Can an RMD raise your Medicare premiums?
November 6, 2026
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Show Notes
Eddie and Betty's Conversation
Welcome back to The American Retirement Advisor. I'm Betty, Eddie's here with me in the studio today, and we are deep in a series we have been loving this week, all about RMDs, required minimum distributions, and specifically what they do to your retirement beyond just the withdrawal itself. Eddie, I feel like today's piece is the one people are really going to need to hear.
It's the one that made me go, oh, that's why nobody sees this coming. Because the thing Ian Schaeffer opens with is that the RMD itself is rarely the worst part. It's what it does to other numbers.
Okay, say more about that, because I think most people hear RMD and think, fine, I take the money out, I pay the tax on it, done. What am I missing?
It lands on your tax return as income. And income, in retirement, is not a neutral number. It touches things. It can raise your Medicare premiums. It can make more of your Social Security taxable. The withdrawal is the first domino, and today's piece is specifically about the Medicare piece.
Which is called IRMAA, and I have to say, that acronym is doing a lot of work. It stands for income-related monthly adjustment amount, which is a very polite way of saying Medicare charges you more if you make more.
That is exactly what it is. Same Part B, same Part D coverage, higher bill. It's a surcharge layered on top of your standard premium.
So walk me through how an RMD actually triggers this. Because you take the money out, and then what?
Here is the part that surprises everyone. Social Security looks at your tax return from two years earlier to set your Medicare premiums. So an RMD you take in 2026 can raise your premiums in 2028.
That far apart?
Two years later. The withdrawal and the higher premium show up in completely different years. That's why the article says so few people ever connect them. You don't remember the RMD from 2026 when you get a surprising Medicare bill in 2028.
That is genuinely sneaky. Like, not intentionally sneaky, but the timing just makes it invisible.
It's the financial equivalent of eating something bad on Monday and not feeling it until Wednesday. You've already moved on.
Ha, okay, that is the most Eddie analogy possible. But it works. So what are the actual income lines where this kicks in?
For 2026 premiums, the first IRMAA threshold for a married couple filing jointly is income over $218,000. For a single filer, it's over $109,000. And the income they're looking at is your modified adjusted gross income, which is your regular adjusted gross income plus any tax-exempt interest.
So if you're close to those lines, an RMD could push you over.
Exactly. And here's the number that really stopped me when I read it. For a married couple, crossing that first line by one dollar costs about $2,297 a year in extra premiums.
Just one cent over the line.
One dollar over. $2,297. That's not a rounding error, that's a real number with real consequences.
So it's not a gradual climb, it's a cliff.
That's the right word for it. You're on flat ground and then you're not.
And that second thing you mentioned, the Social Security side of it, I want to stay there for a second. Because it feels like that's its own separate thing happening at the same time, almost like a second wave hitting while you're still dealing with the first one.
It is, and this is the domino chart the article references. The same income that triggers IRMAA can also push more of your Social Security benefits into taxable territory. Up to 85 percent of your benefits can be taxed once your income clears certain thresholds.
85 percent of it. So you take an RMD, it raises everything, that triggers a Medicare surcharge AND potentially taxes more of your Social Security. One action, multiple consequences.
And those thresholds, the article points this out, have never been adjusted for inflation. So they're the same numbers they've always been, and more people drift over them every year just from cost of living adjustments.
That seems like it should bother more of us than it does.
I think most people don't even know it's happening to them.
Fair point. Okay, so what can we actually do about this? Because I don't want to just sit here describing a problem.
The first thing the article says is estimate before the year ends. Figure out what your RMD adds to your income and compare it against those IRMAA lines. You can't manage what you haven't measured.
And that sounds like something you'd do alongside whoever's doing your taxes.
Very much so. The article frames it as sitting down with your tax professional to see where your withdrawals land relative to those Medicare lines. The exact math there is worth a real conversation, not a guess.
What about the first-year double? Because this series covered earlier in the week that you can delay your very first RMD to April 1st of the next calendar year.
Right, and the article flags that specifically. Push it to the following year and you end up taking two RMDs in the same calendar year, because the second one is still due by December 31st. Two RMDs in twelve months can absolutely push your income over an IRMAA line when one alone wouldn't have.
