A 68-year-old widow in Ohio inherited her brother’s $400,000 traditional IRA in 2024. As a non-spouse beneficiary, she generally has to empty the account by the end of the 10th year after his death. She tried to avoid one huge tax bill by spreading withdrawals over time, taking roughly $40,000 in 2024. In late 2025, she opened her Medicare letter and saw that her 2026 Part B premium had jumped by $81.20 a month. She had walked straight into IRMAA, and the cause was a withdrawal she made two years earlier.
If your household MAGI sits comfortably below $109,000 single or $218,000 joint, IRMAA may not be an immediate concern. CMS says income-related Part B adjustments affect about 8% of people with Medicare Part B. The rest of this article is for retirees near a threshold who are about to start emptying an inherited account.
How an inherited IRA distribution becomes a Medicare bill
Medicare generally uses your MAGI from two years ago to set this year’s premium, and Social Security makes the IRMAA determination. Inherited traditional IRA withdrawals are taxable income for IRMAA purposes, so a 2024 withdrawal can affect the 2026 premium, and a 2025 withdrawal can affect the 2027 premium. By the time you see the surcharge, the income event is already locked in unless a qualifying SSA-44 event applies.
Here is what the brackets cost in 2026, on top of the standard $202.90 Part B premium, per person:
| Single MAGI (joint MAGI) | Part B surcharge / month | Part D surcharge / month | Added cost / year, per person |
|---|---|---|---|
| $109,001 to $137,000 ($218,001 to $274,000) | $81.20 | $14.50 | $1,148.40 |
| $137,001 to $171,000 ($274,001 to $342,000) | $202.90 | $37.50 | $2,884.80 |
| $171,001 to $205,000 ($342,001 to $410,000) | $324.60 | $60.40 | $4,620.00 |
| $205,001 to $499,999 ($410,001 to $749,999) | $446.30 | $83.30 | $6,355.20 |
| $500,000+ ($750,000+) | $487.00 | $91.00 | $6,936.00 |
For our Ohio widow, her Social Security, a small pension, and the $40,000 inherited-IRA withdrawal pushed her 2024 MAGI to about $115,000. She is single, so she crossed the $109,000 line by roughly $6,000. The penalty for that $6,000 of income: an extra $81.20 per month on Part B and $14.50 per month on Part D, all of 2026. That is roughly $1,148 for the year, and it does not return any benefit. The 2.8% Social Security COLA for 2026 does not come close to covering it.
What MAGI counts, and the survivor trap
For IRMAA, MAGI is your Form 1040 adjusted gross income plus tax-exempt interest from line 2a. Municipal bond income that feels tax-free still counts. So does a taxable distribution from an inherited traditional IRA, even if you reinvest the money in a regular brokerage account the next day.
The cruelest version of this is the survivor trap. A couple at $260,000 of joint MAGI sits in the first IRMAA tier in 2026 and pays the $81.20 Part B surcharge per person. After one spouse dies, the survivor may still be able to file jointly for the year of death, but many older survivors eventually file as single. If the survivor had $260,000 of MAGI as a single filer, the surcharge would jump to $446.30 for Part B plus $83.30 for Part D each month.
SSA-44 will not save you here
Form SSA-44 applies when a qualifying life-changing event reduces household income. The list includes marriage, divorce or annulment, death of a spouse, work stoppage, work reduction, loss of income-producing property, loss of pension income, and an employer settlement payment. A voluntary inherited-IRA withdrawal does not qualify, no matter how badly it raised your MAGI. The death of a sibling who left you an IRA does not qualify either.
What to do
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Model your distributions against the brackets before December. If your projected MAGI lands within $10,000 of $109,000 single or $218,000 joint, consider trimming any optional withdrawal and pushing the difference to a later year inside the 10-year window. The IRS gives many non-spouse beneficiaries flexibility on timing, but some beneficiaries must also take annual RMDs during years one through nine if the original owner had already reached the required beginning date.
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Coordinate withdrawals with other taxable events. A home sale, a Roth conversion, or a large capital gain in the same year as your inherited-IRA distribution stacks on the same MAGI. Spread them across tax years.
- If you lost a spouse this year and household income fell, consider filing SSA-44 with documentation such as a death certificate and evidence of the lower income year. That is the inherited-IRA-adjacent scenario where the form may work, because death of a spouse is a qualifying event and the survivor’s income often falls when the deceased spouse’s wages or pension end.
Source note: 2026 Medicare premiums, IRMAA brackets, and Part D adjustment amounts are from the CMS fact sheet released November 14, 2025. COLA data from the Social Security Administration.
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