IRMAA Basics
Understanding IRMAA, RMDs, and Required Distribution Planning for Retirement Accounts
Verified against SSA POMS as of September 2, 2026
The short answer
Income-Related Monthly Adjustment Amounts (IRMAA) applies to Medicare Part B and D premiums based upon modified adjusted gross income (MAGI) levels. Required Minimum Distributions (RMDs) are mandated withdrawals from retirement accounts upon reaching a certain age. These distributions are a component of MAGI. Prior to RMD age, distribution amounts from pretax retirement accounts are made at the discretion of the individual. Upon reaching RMD age, a certain percentage of your total pretax qualified accounts must be distributed annually, and that percentage increases every year. Individuals having significant balances must distribute amounts that could jeopardize maintaining an MAGI below the IRMAA thresholds. Proper tax and financial planning should be done in advance to avoid the RMD trap leading to increased IRMAA surcharges.
Defining IRMAA and Its Impact on Medicare Premiums
The Income-Related Monthly Adjustment Amount (IRMAA) is an extra charge added to Medicare Part B and D premiums for beneficiaries with income above certain thresholds. These amounts are determined annually based on the beneficiary's modified adjusted gross income (MAGI) levels from two years prior.
MCR:basics/forms-publications-mailings/mailings/costs-and-coverage/medicare-premium-billUnderstanding Required Minimum Distributions (RMDs) for Retirement Accounts
RMDs are government-mandated minimum amounts that individuals must withdraw annually from their pretax retirement accounts, such as 401(k)s and IRAs, starting at age 73. For those born in 1960 or later, the starting age for RMDs is 75. RMDs ensure that individuals don't just accumulate funds in their retirement accounts without ever withdrawing them. These distributions are governed by IRS rules, as outlined in the IRS Code and available on the IRS website.
CMS:medicare/enrollment-renewal/original-part-a-bIntegrating IRMAA and RMDs into Your Retirement Distribution Plan
Effective retirement planning involves considering both IRMAA and RMDs. While IRMAA increases costs associated with your Medicare coverage based on income, RMDs dictate the minimum you must withdraw from retirement accounts. It's crucial to strategize withdrawals to manage taxable income and potentially reduce the impact of IRMAA. Since the RMD tables are known in advance, planning ahead is possible, particularly for individuals and married couples with significant pretax retirement assets. By anticipating future RMD amounts, retirees can better align their withdrawal strategies to minimize taxable income spikes that could trigger higher IRMAA charges.
CMSPDF:medicare/prescription-drug-coverage/employerretireedrugsubsid/downloads/applicationinstructions.pdfFrequently asked
At what income does IRMAA affect my Medicare premiums?
IRMAA impacts Medicare premiums when your modified adjusted gross income (MAGI) exceeds specific thresholds set by Medicare two years prior to the premium year. For example, in 2026, if your modified adjusted gross income (MAGI) from 2024 is above $109,000 for individuals or $218,000 for married couples filing jointly, you will be subject to IRMAA surcharges. These thresholds are adjusted annually, so it's important to refer to the latest Medicare Fact Sheet at Medicare.gov for the most current information.
How do I calculate Required Minimum Distributions from my retirement account?
RMDs are calculated based on the account balance and life expectancy factors. The RMD tables, which provide these life expectancy factors, are available at IRS.gov. There are different tables depending on the age of the beneficiary. For most people, the Uniform Lifetime Table is the appropriate table to use. To calculate your RMD, once you reach the age required to take RMDs, take the prior year-end balance of all accounts that require an RMD and divide that sum by the life expectancy factor listed in the appropriate IRS table that fits your situation. The result is the RMD dollar amount that you must withdraw that year. RMD rules can be complex, especially with respect to beneficiary distributions and the correction of miscalculations or missed RMD obligations. You might want to consult a tax or financial professional to avoid costly errors.
What's the age to start withdrawing RMDs?
The age at which individuals must start withdrawing Required Minimum Distributions (RMDs) depends on their birth year. Those born from 1951 through 1959 generally need to take their first RMD by April 1 of the year following the year in which they turn 73. For individuals born in 1960 or later, the starting age is 75, with the first RMD due by April 1 of the year after they turn 75. There are exceptions for qualified monies held in employer-sponsored plans if the individual is still employed with that employer. RMD rules can be complex, so you might want to consult a tax or financial professional.
Can RMD’s impact IRMAA planning?
Yes. RMD’s are required once you attain a certain age based upon your birth year. From the first year onward, the percentage that you will be required to withdrawal from the sum of all of your pretax retirement accounts will increase. At 75 years of age, the RMD will be approximately 4% of the sum. By 80, approximately 5%, 85, over 6%, and by 90, your RMD will exceed 8%. For those with significant retirement account balances, the likelihood of breaching the IRMAA thresholds is likely. Planning with your tax and/or financial advisor is recommended before you are required to make RMD’s. Failure to take RMD’s may result in a significant excise tax and may cause retroactive IRMAA charges.