09/03/2026
Some Medicare costs are determined long before the bill arrives.
For 2026, Medicare uses income from your 2024 tax return to determine whether you owe an Income-Related Monthly Adjustment Amount (IRMAA) on Part B and Part D. That two-year lookback means decisions involving Roth conversions, investment gains, retirement distributions and other taxable income can have consequences that show up later in health care costs.
The planning opportunity is not simply to keep income as low as possible. It is to coordinate taxes, retirement income and Medicare so one decision does not unintentionally make another more expensive.
And if your income has fallen because of a qualifying life event such as retirement or the death of a spouse, you may be able to ask Social Security to reconsider the surcharge.
Health care planning is part of retirement income planning — not a separate conversation.
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