Do RMDs Affect IRMAA? 2026 Medicare Costs & Examples

Yes. Required minimum distributions can raise your Medicare premiums, but only indirectly. The taxable part of an RMD is income on your federal tax return. Social Security uses that return, usually from two years earlier, to decide whether you owe IRMAA (the income-related monthly adjustment amount), a surcharge added to Medicare Part B and Part D premiums. An RMD changes your premium only if it pushes your modified adjusted gross income (MAGI) over an IRMAA threshold.

Figures checked against CMS, SSA and IRS sources on October 17, 2026. CMS had not yet published 2027 premiums or brackets as of that date.

The short answer

• RMDs count. The taxable part goes into adjusted gross income (AGI). IRMAA uses AGI plus tax-exempt interest.
• Two years later. A 2024 RMD shaped 2026 premiums. The RMD you take in 2026 will shape 2028 premiums.
• Brackets are cliffs. For 2026, IRMAA starts above $109,000 of 2024 MAGI on an individual return, or $218,000 on a joint return. One dollar over puts you in the next tier for the whole year.
• Some withdrawals don't count. Qualified charitable distributions (age 70½ and up, up to $111,000 in 2026) and qualified Roth withdrawals stay out of AGI.
• An RMD isn't a life-changing event. To get a lower figure, you usually need a qualifying event such as stopping work, or proof that SSA used the wrong income.

Yes, the taxable part does. An RMD isn't a separate Medicare charge. It's ordinary taxable income, and it flows into the same number Social Security checks for IRMAA.

Here's the chain. Your IRA custodian reports the withdrawal on Form 1099-R. The taxable amount goes on line 4b of your Form 1040, or line 5b for an RMD from a 401(k) or other workplace plan. It becomes part of your adjusted gross income: line 11 on a 2024 return, line 11a on a 2025 return. Social Security then adds any tax-exempt interest from line 2a, which is mostly municipal bond interest. That total is your IRMAA MAGI.

Two distinctions matter here.

Taxable income isn't the number. Taxable income (line 15) is what's left after your standard or itemized deductions. IRMAA ignores those deductions, including the new deduction of up to $6,000 per person for people 65 and older, available for tax years 2025 through 2028. That deduction is claimed through Schedule 1-A on line 13b, below AGI, according to IRS Publication 6142. It can lower your income tax. It won't move your IRMAA MAGI.

The surcharge isn't the premium. In 2026 the standard Part B premium is $202.90 a month. IRMAA is an extra amount stacked on top of it, plus a separate extra amount added to whatever your Part D plan charges.

Married and filing jointly? The RMD comes from one spouse's account, but it lands in the couple's shared MAGI. Each spouse enrolled in Medicare that year pays the surcharge for the tier that shared MAGI falls into: the Part B amount, plus the Part D amount if they have drug coverage. A spouse who isn't on Medicare yet pays nothing extra. For a line-by-line walkthrough with your own return, see our guide on how to calculate MAGI for IRMAA.

An RMD changes your premium only if it moves your MAGI across a threshold. IRMAA isn't a percentage of income. It's a set of brackets, and each one charges a flat monthly amount per enrolled person.

These are the official 2026 amounts from the CMS 2026 premiums fact sheet, released November 14, 2025. They're based on 2024 MAGI. CMS says income-related adjustments affect roughly 8% of people with Part B.

*Extra cost per year is CheckIRMAA's arithmetic for someone with both Part B and Part D: (Part B premium minus the $202.90 standard premium, plus the Part D IRMAA) × 12. Annual totals assume the IRMAA charges apply for all 12 months; someone enrolled for only part of the year may pay a different total. Part D IRMAA is added to your plan's own premium. Married filing separately and lived with your spouse at any time during the year? A steeper table applies: over $109,000 goes straight to $649.20 for Part B and $83.30 for Part D, and $391,000 or more to $689.90 and $91.00.

