A retiree who turns 73 this year has a deceptively simple decision: take the first required minimum distribution by December 31, or use the one-time option to delay it until April 1 of the following year. The delay can look harmless. But it may put two RMDs into one tax year, push modified adjusted gross income across an IRMAA bracket, and raise Medicare premiums two years later.
Only about 8% of Medicare beneficiaries with Part B pay any IRMAA surcharge at all. The risk is concentrated among retirees whose household MAGI is near the 2026 thresholds of $218,000 for joint filers or $109,000 for single filers. If a first RMD lands on top of Social Security, pension income, and taxable interest, one calendar-year timing decision can add thousands of dollars in Medicare premiums.
The two-year lookback is the trap
IRMAA generally uses MAGI from two years back. Your 2026 tax return will usually drive your 2028 Part B and Part D premiums. That means an RMD taken this year, based on the December 31, 2025 account balance, can shape the Medicare bill you pay 24 months from now. For a voluntary RMD, there is usually no appeal simply because income later falls.
MAGI here is AGI (Form 1040 line 11) plus tax-exempt interest (line 2a). Municipal bond income that feels tax-free still counts. Readers routinely miss this and land a bracket higher than they modeled.
What each bracket actually costs in 2026
Here are the 2026 CMS figures for the first three IRMAA tiers most likely to be affected by a first-RMD timing decision. The amounts are monthly and per person: total Part B premium, plus the Part D IRMAA add-on that stacks on top of any separate drug plan premium.
| Joint MAGI | Single MAGI | Part B total/mo | Part D IRMAA/mo |
|---|---|---|---|
| ≤ $218,000 | ≤ $109,000 | $202.90 | $0.00 |
| $218,001–$274,000 | $109,001–$137,000 | $284.10 | $14.50 |
| $274,001–$342,000 | $137,001–$171,000 | $405.80 | $37.50 |
| $342,001–$410,000 | $171,001–$205,000 | $527.50 | $60.40 |
Move a joint filer from the standard tier to the first surcharge tier and each spouse pays an extra $81.20 for Part B and $14.50 for Part D every month. For the couple, that is $2,296.80 a year in surcharges. Cross into the second tier and the added annual cost is $5,769.60 for the household.
Why the first RMD is the classic trigger
The temptation is to defer the first RMD to April 1 of the following year. Do that and two RMDs land in the same tax year: the deferred first one and the mandatory second one. A retiree with a $900,000 traditional IRA who defers could add roughly $70,000 of taxable income in a single year, depending on the next year’s account balance. That can push joint MAGI past $218,000 or $274,000 in one move.
Take the first RMD in the year you turn 73 instead, and the income splits across two calendar years, keeping MAGI lower in each. Under current law, the starting age is 73 for people born in 1951 through 1959 and 75 for those born in 1960 or later.
The survivor trap most couples never model
When one spouse dies, the survivor may eventually file as single. The single brackets are roughly half the joint ones. A household that sat below $218,000 as a couple can leave the survivor closer to, or above, the $109,000 single threshold with the same portfolio and RMD structure. Death of a spouse is an SSA-44 life-changing event, but the lower single thresholds still matter after the transition.
SSA-44 will not save a voluntary RMD
Form SSA-44 lets the Social Security Administration reconsider IRMAA after a qualifying life-changing event: marriage, divorce or annulment, death of a spouse, work stoppage, work reduction, certain losses of income-producing property, loss of pension income, or an employer settlement payment. A large RMD, Roth conversion, or voluntary home sale does not qualify by itself. If you voluntarily raise MAGI, the surcharge usually stands.
What to do
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Consider taking the first RMD in the calendar year you turn 73, not during the April 1 grace period, unless your CPA has run the two-year IRMAA math and confirmed the deferral wins.
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If you are charitably inclined and at least 70½, direct up to the annual QCD limit from the IRA to a qualified charity. For 2026, that limit is $111,000. QCDs can satisfy an RMD without adding to AGI, making them one of the cleanest IRMAA defenses available.
- If your projected joint MAGI is within $20,000 of a threshold, ask a fee-only advisor to model withdrawal timing, capital gains, QCDs, and taxable interest before December 31.
Plan the RMD Before Medicare Prices It
The first RMD decision is not just a tax deadline. It is also a Medicare premium decision that can show up two years later. Deferring until April 1 can be useful in the right tax year, but retirees near an IRMAA threshold should treat that grace period as a planning tool, not a default setting.
Sources: 2026 Medicare premium and IRMAA figures come from the CMS “2026 Medicare Parts A & B Premiums and Deductibles” fact sheet. RMD timing and first-year deferral rules come from IRS RMD guidance. SSA-44 qualifying events come from Social Security Administration Form SSA-44. The 2026 QCD limit comes from IRS Notice 2025-67.
Contact [email protected] for any questions or corrections.
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