Grand Junction · IRMAA and retirement income

Do RMDs Count Toward IRMAA and Raise Medicare Premiums?

Yes. A required minimum distribution is taxable income, and taxable income is what sets your Medicare premium — two years late, and with no appeal. Here is the 2026 math, the April 1 trap that doubles it, and the one lever the IRS itself describes.

Medicare On Main Data Desk

Published September 9, 2026 · 9 min read · Reviewed by Brian Penner

The question usually arrives at the kitchen table in November, holding two letters. One is from the IRA custodian saying the required minimum distribution has to be out by December 31. The other is from Social Security saying next year's Medicare premium went up because of income from two years ago. The people I sit with in Grand Junction have generally figured out that the two letters are related. What they have not always figured out is that the second letter was written by the first one — and that they had more say over it than they thought.

Why an RMD counts toward IRMAA

Two federal rules meet here, and neither is complicated on its own. The first is the IRS rule on required minimum distributions: "You generally must start taking withdrawals from your traditional IRA, SEP IRA, SIMPLE IRA, and retirement plan accounts when you reach age 73," and "your withdrawals are included in taxable income except for any part that was already taxed." An RMD is not a transfer. It is income, and it goes on your Form 1040 like a paycheck used to.

The second is the Medicare rule. Since 2007, CMS notes, "a beneficiary's Part B monthly premium has been based on his or her income," through the income-related monthly adjustment amount — IRMAA. Social Security decides who pays it by looking at the modified adjusted gross income on the most recent tax return the IRS has handed over, which is generally the one from two years earlier. Your adjusted gross income, plus tax-exempt interest, is that MAGI. And your RMD is sitting inside your adjusted gross income.

So the chain is short: RMD → taxable income → MAGI → IRMAA tier → premium, two years later. CMS says IRMAA affects roughly 8% of people with Part B. In my experience, the Mesa County households joining that 8% for the first time are very often doing it at 73, and very often surprised.

The 2026 IRMAA tiers

These are the published 2026 Part B figures, keyed to your 2024 MAGI. The standard premium is $202.90 a month with a $283 deductible; each tier adds a fixed amount on top, and a separate Part D surcharge, published in the same fact sheet, stacks alongside it.

Source: CMS — 2026 Medicare Parts A & B Premiums and Deductibles (Nov 14, 2025). Per person, per month. Part D income-related amounts are published separately in the same release.

Notice the shape. The tiers are cliffs, not slopes. One dollar over $218,000 for a couple costs each spouse $81.20 a month — $974.40 a year, $1,948.80 for two — and one dollar over $274,000 costs each of them $202.90 a month instead. An RMD does not have to be large to matter. It only has to be the income that crosses the line.

The April 1 trap: two RMDs in one year

Here is the piece that does the most damage, and the IRS states it plainly: "You must take your first required minimum distribution for the year in which you reach age 73. However, you can delay taking the first RMD until April 1 of the following year." Its own example: "If you reach age 73 in 2024, you must take your first RMD by April 1, 2025, and the second RMD by Dec. 31, 2025."

Read that twice. The deferral does not skip a distribution; it stacks one. Someone who turns 73 in 2026 and takes the IRS up on the delay will take the 2026 RMD by April 1, 2027 and the 2027 RMD by December 31, 2027 — two distributions on one 2027 return. That return sets the 2029 Medicare premium. For a household already near a tier line, doubling the RMD income for a single year is the difference between one tier and the next, and the surcharge applies to both spouses.

The deferral is sometimes the right call — a large final-salary year, say, that makes the 73 return the worse one to add to. But it is a decision, and the Medicare calendar belongs in it.

A Mesa County example, with the arithmetic shown

Take a retired couple on the Redlands filing jointly: a pension, two Social Security checks, some dividends, and a rollover IRA that starts its RMDs this year. Assume a base MAGI of $220,000 and a first-year RMD of $34,000. Those two numbers are assumptions chosen to sit near a tier line; everything after them is arithmetic on the CMS table above.

Arithmetic on the 2026 Part B tiers in CMS — 2026 Medicare Parts A & B Premiums and Deductibles (Nov 14, 2025); RMD rules from IRS — Retirement plan and IRA required minimum distributions FAQs; QCD rules from IRS — Qualified charitable distributions allow eligible IRA owners tax-free gifts to charity (IR-2023-215). Illustrative; Part D surcharges not included.

The row that matters is the third. The same couple, the same IRA, the same total withdrawn over two years — and the April 1 deferral costs $2,920.80 more in Part B alone for the one year it lands in ($4,869.60 against $1,948.80), before the Part D surcharge. Nothing about their health, their doctors or their plan changed. Only the calendar did.

The lever the IRS describes: qualified charitable distributions

If you give to a church, a food bank, the hospital foundation or the university anyway, the tax code offers a route that is unusually well-suited to the IRMAA problem. The IRS describes it: an IRA owner "age 70½ or over" can have the IRA trustee pay a distribution directly to an eligible charity, and "with a QCD, however, these distributions become tax-free as long as they're paid directly from the IRA to an eligible charitable organization." Then the line that matters at 73: "for those who are at least 73 years old, QCDs count toward the IRA owner's required minimum distribution (RMD) for the year."

Because a qualified charitable distribution is excluded from gross income rather than deducted from it later, it never reaches adjusted gross income — and so never reaches MAGI. That is a stronger effect than an itemized deduction, which comes off after the IRMAA number is already set. For 2026, IRS Notice 2025-67 raises the annual ceiling: "the aggregate amount of qualified charitable distributions that are not includible in gross income under section 408(d)(8)(A) is increased from $108,000 to $111,000." Per person, so each spouse with their own IRA has their own limit.

