How to avoid IRMAA

This page explains how the rules work. It is not tax or financial advice.

What is the maximum income to avoid IRMAA?

For 2026 premiums, the maximum 2024 MAGI with no IRMAA is $109,000 for a single filer and $218,000 for a married couple filing jointly. The MAGI in question is adjusted gross income (Form 1040 line 11) plus tax-exempt interest (line 2a), with nothing else added; the full list of what counts and what does not is on the MAGI for IRMAA page.

Sources: CMS fact sheets announcing the 2025 and 2026 premiums; the 2027 row is our projection from the statutory CPI formula, final figures from CMS in fall 2026.

Landing exactly on the line is safe. The first surcharge tier starts above $109,000, not at it, so a single filer whose 2024 MAGI comes to exactly that figure pays only the standard $202.90 Part B premium. For 2025 premiums the equivalent limits were $106,000 and $212,000, measured on the 2023 return. For 2027 the projected first threshold is $112,000 single and $224,000 joint, measured on the 2025 return; that projection is stable across every inflation scenario we compute, and the projected 2027 brackets page tracks it until CMS announces.

Crossing costs real money because the brackets are cliffs, not slopes. One dollar of 2024 MAGI above $218,000 costs a couple with both spouses on Medicare $2,296.80 in extra 2026 premiums, because the surcharge is billed to each spouse and both bills read the same joint return. Per person, the first tier adds $1,148.40 a year in combined Part B and Part D charges; the top tier adds $6,936.00. The full tier tables are on the 2026 IRMAA brackets page. The IRMAA calculator takes a 2024 MAGI and reports which tier it lands in and how many dollars separate it from the next threshold.

Can you avoid IRMAA after the tax year is over?

Not by changing income. The 2026 surcharge reads the 2024 return, which is filed and closed. Lowering 2026 income does not change the 2026 premium; it changes the 2028 premium, because that is the year whose determination will read the 2026 return. This is the part most articles blur. Anything labeled a way to avoid IRMAA this year is, mechanically, a way to shape a return that SSA reads two years from now.

The one lever that works on the current year is a new determination after a qualifying life event. SSA keeps an exhaustive list of eight events, covered below, and will replace the old return with a current-year income estimate when one applies. The list does not include one-time income spikes. It also helps to know the surcharge is recalculated annually: each year's IRMAA comes from that year's lookback return, so a single high-income year produces a single high-premium year, not a permanent charge.

Do Roth conversions raise IRMAA, and why does age 63 matter?

A Roth conversion is taxable income. It lands in adjusted gross income on Form 1040 line 11, so it raises MAGI in the year of the conversion, and that MAGI surfaces in the Medicare premium two years later. A 2024 conversion shows up in the 2026 premium.

Age 63 is where the arithmetic bites for the common case of enrolling at 65: the two-year lookback generally makes the age-63 return the first one SSA uses, though SSA falls back to a return one year older when the newer one is not yet available. A conversion completed before those years does not ordinarily appear in any Medicare determination. A conversion at 63 or later raises MAGI on a return SSA will read, and the premium effect arrives two years out. The rules also close the exit: SSA's own policy manual names IRA and Roth conversions on its list of events that do not qualify for relief, so a conversion year cannot be undone with Form SSA-44.

The mechanism runs the other way once the money is inside the Roth. Qualified Roth withdrawals are excluded from AGI, so dollars already converted come out in later years without adding a cent of MAGI, while a traditional IRA withdrawal of the same size lands in line 11 in full.

The full arithmetic, worked at every 2026 bracket edge with a headroom calculator, is on Roth conversions and IRMAA. For the underlying choice between Roth and traditional accounts, before IRMAA enters the picture, our sister site covers Roth IRA versus 401(k).

Do qualified charitable distributions lower MAGI?

Yes, and they are one of the few things that remove IRA dollars from the return entirely. A qualified charitable distribution, or QCD, goes from the IRA custodian directly to a charity. Up to the annual IRS limit, that money is excluded from AGI and still counts toward the year's required minimum distribution (IRS Publication 590-B covers the specifics).

The contrast with ordinary giving is the point. The same dollars taken as a normal IRA withdrawal and then donated hit AGI first; the charitable write-off is an itemized deduction, which reduces taxable income but never reduces AGI, so it never reduces MAGI. A gift that travels custodian-to-charity never surfaces as income. A gift that passes through a personal account first leaves the withdrawal sitting in MAGI, and for IRMAA purposes the donation might as well not have happened.

Do municipal bonds avoid IRMAA?

No. Municipal bond interest is exempt from federal income tax, but the IRMAA formula adds tax-exempt interest back in through Form 1040 line 2a. MAGI is line 11 plus line 2a, so moving money into munis to get income off the return does nothing here: the interest leaves AGI and re-enters MAGI one line later. A muni portfolio changes the tax bill, not the Medicare surcharge.

Do capital gains count toward IRMAA, even at the 0% rate?

