Roth Timing Can Cut Medicare Costs

Retirees with large traditional 401(k) balances could use Roth conversions before RMDs begin, turning Medicare premium timing into a long-term tax and surcharge management strategy.
For 2026, Medicare IRMAA began above $109K single or $218K joint. Standard Part B cost $202.90 monthly, while higher tiers added steep surcharges.
The two-year lookback mattered: 2026 premiums used 2024 MAGI. A conversion done in 2026 affected 2028 premiums, making yearly planning especially important.
Spreading a $250K conversion across three years could keep joint MAGI below $218K each year, avoiding IRMAA instead of triggering thousands in annual surcharges.
Gap years before RMDs offered prime conversion room. Under the law, people born after 1959 did not face RMDs until age 75.
Once assets reached a Roth IRA, qualified withdrawals stayed tax-free and did not count toward MAGI, helping retirees fund spending without lifting Medicare premiums.
The guidance: review current MAGI, model each conversion