Retirement Transactions and Medicare
Do IRA Withdrawals and Roth Conversions Affect Medicare Premiums?
They can. The taxable portion of a traditional IRA withdrawal, required minimum distribution or Roth conversion generally increases income in the transaction year and may increase Medicare IRMAA two years later.
Quick answer
Taxable Retirement Income Can Raise Part B and Part D Costs
Medicare IRMAA generally uses adjusted gross income plus tax-exempt interest. A taxable IRA distribution or Roth conversion increases adjusted gross income, so it can move the beneficiary into a higher IRMAA tier for a later Medicare premium year.
The key word is taxable. A distribution’s full dollar amount is not always included in income, and a properly qualified Roth distribution generally does not increase AGI.
Traditional IRA Withdrawals and RMDs
Traditional IRA distributions are generally taxable except to the extent the account contains after-tax basis or another exclusion applies. Required minimum distributions follow the same basic principle: the taxable amount is included in income for the year distributed.
Because Social Security generally uses tax information from two years earlier, a taxable withdrawal in 2026 would ordinarily be relevant to 2028 Medicare premiums—not the 2026 premium already being charged.
Roth Conversions
A Roth conversion moves money from a traditional tax-deferred account into a Roth account. The IRS generally includes previously untaxed amounts in income for the conversion year. That taxable conversion amount can therefore affect IRMAA.
A conversion does not need to create a large income-tax rate to affect Medicare premiums. IRMAA uses its own income tiers. Moving just above a tier can change both Part B and Part D amounts for the related premium year.
A conversion and a Roth withdrawal are different events
The taxable amount of a conversion generally increases AGI. A later qualified distribution from the Roth account is generally tax-free and ordinarily does not increase AGI. Nonqualified distributions require a separate tax analysis.
Timing example
How the IRMAA Lookback Connects the Years
2026: Transaction Year
A beneficiary takes a taxable IRA withdrawal or completes a taxable Roth conversion.
2027: Tax Return Filed
The 2026 federal return reports the taxable amount as part of adjusted gross income.
2028: Medicare Premium Year
Social Security generally uses the 2026 MAGI to determine 2028 Part B and Part D IRMAA.
This is the usual two-year relationship, not a guarantee for every case. Social Security uses the most recent tax information the IRS can provide and may sometimes use information from three years earlier when the expected return is unavailable.
Does a One-Time Withdrawal Cause Permanent IRMAA?
Usually not by itself. IRMAA is determined again for each premium year. A single large taxable transaction can increase premiums for the year tied to that tax return, while a later lower-income return may move the beneficiary back down.
That does not mean the change corrects immediately. The two-year lookback can make a one-time event appear in Medicare costs after the transaction has already passed.
Five Questions to Review Before a Large Retirement Transaction
- What portion will actually be taxable? Basis, account type and transaction structure can change the amount included in AGI.
- Which Medicare premium year will use this return? The usual answer is two years later.
- Are both spouses on Medicare? A joint return can set the bracket for both, while IRMAA is assessed separately to each beneficiary.
- Could the transaction cross an IRMAA tier? The relevant thresholds change annually, and future thresholds may not yet be known.
- Does the overall strategy still make sense? Avoid letting one year of Medicare premiums control a long-term tax or retirement decision without a complete analysis.
Can You Appeal IRMAA Caused by a Withdrawal or Conversion?
A voluntary IRA withdrawal, Roth conversion or investment decision is not by itself one of Social Security’s recognized life-changing events. Form SSA-44 is designed for an income reduction connected to an event such as work stoppage, work reduction, marriage, divorce, death of a spouse or another listed event.
Retirement may support a request to use newer income when work stops and income falls. However, Social Security will consider the more recent MAGI, including taxable retirement transactions in that year. It does not simply remove a conversion or withdrawal because it was unusual.
Use our SSA-44 guide for retirement and other life-changing events to understand the correct route.
How This Fits With the Other IRMAA Rules
Before evaluating a retirement transaction, it helps to separate three questions:
Frequently asked questions
IRA, Roth Conversion and IRMAA Questions
Do required minimum distributions affect Medicare premiums?
The taxable portion of an RMD generally contributes to AGI and can therefore affect IRMAA for a later premium year.
Does the entire IRA withdrawal count?
Not always. The taxable portion generally affects AGI. After-tax basis or another tax rule may make part of a distribution nontaxable. A tax professional should calculate the reported amount.
Does a qualified Roth withdrawal affect IRMAA?
A qualified tax-free Roth distribution generally does not increase AGI. A taxable Roth conversion or nonqualified distribution is different.
Can tax withholding keep a withdrawal below an IRMAA bracket?
No. Withholding is a payment toward tax; it does not ordinarily reduce the gross taxable distribution reported as income.
Should I avoid a Roth conversion only because of IRMAA?
That requires a broader tax and financial analysis. IRMAA is one cost to consider, but it should not be evaluated without the long-term tax, estate and retirement objectives.
Medicare premiums and IRMAA series
Continue the IRMAA Guide Series
Official information
IRS and Social Security Resources
Review the Medicare side of the decision
Account for IRMAA When Comparing Medicare Coverage
Thompson Medicare Brokerage helps people in Missouri and Illinois understand how Part B, Part D and IRMAA fit around the private Medicare coverage options we represent.
Use a qualified tax or financial professional for withdrawal and conversion strategy. We can explain how the resulting Medicare premiums affect the coverage comparison.
This article provides general Medicare information and does not provide tax, investment, accounting or legal advice. IRMAA rules and thresholds can change. Social Security and the IRS make official determinations.