They count at every rate. A realized gain sits inside AGI, including the taxable part of a home sale above the Section 121 exclusion, so it raises MAGI in the year of the sale. A widely repeated idea holds that gains harvested inside the 0% long-term capital gains bracket are invisible to Medicare. The tax on such a gain is zero; its effect on MAGI is not. A gain taxed at 0% enters AGI in full and counts toward IRMAA like any other gain.

Two timing facts follow from the lookback. A gain realized in a year whose return SSA does not read, generally any return before the age-63 year for someone enrolling at 65, does not ordinarily touch a premium. And a gain split across two tax years can leave each year's MAGI under a threshold that one combined realization would cross. SSA treats a realized gain the way it treats a conversion: a one-time spike that does not qualify for a new determination, so the year it lands is the year that counts.

Where do HSA withdrawals show up in MAGI?

They do not. Qualified distributions from a health savings account are excluded from income, so HSA money spent on qualified medical costs in retirement pays real bills without generating any MAGI. An IRA withdrawal covering the same bill lands in AGI in full. The other side of the account works during employment years: HSA contributions are deducted in arriving at AGI, so they lower the MAGI on returns filed while still working, including the returns that later fall inside the lookback window.

What happens to IRMAA when a spouse dies?

Two separate rules apply. First, death of a spouse is a qualifying life event, the first item on SSA's list. A survivor whose income falls can ask for a new determination for the current year, with Form SSA-44 or by phone, and SSA will use an estimate of this year's income instead of the old joint return.

Second, the thresholds themselves change with filing status. Joint-filer thresholds are double the single thresholds at every tier except the top, so a survivor who later files single is measured against lines half as high. The arithmetic on the published table: joint MAGI of $180,000 in 2026 sits under the $218,000 first threshold and carries no surcharge. The same $180,000 on a single return is above $171,000, the third surcharge tier, which adds $4,620.00 a year in combined Part B and Part D charges. Household income can stay level while the bracket position moves, because the columns changed. The IRMAA appeal page covers the new-determination process itself.

Does married filing separately avoid IRMAA?

It does the opposite. The separate-filer table, for anyone who lived with their spouse at any point in the tax year, has no middle tiers. One dollar of 2024 MAGI above $109,000 jumps directly to the 80% tier: $446.30 a month in Part B surcharge plus $83.30 for Part D, $6,355.20 for the year. The joint table would put that same income in the first tier or below. The exception is real separation: spouses who lived apart for the entire year are measured on the single-filer table, and SSA corrects the record on a signed statement that the spouses lived apart the entire year, or the separated notation on the return itself (POMS HI 01120.060).

The complete separate-filer tables for both years, and the lived-apart correction, are on the married filing separately page.

How do you appeal IRMAA after a life event?

Eight events qualify: death of spouse, marriage, divorce or annulment, work stoppage, work reduction, loss of income-producing property beyond your control, loss of employer pension income, and receipt of an employer settlement payment. After any of them, a request for a new determination, filed on Form SSA-44 or made verbally, lets SSA swap the two-year-old return for an estimate of the current year's MAGI. That makes this the only mechanism on this page that changes the premium already being billed.

The not-qualifying list matters as much as the qualifying one: capital gains, IRA and Roth conversions, lottery and casino winnings, cashing savings bonds, and higher living costs are all excluded. New enrollees hit a specific version of this. The lookback reads peak working-years income, but work stoppage and work reduction are qualifying events, so someone who retired since that return can file with a current-year estimate. The step-by-step process, evidence requirements, and deadlines are on the IRMAA appeal and SSA-44 pages.

Which mechanisms apply in which situation?

The rows sort themselves by one question: has the return SSA will read already been filed? Before age 63 the answer is no, so conversion and gain timing operate freely and nothing yet touches a premium. From 63 on, each return feeds a determination two years later, and the levers narrow to what stays out of AGI in the first place: QCDs routed through the custodian, qualified Roth and HSA dollars, and where a realized gain falls relative to a threshold. After the fact, only a listed life event reopens a determination. Filing status is its own axis, since the separate-filer and single-filer tables replace the thresholds wholesale rather than adjusting income against them.

Where do these numbers come from?

Thresholds and surcharge dollars come from the CMS fact sheets announcing the 2025 and 2026 Medicare premiums (the 2026 figures published November 14, 2025) and the Federal Register notice at 90 FR 52063. The MAGI definition and the life-event lists come from SSA's policy manual, POMS HI 01101.010, HI 01120.005, and HI 01120.060. The 2027 threshold is our computation from the statutory CPI formula, labeled a projection until CMS announces. QCD and Roth tax treatment follows IRS Publication 590-B and the Form 1040 instructions.

To place a specific 2024 MAGI on the 2026 table, the IRMAA calculator does the arithmetic. The complete tier tables, including Part D and the separate-filer schedule, are on the 2026 IRMAA brackets page.