Staying inside a bracket versus crossing one

Hypothetical illustration

Take two single filers. To keep the arithmetic simple, assume 85% of each one's Social Security is already taxable, so every extra dollar withdrawn adds exactly one dollar to MAGI. Filer A's 2024 MAGI before any extra withdrawal was $108,000. Filer B's was $150,000, already in the second tier.

Filer A's extra $2,000 costs $1,148.40 in Medicare premiums for the year, on top of the income tax. Filer B's $15,000 withdrawal costs nothing more on the Medicare side, because it never leaves the bracket, though it leaves B only $6,000 below the next line. The size of the withdrawal matters less than how far you are from the next line, which is why the same RMD can be harmless for one retiree and expensive for another.

Social Security generally sets each year's IRMAA from your tax return two years earlier, so your 2024 return sets your 2026 premiums. If the IRS can't supply that year yet, SSA uses the return from three years before, but no older, according to SSA's operating manual.

That lag matters most in the fall. By October 2026, your 2024 and 2025 income are locked in. The 2026 RMD you haven't taken yet, and any extra withdrawal you're weighing, is the income you can still shape, and it sets your 2028 premiums. The lower thresholds rise with inflation each year (the first individual line went from $97,000 for 2023 to $109,000 for 2026), while the $500,000 and $750,000 top lines have stayed put. Treat the 2026 lines as a placeholder when you plan for 2028.

Why RMDs keep coming back

A Roth conversion is a one-year spike. An RMD returns every year, and it tends to grow as a share of the account. The IRS divisor shrinks with age: 26.5 at 73 works out to about 3.8% of the prior year-end balance, and 24.6 at 75 is about 4.1% (IRS Publication 590-B, Uniform Lifetime Table). If an RMD pushes you over a threshold once, it can do it again the next year unless your balance or other income falls.

The first-RMD double-up

You can delay your first RMD until April 1 of the year after you reach RMD age. If you do, you'll take two RMDs in that second calendar year: the delayed first one and the regular one due by December 31, as the IRS RMD FAQs explain. Both land on one tax return, and on one IRMAA determination two years later.

Hypothetical example

The couple and their figures are invented to show the arithmetic. The thresholds and premiums are the official 2026 amounts.

A married couple files jointly. In 2024 the husband turned 75. His traditional IRA held $1,426,800 at the end of 2023, and the IRS divisor for age 75 is 24.6, so his 2024 RMD was $58,000. Both spouses are enrolled in Part B and a Part D plan in 2026.

Notice that 85% of their Social Security is taxable in both columns. Their other income is already high enough to hit that maximum, so each RMD dollar adds exactly one dollar to MAGI. For retirees below the 85% cap, an RMD can also pull more Social Security into AGI, and MAGI rises by more than the RMD itself (IRS Publication 915).

What the $3,800 costs: both spouses land in the first tier for all of 2026. Each pays $284.10 a month for Part B instead of $202.90, plus $14.50 a month of Part D IRMAA on top of their plan premium. That's $1,148.40 per person, or $2,296.80 for the couple.

If only one spouse had been enrolled in 2026, only that spouse would have paid it. Same income, half the surcharge, until the second spouse enrolls.

What would have kept them under?

Taking $3,800 less out of MAGI. Say the husband was already giving to charity. Had he sent $4,000 of the RMD straight from the IRA to a qualified charity as a qualified charitable distribution, the RMD would still have been satisfied in full, but only $54,000 would have been taxable. MAGI would have been $217,800. No IRMAA for 2026.

Two hundred dollars isn't a cushion, though. Mutual fund capital-gain distributions often aren't known until December, and a single late one would have erased that margin.

None of this can change their 2026 premiums now. The 2024 return is filed. The same arithmetic applies to the 2026 RMD that's still due by December 31, and that one sets 2028 premiums.

No. What matters is whether the money is included in your income. Taxable distributions count toward IRMAA MAGI. Money excluded from income, such as a QCD or a qualified Roth withdrawal, doesn't.

Sources: IRS Publication 590-B (2025) and the IRS RMD FAQs. Roth IRAs and designated Roth accounts in 401(k) and 403(b) plans don't require withdrawals while the owner is alive, but beneficiaries do take RMDs.

