Can an RMD raise your Medicare premiums?

Part 5 of The Rule That Taxes Your Retirement. An RMD is income, and income moves other numbers. Medicare sets its IRMAA surcharge from your tax return two years earlier, so a 2026 RMD can raise your 2028 premiums. The first lines, and what it costs a couple to cross one.

Ian Schaeffer · November 6, 2026 · 2 min read

David makes a point in his guide that surprises most people: the RMD itself is rarely the worst part. It's income, and income moves other numbers.

This week we've covered why RMDs exist, when they start, how much to take and what happens if you miss one. Today is the first domino: your Medicare premiums.

Pen-and-ink illustration of Eddie and Betty studying an old ledger with a magnifying glass — The withdrawal and the higher premium show up in different years. That's why so few people connect them.

How does an RMD reach your Medicare bill?

Medicare charges higher-income people more for the same Part B and Part D coverage. The surcharge is called IRMAA, the income-related monthly adjustment amount.

Social Security sets it from your tax return two years earlier. So an RMD in 2026 can raise your premiums in 2028. The withdrawal and the higher premium arrive in different years, which is why so few people connect them.

Where are the lines?

For 2026 premiums, the first IRMAA line is based on income from two years earlier:

Married filing jointly: over $218,000.
Single: over $109,000.
The cost of crossing it: for a married couple one dollar over the line, about $2,297 a year in extra Part B and Part D premiums.

Income here means modified adjusted gross income: your adjusted gross income plus tax-exempt interest. The lines are set every year and usually rise a little.

What else does that income touch?

The same income can make more of your Social Security taxable. Up to 85% of your benefits can be taxed once your income passes thresholds that have never been adjusted for inflation.

What can you do about it?

Estimate first. Before the year ends, estimate what your RMD adds to your income, and compare it with the IRMAA lines.
Watch the first-year double. As we covered Tuesday, delaying your first RMD to April 1 means two in one year, which can push you over a line.
Look at how you give. If you give to charity, there's a way to send IRA money straight to the charity without it counting as income. That's tomorrow.
Know the appeal. If your income dropped because of a life-changing event, like retiring or losing a spouse, you can ask Social Security to use a more recent year, on Form SSA-44.

We've written more about how IRMAA works and what your first RMD can do to it.

The full domino chart is in David's guide, The Hidden History of the Rule That Taxes Your Retirement. If you'd like to see how your withdrawals line up with the Medicare lines, alongside your tax professional, you can begin the conversation here.

This is Part 5 of The Rule That Taxes Your Retirement, a seven-part series from David Schaeffer's guide. Figures reflect 2026 amounts from CMS and change every year. For education only. Not tax, legal or investment advice.

Disclaimer: The information in this article is for educational purposes only and does not constitute tax, legal, or investment advice. Tax laws change frequently, and individual circumstances vary. American Retirement Advisors does not provide tax or legal services. Before making any tax-related decisions, consult a qualified CPA, tax attorney, or financial planner who can evaluate your specific situation.