Three rules, all from the same IRS release, break it if you get them wrong:

• The money has to go directly to the charity. "A check made payable to the IRA owner is not a QCD," and neither is a distribution paid to you that you then donate.
• You cannot also deduct it. "Transferred amounts are not taxable, and no deduction is available for the transfer." It is one or the other, and the exclusion is the one that helps IRMAA.
• Get the receipt. The donor "must get a written acknowledgement of their contribution from the charitable organization before filing their return."

The fourth row in the table above shows the effect. A $20,000 qualified charitable distribution out of a $34,000 RMD leaves $14,000 of taxable income instead of $34,000 — and for a couple whose base sits under about $204,000, that is the difference between paying IRMAA and not paying it, for a year, for both of them.

What you cannot do about it

Two things, and people try both. The first is skipping the distribution. The IRS: "If an account owner fails to withdraw the full amount of the RMD by the due date, the amount not withdrawn may be subject to an excise tax of 25%, 10% if the RMD is timely corrected within two years." A 25% excise tax on the missed amount is a far larger number than any Part B surcharge, so this is not a strategy; it is a mistake with a penalty attached.

The second is appealing. Social Security will use a more recent tax year only after one of the life-changing events in 20 CFR § 418.1205 — a marriage, a divorce, a spouse's death, a work stoppage or reduction, the loss of income-producing property, the loss of a pension, an employer settlement — and § 418.1210 says it "will not consider events other than those." A required minimum distribution is a tax rule that arrived on schedule. It is not an event, so there is nothing to appeal; the surcharge stands for the year and falls off when a lower return works through the two-year lag. We walked through the appeal mechanics themselves in the SSA-44 post.

Two other rules worth knowing

Still working at 73? The IRS allows workplace-plan participants — "for example, 401(k) or profit-sharing plan" — to "delay taking their RMDs until the year they retire, unless they're a 5% owner of the business sponsoring the plan." That exception covers the employer plan only, not a traditional IRA sitting beside it. Roth IRAs have no lifetime RMD for the owner at all — the IRS says distributions from Roth IRAs and designated Roth accounts "are not required until after the death of the account owner" — which is the long-game reason people do Roth conversions in their sixties, and why we wrote about the conversion year's own IRMAA cost separately.

Why this lands in Mesa County

Grand Junction retires a particular kind of household: a career at the hospital, the college, the county or an energy company, a pension or a well-funded 403(b), and a second spouse with a rollover IRA of their own. Those households arrive at 73 with two accounts and one joint return, and they sit closer to the $218,000 line than they would guess. The health side of the ledger cuts the same way: per CDC PLACES, 26.6% of Mesa County adults live with high blood pressure, 8.1% with diabetes and 5.2% with coronary heart disease — the profile of a household that uses its Part B and its Part D, and pays every surcharge dollar on both.

And the calendars overlap. The RMD deadline is December 31. Medicare's Annual Enrollment closes December 7. The qualified charitable distribution has to clear the custodian before year end. The people who handle all three well are the ones who start in October, which is the month this post is written for.

What I would do this fall

1. Find your line. Pull the 2025 return, estimate 2026 MAGI without the RMD, and see which tier you are already in and how far the next one is.
2. Get the RMD number from the custodian — every account, since the IRS says an IRA owner "must calculate the RMD separately for each IRA they own but can withdraw the total amount from one or more of the IRAs."
3. Decide the April 1 question on purpose. If this is your first RMD year, model the doubled year before you defer, not after.
4. If you give anyway, give from the IRA. Set the qualified charitable distribution up as a trustee-to-charity transfer, keep it under $111,000 per person, and get the acknowledgement letter.
5. Take the tax questions to your tax advisor. Conversions, the deferral, the QCD and any capital gains are their call, and they need the Medicare calendar to make it.
6. Bring the Medicare questions to us — which tier the premium will land in, what it does to Part D, and whether the plan you are in for 2027 still fits.

How we know all this: the Medicare On Main Data Desk frames every article with public data. The age-73 starting rule, the "included in taxable income" language, the April 1 first-year deferral and its two-RMDs-in-one-year example, the 25% / 10% excise tax, the workplace-plan and 5%-owner exception, the per-IRA calculation rule and the Roth exemption are all quoted from the IRS's required minimum distribution FAQs. The qualified charitable distribution rules — age 70½, trustee-to-charity, "a check made payable to the IRA owner is not a QCD," no deduction, the acknowledgement letter and the RMD-satisfaction rule at 73 — are from IRS release IR-2023-215; the $111,000 2026 limit (up from $108,000) is from IRS Notice 2025-67. The $202.90 premium, $283 deductible, "roughly 8%" figure and every 2026 IRMAA tier and dollar amount are from the CMS fact sheet of November 14, 2025; the two-year lookback is Social Security's published rule; the closed list of life-changing events is 20 CFR §§ 418.1205 and 418.1210 on the eCFR. The worked example's $220,000 base and $34,000 RMD are stated assumptions, not figures from any table, and every dollar that follows them is arithmetic on the CMS tiers. County chronic-condition prevalence is CDC PLACES County Data 2023. No annuity, investment or charitable product is named or recommended; no carrier is endorsed. This is education, not tax or investment advice — the RMD, conversion and charitable decisions belong with your tax advisor, and Medicare premium questions with a licensed agent or Medicare.gov.