A 70-Year-Old Held Off on His Roth, Sure It Would Raise His Medicare Premium and Tax His Social Security. Qualified Withdrawals Touch Neither.

A 70-year-old retiree sits on a healthy Roth IRA and refuses to touch it. He has heard, somewhere along the way, that pulling money out will raise his Medicare premium and drag more of his Social Security into the taxable column. So the Roth sits untouched while he pulls from his traditional IRA, watches his tax bill climb, and wonders if he is being smart or just scared. Versions of this exact worry show up on retirement forums every week, usually with the same anxious phrasing: will my Roth withdrawal mess up my Medicare?

The fear is understandable. It is also backwards.

What actually counts as income, and what does not

Qualified Roth IRA withdrawals are tax-free, and the IRS does not include them in the income figures that drive either Social Security taxation or Medicare premiums. They are invisible to both formulas. That is the entire point of having paid the tax up front years ago.

“Qualified” has a specific meaning: the owner must be at least 59½ and the Roth account must have been open at least five years. A 70-year-old with a long-held Roth almost certainly clears both bars, but it is worth confirming before the first distribution.

The Social Security tax torpedo works off provisional income, which is adjusted gross income (AGI) plus tax-exempt interest plus half of the Social Security benefit. Once provisional income crosses certain thresholds, up to 85% of the benefit can become taxable. That 85% is the share of the benefit that gets taxed, not the tax rate itself. A traditional IRA withdrawal lands inside AGI and can push more of the benefit into that taxable zone. A qualified Roth withdrawal does not.

Medicare’s income-related monthly adjustment amount, or IRMAA, works similarly. Part B and Part D premiums step up at modified adjusted gross income (MAGI) thresholds. For 2026, the first surcharge tier kicks in above $109,000 for single filers and $218,000 for joint filers, with the standard Part B premium of $202.90 rising in steps from there. Qualified Roth withdrawals are not in that MAGI calculation, so they cannot tip a retiree into a higher premium tier.

The trap that catches people: conversions are not withdrawals

Here is where the confusion often starts. A qualified Roth withdrawal does not count toward income. A Roth conversion, moving money from a traditional IRA into a Roth, absolutely does count as ordinary income in the year of the conversion. That is the upfront cost of getting money into the Roth in the first place, and it is a real IRMAA and Social Security taxability event in the conversion year. Spending from an existing Roth is a completely different transaction from filling one up.

One more useful piece: under SECURE 2.0, lifetime required minimum distributions (RMDs) on Roth 401(k)s were eliminated starting in 2024. Roth IRAs already had no lifetime RMDs for the original owner. So Roth dollars are not forced out during his life on any schedule but his own.

Where the Roth fits in the broader picture

With the 2026 cost-of-living adjustment (COLA) set at 2.8%, Social Security checks rose modestly this year, and that bump itself can nudge provisional income upward. The Roth becomes a useful shock absorber against exactly that drift.

If a $30,000 kitchen remodel comes up, pulling the money from a traditional IRA adds $30,000 to AGI, potentially shoves more Social Security into the taxable zone, and can push Medicare premiums into a higher tier two years later. Pulling the same $30,000 from a qualified Roth: no income added, no taxability shift, no IRMAA consequence. Same kitchen, very different tax outcome.

What to do with this

Two steps make the Roth worthwhile.

1. Confirm qualified status before the first big draw. Age 59½ is easy at 70, but verify the five-year clock on the specific Roth account. The hardest mistake to undo is assuming qualification that does not yet exist.
2. Use the Roth where it does the most work. Top off a year when an extra dollar from the traditional IRA would cross an IRMAA threshold or pull more Social Security into tax. That is the moment the Roth earns its keep.

Every retiree’s mix of accounts, filing status, and other income is a little different, and the thresholds that matter most depend on where the year is already landing. A quick run through the numbers with a tax preparer before a large withdrawal usually pays for itself several times over.

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