Sometimes. You can't skip an RMD, but you can sometimes change how much of it counts as income and when your other income lands. None of these moves guarantees a lower premium, and each has income tax trade-offs worth running past a tax professional before you act.

Qualified charitable distributions

A QCD is the main way to satisfy an RMD without adding the money to your income. Once you're at least 70½, your IRA trustee can send money directly to an eligible charity. That amount counts toward your RMD and is excluded from income, up to 108,000 for 2025). Because it never enters AGI, it never reaches IRMAA MAGI.

• It has to come from an IRA. A 401(k) or 403(b) RMD can't be sent as a QCD, and neither can a distribution from an ongoing SEP or SIMPLE IRA.
• The trustee pays the charity directly. A check made out to you and then donated doesn't qualify.
• There's no charitable deduction for the excluded amount. You can't count the same gift twice.
• Deductible IRA contributions made at 70½ or older reduce how much you can exclude.
• Donor-advised funds and private foundations aren't eligible recipients.

Order matters. If you want a QCD to replace part of your RMD, make it before you've taken the full RMD as cash. A QCD made after the full RMD is already out is still excluded from income, but it can't make the RMD you received tax-free.

Check the return, not just the 1099-R. Until 2025, custodians reported a QCD on Form 1099-R the same way as any other distribution. The IRS added a QCD code (Y) for 2025 but made it optional for that year, so many 2025 forms still won't show it. Either way, the exclusion happens on your Form 1040: the full distribution goes on line 4a and only the taxable amount on line 4b. A 2025 return also has a QCD box to check on line 4c (IRS Pub. 590-B). A QCD left in line 4b by mistake inflates both AGI and IRMAA MAGI.

Before RMDs begin

The years between retirement and RMD age are often a retiree's lowest-income years. Some people use them to draw down a traditional IRA, or convert part of it to a Roth, so later RMDs are smaller. The catch is that those withdrawals and conversions count toward IRMAA too, on the same two-year delay. Income in the year you turn 63 already shapes premiums for the year you turn 65.

Timing the first RMD and other income

Deferring your first RMD to April 1 stacks two RMDs into one tax year. Taking the first one in the year you reach RMD age spreads them out. It's worth comparing both years' projected MAGI before choosing.

Other income is often easier to move than the RMD itself: a large capital gain, an optional extra withdrawal, or a Roth conversion. If you still work for the company that sponsors your 401(k) and don't own 5% or more of it, you can generally delay that plan's RMDs until you retire. That exception doesn't apply to IRAs.

Before you take more than the minimum

Not on the RMD alone. If the income SSA used is correct and the RMD is what pushed you over, there's usually no basis for a lower figure. SSA's list of life-changing events is exclusive, and an RMD isn't on it. SSA's manual also names one-time income such as capital gains, cashed bonds and IRA conversions as non-qualifying events (SSA POMS HI 01120.005).

You keep the right to appeal. SSA must accept a reconsideration request if you want to file one. But when the IRS figures are right and no qualifying event applies, SSA's procedures call for the determination to be affirmed.

Three situations are different.

1. A qualifying life-changing event also happened

SSA recognizes eight events: death of a spouse, marriage, divorce or annulment, work stoppage, work reduction, loss of income-producing property, loss of employer pension income, and a settlement payment from a current or former employer because of its bankruptcy or reorganization. If one of them significantly reduced your income after the tax year SSA used, you can ask for a new initial determination based on a more recent year. The usual route is Form SSA-44, which you can also complete online through SSA's request page. "Significantly" means enough to lower or remove your IRMAA.

One detail matters at RMD age: the newer income you report still includes your RMDs. Say you stopped working in 2025, and your 2026 IRMAA was set from a 2024 return showing a full salary plus an RMD. A request based on your estimated 2026 income can help, because the salary is gone. The RMD and any pension stay in the estimate, though. Depending on their size, the result may be a lower tier rather than no IRMAA at all. Our SSA-44 guide for retirees covers which tax year to enter and what proof to attach.