So the flexibility that sounds like a gift can turn into a tax headache.
It can. Delaying might still be the right move for somebody, but you have to run the numbers first. You can't just assume later is always better.
The article also mentions something about giving to charity. I saw that and wanted to ask you about it.
So the piece points ahead to tomorrow's installment in this series, which covers this in detail, but the short version is there's a way to send IRA money directly to a charity without that amount counting as income. Which means it doesn't touch your IRMAA calculation.
So if you were going to give anyway, doing it through the IRA is smarter than taking the money out, paying tax on it, and then writing a check.
That's the idea. And Ian Schaeffer's piece mentions it as one of the tools worth knowing about. The full mechanics of that one, I'd genuinely want to send people to our advisors at American Retirement Advisors, because the rules on exactly how that has to be set up are worth getting right.
Good call. Okay, there was one more thing in the article that I thought was really interesting, which is the appeal. If your income dropped because something big changed in your life, you can actually push back on the IRMAA calculation?
You can. If you had what the article calls a life-changing event, things like retiring or losing a spouse, you can ask Social Security to use a more recent tax year instead of the one from two years back. There's a form for it, SSA-44.
That is a detail I would never have known existed.
Most people don't. Which is kind of the whole point of this series, right? These things exist. They're not secret. They're just not obvious, and nobody hands you a map.
And the map, in this case, is David Schaeffer's guide. The article is Part 5 of a seven-part series based on that guide, called The Hidden History of the Rule That Taxes Your Retirement.
And the full domino chart, all the places that RMD income can land and what it affects, that's all in it. The article just shows you the first big one, the Medicare premium piece.
Can we just pause on the domino image for a second? Because I think it's such a useful frame. You're not just taking money out of an account. You're pushing a domino, and you may not see what falls down until two years later.
And some of those dominoes are loud, like a $2,297 Medicare surcharge. And some are quieter, like just a slightly higher percentage of Social Security getting taxed. But they're all connected to that one number on your tax return.
What would you say to someone who's maybe five years from retirement and thinking, this doesn't apply to me yet?
I'd say this is precisely the time to care about it. Because by the time the RMD is mandatory, you want to already know where your income lines are, what accounts you're pulling from, and what that does to your Medicare. Doing that planning at 73 is a lot harder than doing it at 65.
You're not reacting, you're deciding.
That's the whole ballgame.
What about someone who's already taking RMDs and has no idea if they've been hitting these lines?
Pull your last couple of tax returns and look at your modified adjusted gross income. Then look at the IRMAA thresholds for the corresponding years. If you've been over those lines, you've been paying the surcharge, and you may not have realized you had any options.
And the form, the SSA-44, if something changed for you, that's still potentially available to you.
Worth asking about, for sure. I would not want to guess on the specific deadline rules and eligibility there, that's a conversation for an advisor who knows the current rules cold.
One thing I keep wanting to say to listeners is that the numbers in this article, the $218,000 threshold, the $2,297 surcharge, those are 2026 figures. They change every year.
It says exactly that. These come from CMS and they adjust annually. So the framework is stable, the specific dollar amounts shift. Which is another reason to check in with a professional regularly, not just once.
It's not a one-time thing. Retirement income planning is like a garden. You can't plant it and ignore it.
Did you just out-analogy me?
I think I did. You'll recover.
I'm fine. I'm totally fine.
What's the takeaway you'd leave someone with from this piece? If they could only remember one thing.
That the income from an RMD doesn't just cost you the tax on the withdrawal. It can cost you thousands more in Medicare premiums two years down the road. And if you don't know the lines, you can't plan around them.
Know them before you hit them.
That's it. One dollar over is still over.
If today's conversation has you thinking about your own numbers, that's exactly the right response. The article gives you a link to start a conversation with the team at American Retirement Advisors, where you can look at how your withdrawals line up with those Medicare thresholds alongside your tax professional. That's at no cost to you, and it's a real conversation, not a sales pitch. Find Ian Schaeffer's piece, find the guide, and if you're not sure where to start, you know where we are. Thanks for being here today.