Does selling a house, Roth conversion, or taking RMDs affect IRMAA?
The short answer
Yes, all three can trigger or increase IRMAA, the income-related surcharge added to Medicare Part B and Part D premiums. IRMAA is based on your income from two years prior, so a large transaction today can raise your premiums in the future.
The full explanation
IRMAA stands for Income-Related Monthly Adjustment Amount. It's an extra charge added to your Medicare Part B and Part D premiums if your income exceeds certain thresholds. The income Medicare uses is your modified adjusted gross income, or MAGI, from two years back. So your 2025 premiums are based on your 2023 tax return. Selling a house can create a large capital gain in a single year, which could push your income well above the IRMAA thresholds. A Roth conversion, where you move money from a traditional IRA into a Roth IRA, counts as taxable income in the year it happens, and a large conversion can do the same thing. Required Minimum Distributions, called RMDs, are the mandatory annual withdrawals from traditional retirement accounts that start at a certain age. Those distributions count as income too, and if they're substantial, they can push you into a higher IRMAA bracket. The surcharges are applied in tiers, so even crossing a threshold by a small amount can mean a meaningfully higher premium. The good news is that if you had a one-time income spike, you can appeal IRMAA using a form called SSA-44 if you've since had a qualifying life event, such as retirement, that reduced your income. Plan details and thresholds change annually, so check current figures at ssa.gov or speak with a financial advisor.
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