"Loss of pension income" is narrower than it sounds. It means a traditional defined-benefit or cash-balance pension that was reduced or stopped because the plan failed or ended, or because of a payout schedule you chose in the past. Taking less from your IRA doesn't qualify. More on that on our page about IRMAA after a loss of pension income.

Death of a spouse qualifies, but the arithmetic can surprise survivors. A survivor who files as single, or as a qualifying surviving spouse, moves to the individual table, where 2026 IRMAA starts above $109,000 instead of $218,000. For the year of the death itself you can generally still file jointly, so the individual table usually applies from the following tax year. If the survivor now owns the IRA and RMDs continue, MAGI can stay above the lower line even though household income fell. See IRMAA after the death of a spouse.

Two practical rules. A request applies only to the person who files it, so if both spouses pay IRMAA, each needs their own. And timing: there's no 60-day deadline on a life-changing-event request. An approved request generally takes effect from January of the year you file it, or your first month of Part B if later. SSA ordinarily won't reach back to an earlier premium year, though, unless the event happened in October through December and you file by March 31.

2. The income SSA used is wrong or out of date

This is where an IRA withdrawal can be part of a legitimate request. SSA can make a new initial determination, without a formal appeal, when:

• You amended the return SSA used. For example, a QCD was left in line 4b, or a corrected 1099-R arrived after you filed. SSA asks for the amended return plus the IRS letter acknowledging it, or a transcript. SSA's request page says to start this by phone at 1-800-772-1213.
• The IRS data itself was wrong. The IRS has to correct it first. Then you bring the proof to SSA.
• SSA used three-year-old data. You can provide the two-year-old return instead.
• You filed separately but lived apart from your spouse all year. The steeper separate-filer table shouldn't apply.

3. You think SSA applied the rules incorrectly

If the income is right but the tier or calculation looks wrong, request reconsideration, the formal appeal (the paper form is SSA-561-U2). The deadline is 60 days from when you receive the notice, and SSA assumes you received it five days after the date printed on it (SSA POMS HI 01140.001). You can file a reconsideration and a new-determination request at the same time.

Work through these in order. Most people can finish the first four with their tax return and the SSA notice in front of them.

1. Find the two years on the notice. SSA's letter shows the premium year and the tax year it used. For 2026 premiums, that's normally your 2024 return.
2. Rebuild that year's MAGI. Add AGI (line 11, or 11a on a 2025 return) and tax-exempt interest (line 2a). Your figure should match SSA's.
3. Check the IRA lines. Compare each Form 1099-R with lines 4a and 4b. Make sure any QCD was excluded, and that after-tax basis was claimed on Form 8606 if you have it.
4. Measure the gap. How far over the threshold were you? A small gap tells you how little would need to change in future years.
5. Ask whether a qualifying event happened since. Retirement, reduced work, marriage, divorce, a spouse's death, a lost pension or an employer settlement can open a new determination.
6. Note the deadlines. Reconsideration: 60 days from receiving the notice. Life-changing-event requests: no fixed deadline, but limited backdating.
7. Plan this year before December 31. The RMD, any QCD and any realized gains you take this year will set premiums two years from now.

Does taking an RMD increase Medicare premiums?

Only if it pushes your IRMAA MAGI over a threshold. The taxable RMD counts toward the premium year two years later. If your MAGI stays inside the same bracket, your premiums don't change because of it.

How much can an RMD add to Medicare premiums?

In 2026, crossing the first threshold adds $1,148.40 a year per person enrolled in Part B and Part D: $81.20 a month for Part B and $14.50 for Part D. A large RMD can cross more than one line, and the top tier costs $6,936 a year more per person than paying no IRMAA. On a joint return with both spouses enrolled, each pays.

Does an RMD make more of my Social Security taxable?

It can. Up to 85% of Social Security benefits can be taxable, and the taxable part is included in AGI. If you're below that maximum, an RMD can raise AGI by more than the RMD itself. Once 85% of your benefits are taxable, that extra effect stops.

