IRMAA Basics
How Roth Conversions Affect IRMAA for Medicare Premiums
Verified against SSA POMS as of August 20, 2026
The short answer
IRMAA may be affected by a Roth IRA conversion. The IRS includes income from a Roth conversion in your MAGI, which determines if you must pay IRMAA for Medicare.
Understanding IRMAA
IRMAA stands for Income-Related Monthly Adjustment Amount, an extra charge added to Medicare Part B and D premiums for beneficiaries with higher income. It affects those with modified adjusted gross incomes (MAGI) above specific dollar thresholds, which vary based on tax filing status. The calculation includes the sum of their adjusted gross income and tax-exempt interest earnings. This ensures that higher earners contribute more towards their healthcare costs.
HI 01194.130How IRMAA is Calculated
The IRS provides your modified adjusted gross income (MAGI) to the Social Security Administration (SSA), which includes your adjusted gross income and any tax-exempt interest income. MAGI may also include one-time only income from events like capital gains, property sales, and conversions from a traditional IRA to a Roth IRA. This one-time income affects your Medicare premium for only one year. Social Security compares your MAGI to IRMAA income thresholds, based upon tax filing status, to determine if you owe an IRMAA.
HI 01194.110 View source ›Impact of Roth IRA Conversions on IRMAA
Converting a traditional IRA or other pretax qualified account to a Roth IRA is considered a taxable event that will increase your adjusted gross income. This increase in adjusted gross income will, in turn, raise your modified adjusted gross income (MAGI), which is the sum of your adjusted gross income and tax-exempt income. An elevated MAGI could push your income above the IRMAA threshold, leading to increased Medicare premiums for one year. It's important to consider the timing and amount of conversions to minimize potential IRMAA charges.
HI 01194.010 View source ›Frequently asked
Does a Roth conversion affect Medicare premiums?
Yes, a Roth conversion can increase your MAGI, which may lead to an IRMAA surcharge on your Medicare premiums. However, an increase in MAGI alone does not guarantee a surcharge. The MAGI must reach specific dollar threshold levels, which vary based on your tax filing status, to trigger an IRMAA surcharge.
What income affects Medicare IRMAA?
IRMAA is based on MAGI, which includes adjusted gross income, tax-exempt interest, and one-time income like Roth conversions.
How long does a Roth conversion affect IRMAA?
A Roth conversion affects your IRMAA based on the modified adjusted gross income (MAGI) for the taxable year in which the conversion occurs. Each year's conversion amount is considered separately, impacting your IRMAA only for that specific year. If you perform Roth conversions over multiple years, each year's conversion will count towards your MAGI for that particular year.
Can I appeal an IRMAA decision due to a Roth conversion?
While you can request an appeal if you believe your IRMAA was calculated incorrectly, it's important to note that Roth conversion income is typically included in the calculation and is not a basis for appeal. Appeals are generally based on errors or mistakes by the IRS or one of the 8 life-changing events listed in the SSA-44 form.