitable Distributions from IRAs, increased pre‑tax retirement contributions while still working, and timing sales or capital gains into lower‑income years are repeatedly recommended ways to reduce MAGI in the critical year [2] [13] [14]. Some sites highlight that moving income between 2024 and 2025 or using tax‑deferral vehicles can change your MAGI two years later and thus your 2026 IRMAA [14] [15].
5. Appeals and life‑change exceptions — the administrative pathway
If your income has fallen because of certain life events (retirement, death of a spouse, divorce, etc.), you can request a recalculation using Form SSA‑44 and supporting documentation; SSA considers specific life‑changing events and may lower IRMAA before the otherwise applicable two‑year lag [4] [16]. Sources warn appeals are for genuine income reductions and are not routinely granted for ordinary one‑time events unless documented and qualifying [16] [9].
6. Tradeoffs and political/tax law context to factor in
Advisers point out tradeoffs: paying tax now on a Roth conversion can be worthwhile if you expect higher future tax rates or want to reduce RMD‑driven MAGI, but conversions can also push you into higher IRMAA brackets or reduce other tax benefits in the short term — so plan with an eye to both Medicare and the tax code timeline [17] [10]. Several commentators also note that IRMAA brackets are indexed for inflation and can creep upward, increasing the risk of “bracket creep” over time [18] [19].
7. Practical checklist for beneficiaries who want to act for 2026
1) Identify your 2024 MAGI today from your filed return and compare to 2026 thresholds [1]. 2) Model one‑time events (Roth conversions, stock sales, severance) for their 2024 MAGI impact and run IRMAA simulations (tools exist; see interactive calculators referenced by planners) [8]. 3) If eligible, use QCDs or pre‑tax contributions to lower MAGI. 4) If a qualifying life change occurred after 2024, file SSA‑44 with documentation promptly [4] [16]. 5) Consult a CPA or fee‑only advisor to coordinate tax, Medicare, and retirement goals because consequences span multiple years [6] [3].
Limitations and source framing: the above summarizes planning approaches and warnings found in retirement‑planning and financial media and SSA/CMS guidance provided in the cited sources; official IRMAA bracket tables and individual outcomes depend on SSA/CMS final notices and your detailed tax return [5] [1]. Available sources do not mention specific personalized tax thresholds or the effect of any legislation enacted after the cited articles; consult SSA/CMS and your tax advisor for definitive calculations.