Does withholding income tax from an RMD reduce the amount counted toward IRMAA?

No. Withholding is a prepayment of your income tax, not a cut in your income. Say you take $20,000 from a fully taxable traditional IRA and have $3,000 withheld for federal tax. Your bank account gets $17,000, but the taxable distribution is still $20,000, because Form 1099-R reports the amount before withholding. The $3,000 goes on your Form 1040 as tax already paid (line 25b), so it doesn't lower AGI or IRMAA MAGI.

Do Roth IRA withdrawals count toward IRMAA?

Qualified Roth withdrawals don't. They're tax-free and stay out of AGI. A Roth conversion does count, because the converted pre-tax amount is taxable in the year you convert.

Can a QCD lower IRMAA?

It can keep future IRMAA MAGI lower, because the QCD amount is excluded from AGI. It won't change a determination already set from an earlier return, unless that return wrongly reported the QCD as taxable and you amend it.

Can I appeal IRMAA because of an RMD?

Not on that basis alone. An RMD isn't one of SSA's eight life-changing events. A request can work if a qualifying event also lowered your income, or if the income SSA used was wrong or out of date.

How long does one IRA withdrawal affect Medicare premiums?

Usually one premium year. Each premium year is normally priced from the return two years earlier, so a withdrawal in 2026 affects 2028 premiums. If SSA has to fall back on a three-year-old return, the same year's income can be used again until the newer return arrives, and you can ask SSA to use the newer one. RMDs repeat, so the effect can repeat too.

When do RMDs start?

It depends on your birth year. Under the IRS's 2024 final RMD regulations, the age is 73 if you were born from 1951 through 1958 and 75 if you were born in 1960 or later. People born in 1959 fall into a drafting overlap in the SECURE 2.0 Act. Proposed regulations would set their age at 73, but those rules weren't final as of this update. Roth IRAs have no RMDs for the original owner.

An RMD affects IRMAA the way any taxable income does. It counts two years later, and it only costs you if it pushes MAGI over a line. Because RMDs come back every year, so does the planning window, and each one closes on December 31.

This article explains federal rules as of October 17, 2026. It's general information, not tax, legal or financial advice. CheckIRMAA is a private service, independent of the Social Security Administration, CMS and Medicare.

Published by CheckIRMAA · Updated October 17, 2026

• CMS, 2026 Medicare Parts A & B Premiums and Deductibles: 2026 Part B and Part D IRMAA tables, $202.90 standard premium.
• SSA POMS HI 01101.010: MAGI definition, two-year lookback, 2023 to 2026 thresholds.
• SSA POMS HI 01120.005: life-changing events, non-qualifying events, effective dates.
• SSA POMS HI 01120.001: new initial determinations, amended and corrected returns, per-person requests.
• SSA POMS HI 01120.040: what counts as loss of pension income.
• SSA POMS HI 01140.001 and HI 01140.005: reconsideration deadline and process.
• SSA, Request to lower an IRMAA and Form SSA-44 (12-2025): how to request, amended returns, evidence.
• IRS, Retirement plan and IRA RMD FAQs: first-year deadline, Roth accounts, still-working exception, taxation.
• Treasury and IRS, Required Minimum Distributions final regulations (July 19, 2024): RMD starting ages.
• Treasury and IRS, Required Minimum Distributions proposed regulations (July 19, 2024; not final): age 73 for people born in 1959.
• IRS Publication 590-B: QCD rules and limits, line 4c reporting, basis, rollovers, RMD divisors.
• IRS, Entering code Y in a 2025 Form 1099-R is optional: QCD reporting on Form 1099-R.
• IRS, Instructions for Forms 1099-R and 5498: box 1 shows the distribution before tax is withheld.
• IRS, Form 1040: AGI on line 11 (11a on the 2025 form), tax withheld on Forms 1099 on line 25b.
• IRS Publication 915: taxation of Social Security benefits.
• IRS Publication 6142: additional deduction for seniors, line 13b.