10/07/2026
📋 A retiree's Medicare bill can jump in a year when nothing about their health changed, because of a tax return filed two years earlier.
Medicare's income surcharge, IRMAA, looks at your modified adjusted gross income from two tax years back, so your 2024 return sets your 2026 premiums.
For 2026, going over $109,000 single or $218,000 joint by even one dollar triggers the first surcharge, and it applies to both Part B and Part D.
Most of what shows up on the front page of a tax return counts: wages, pensions, traditional IRA and 401(k) withdrawals, capital gains, and the taxable part of Social Security.
Two items catch people off guard. Municipal bond interest is free of federal income tax, yet IRMAA adds it back. And a Roth conversion counts in full in the year you convert.
The other column is where the planning room is. Qualified Roth withdrawals, HSA money spent on medical costs, and loan proceeds, including a reverse mortgage, don't count.
If you're 70½ or older, a qualified charitable distribution can send up to $111,000 from an IRA straight to charity in 2026 without counting, and it can also satisfy a required minimum distribution.
Home sales split in two: gain inside the $250,000 single or $500,000 joint exclusion stays out, and gain above it counts.
The two-year lag is what to plan around. A large conversion this year lands on the bill two years from now, so deciding to convert is also deciding what you'll pay for Medicare later.
If your income drops because you retire, cut back work, lose a spouse, or divorce, Form SSA-44 lets you ask Social Security to use a more recent, lower year instead.
Which item on this list surprised you most?
P.S. Once a week, I email the best money article I read, with my take on this week's top Facebook posts and what's new on the Ways to Wealth blog. It's free, and you can sign up on the Ways to Wealth home page.
R.J. Weiss, CFP®
The content shared here is for educational and informational purposes only. It is not personalized investment, tax, legal, or financial advice. Consult a licensed professional before making decisions based on your specific situation.