Subtitle: If you’re pulling money from your 401k or IRA in retirement, the IRS is not the only one watching.
You did everything right. You maxed out your 401k. You saved aggressively. You built a nest egg that most people your age never got close to. And now, in retirement, Medicare is going to charge you extra for it. Welcome to IRMAA. Most men 50+ have never heard of it until the bill shows up. By then, it’s too late to do anything about it for that year.
Let’s fix that right now.
What Is IRMAA?
IRMAA stands for Income-Related Monthly Adjustment Amount. It’s a surcharge on top of your standard Medicare Part B and Part D premiums. The more income Medicare sees on your tax return, the more you pay.
Here’s what that looks like in real numbers for 2026. If your Modified Adjusted Gross Income (MAGI) stays under $109,000 as a single filer (or $218,000 married filing jointly), you pay the standard Part B premium: $202.90 per month. Once you cross those thresholds, the surcharge kicks in and it climbs fast:
| Individual MAGI | Monthly Part B Premium |
|---|---|
| <$109,000 | $202.90 |
| $109,001 – $137,000 | $284.10 |
| $137,001 – $171,000 | $405.80 |
| $171,001 – 205,000 | $527.50 |
| $205,001 – $500,000 | $649.20 |
| Above $500,000 | $689.90 |
That’s not a rounding error. A single large IRA withdrawal could jump you from $202.90a month to $284.10a month. That’s $1,460 extra per year for one income event.
And Part D (prescription drug coverage) has its own IRMAA surcharge on top of that.
The Trap: The Two-Year Lookback Rule
Here’s where it gets sneaky.
Medicare does not look at what you earned this year. It looks at your tax return from two years ago. That means your 2026 Medicare premiums are based on your 2024 income. Your 2027 premiums are based on 2025. And so on. So if you retired in 2024 and had a high-income year, or if you did a large 401k rollover or Roth conversion in 2024, you could be paying elevated premiums in 2026 even though your income is now a fraction of what it was.
This catches a lot of retirees off guard. You leave the workforce, income drops significantly, and Medicare is still billing you like you’re at your peak earning years.
The good news: you can fight it.
How 401k and IRA Withdrawals Trigger IRMAA
Traditional 401k and IRA accounts are tax-deferred. Every dollar you pull out in retirement counts as ordinary income in the year you take it. That sounds straightforward. What surprises people is how quickly a “reasonable” withdrawal can push them into an IRMAA bracket. Say you’re collecting Social Security at $2,500 a month and a pension adds another $3,000 a month. That’s $66,000 a year before you touch your IRA. Now you need a $50,000 withdrawal to cover a major expense: a new roof, a car, a family emergency. Your MAGI just hit $116,000. You’ve crossed the first IRMAA threshold.
This is not about being wealthy. This is about having done the right thing for 30 years. The key is understanding that every dollar matters when you’re near a threshold, and that large, unplanned withdrawals can cost you more than you think once you factor in the Medicare surcharge.
Roth Conversions: The Long Game
One of the most effective strategies for managing IRMAA over time is converting traditional 401k or IRA money into a Roth account before you hit Medicare age. Here’s the logic. Roth withdrawals in retirement are not counted as income for MAGI purposes. So if you do the tax work now, during your pre-Medicare years, you can build a pool of tax-free money that won’t trigger IRMAA later. This is not a free lunch. You pay ordinary income tax on every dollar you convert. The question is whether paying taxes now at your current rate is better than paying IRMAA surcharges plus taxes later at higher withdrawal levels.
For a lot of men 50+, particularly those still working with five or more years before Medicare, the math often favors a conversion strategy. You control the income you recognize each year. You can convert up to the top of a tax bracket without crossing into the next one. And you gradually reduce the balance in your traditional accounts, which also reduces your future Required Minimum Distributions. This is worth running by a fee-only financial planner or a CPA who works with retirees. The numbers are personal and the window for doing this well is finite.
How to Appeal IRMAA: You Have More Power Than You Think
If you’re being hit with IRMAA based on income that no longer reflects your current situation, you can appeal. The Social Security Administration handles IRMAA determinations, and they will consider what’s called a “life-changing event” as grounds for using more recent income instead of the two-year lookback.
Qualifying life-changing events include:
- Retirement or reduction in work hours
- Death of a spouse
- Divorce or annulment
- Loss of income-producing property (due to disaster or other circumstances beyond your control)
- Loss of pension income
- Employer settlement payment
To appeal, you file Form SSA-44 with your local Social Security office. You’ll need documentation showing the life-changing event and evidence of your more current income. If you retired recently and your income dropped significantly, this is not a long shot. It’s a legitimate process that SSA expects people to use. You are not asking for a favor. You are providing accurate information and asking to be billed correctly. The process is not instant, but it works. Get your paperwork together, submit it, and follow up.
The Bottom Line
IRMAA is not a penalty for doing something wrong. It’s a surcharge built into Medicare that hits people who saved well and pulled from tax-deferred accounts. That describes a lot of retirees who did everything right.
The four things worth knowing:
One: IRMAA is based on income from two years ago. A high-income year in 2024 affects your 2026 premiums.
Two: 401k and IRA withdrawals count as income. Large, unplanned withdrawals can push you into a higher bracket.
Three: Roth conversions in your pre-Medicare years can reduce future IRMAA exposure significantly.
Four: If you’ve had a life-changing event, appeal. Form SSA-44. Use it.
If you’re already on Medicare and just learned this for the first time, you’re not alone. This is exactly the kind of thing nobody puts in the retirement briefing.
That’s what we’re here for. Join in, what are your thoughts on this? Got any additional information to share?
Related: Social Security at 62, 67, or 70: Here’s What I Decided
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