Retirees Doing Big Roth Conversions Are Being Warned About This IRMAA Surcharge That Cannot Be Reversed Even With Form SSA 44

On her September 15, 2022 Women & Money episode, Suze Orman dropped a line every retiree planning a Roth conversion should hear before they sign the paperwork: “we have a new IRMAA in our life.” The income spike from a Roth conversion can blow past Medicare’s income thresholds and trigger a surcharge that most people never see coming until the bill arrives two years later.

Convert a chunk of a traditional IRA to a Roth in your 60s and the entire converted amount counts as ordinary income that year. That income lands on your tax return, and Medicare uses your modified adjusted gross income from two years prior to set your Part B and Part D premiums. The penalty shows up long after the conversion feels like a closed decision.

Orman is right, and the math is brutal

IRMAA, the Income-Related Monthly Adjustment Amount, works as a cliff. Cross a threshold by one dollar and your Medicare premium jumps for the entire year. There is no phase-in and no proration.

Here is how the trap snaps shut. The standard 2025 Part B premium runs roughly $185 per month per person. A married couple filing jointly with MAGI up to about $212,000 pays that base rate. Push joint MAGI one dollar higher and both spouses move into the first IRMAA tier, where Part B climbs to roughly $259 each, plus a Part D surcharge on top. These are illustrative 2025 figures; 2026 thresholds shift with inflation, which CPI data shows running at about 2.1% year-over-year.

The damage scales fast. A couple converting $200,000 in one shot, on top of $80,000 of other taxable income, can land in the higher IRMAA tiers. Their combined Part B and Part D surcharges for that single year can run several thousand dollars above what a couple just under the threshold pays. That is on top of the federal income tax owed on the conversion itself, which under 2026 brackets puts joint income above $211,400 at a 24% marginal rate.

Orman pays it herself. On that same episode she said “I think we pay 526 a month KT out of our Social Security check for Medicare Part B”, which puts her household in one of the upper IRMAA tiers.

The two-year lookback is what catches people

A conversion you complete in 2026 sets your 2028 Medicare premiums. By the time the higher bill arrives the money is already in the Roth and you cannot reverse it. The IRS eliminated Roth recharacterizations in 2018.

One escape hatch exists. SSA Form SSA-44 lets you request an IRMAA adjustment after a life-changing event such as retirement, the death of a spouse, or divorce. A one-time Roth conversion does not qualify. Selling a rental property does not qualify either. The surcharge sticks for the full year.

The variable that flips the answer

The factor that decides whether a Roth conversion is worth the IRMAA hit is your expected future tax rate. If you sit in the 24% federal bracket today and expect to drop to 12% in your 70s once required minimum distributions calm down, paying tax now plus a $5,000 IRMAA surcharge to convert $100,000 is a bad trade. You paid roughly 29% effective to avoid a 12% bill later.

Flip the scenario. If you expect higher rates later because RMDs will be enormous or because federal rates rise, paying IRMAA once on a sized conversion can save six figures over a 20-year retirement. The lever is conversion size. Converting $40,000 a year for five years often keeps you under the next IRMAA tier each year. Converting $200,000 in one shot blows through three tiers at once.

What to actually do

1. Pull last year’s tax return, find your MAGI, and add your planned conversion. Check where the total lands against current IRMAA brackets at Medicare.gov before you pull the trigger.
2. Build a multi-year conversion ladder. Most planning software solves for the largest conversion that keeps you below the next IRMAA cliff.
3. Track the five-year rule on each conversion. Orman covers this in her Women & Money app masterclass on the five-year rule and Roth conversions; each converted amount has its own five-year clock before earnings come out penalty-free.
4. If a qualifying life event hits, file SSA-44 the year the higher premium kicks in. The form is free and the appeal is routine.

Orman’s IRMAA warning is the reminder that a Roth conversion run without checking the next two years of Medicare premiums can cost more than it saves. The conversion is the easy part. The surcharge is the part nobody mentions until it shows up in the mail.