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 draws from his traditional IRA, watches his tax bill climb, and wonders whether he is being smart or just scared. Versions of this exact worry appear 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 wrong.

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 whole point of having paid the tax up front years ago.

“Qualified” has a specific legal meaning: the account owner must be at least 59.5 years old and the Roth account must have been open for 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 sizable distribution.

The Social Security tax torpedo runs off provisional income, which equals adjusted gross income (AGI) plus tax-exempt interest plus half of the Social Security benefit. For single filers, once provisional income crosses $25,000, up to 50% of the benefit becomes taxable. Above $34,000, up to 85% can be taxable. For married couples filing jointly, those tiers kick in at $32,000 and $44,000. Those thresholds have not been adjusted for inflation since the 1990s, which means every COLA increase quietly nudges more retirees into higher taxability territory. That 85% is the share of the benefit that can be included in taxable income, not the tax rate itself. A traditional IRA withdrawal lands inside AGI and can push more of the benefit into that zone. A qualified Roth withdrawal does not.

Medicare’s income-related monthly adjustment amount, known as IRMAA, works on similar logic. 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 per month rising in steps all the way to $689.90 per month at the top tier. IRMAA also functions as a cliff: crossing a threshold by even $1 triggers the full surcharge for that tier and every dollar of the year that follows. Qualified Roth withdrawals are not included in that MAGI calculation, so they cannot tip a retiree into a higher premium bracket. Because IRMAA is based on income from two years prior, a large traditional IRA withdrawal today can surface as a Medicare premium hike two years down the road.

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, which involves moving money from a traditional IRA into a Roth, counts as ordinary income in the year the conversion happens. That upfront cost is real, and it is a genuine IRMAA and Social Security taxability event in the conversion year. Spending from an existing Roth is an entirely different transaction from funding one, and conflating the two leads retirees to avoid a tool that is actually free of those costs at the point of use.

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 carried no lifetime RMDs for the original owner. Roth dollars are therefore not forced out during the owner’s lifetime on any fixed schedule.

Where the Roth fits in the broader picture

With the 2026 cost-of-living adjustment confirmed at 2.8%, Social Security checks rose modestly this year, and that bump itself nudges provisional income upward. The average retired worker saw a monthly benefit gain of roughly $56, bringing the average check to about $2,071. Because the taxability thresholds are frozen, even a small COLA can drag more of a benefit into the taxable column. The Roth serves as a useful shock absorber against exactly that drift, letting a retiree cover expenses without adding a single dollar to provisional income.

The One Big Beautiful Bill Act, signed in July 2025, created a temporary additional deduction of $6,000 per senior age 65 and older (up to $12,000 for eligible couples filing jointly) for tax years 2025 through 2028. The deduction stacks on top of the regular standard deduction and is available whether or not the filer itemizes. It phases out starting at $75,000 of MAGI for single filers and $150,000 for joint filers, and is fully eliminated above $175,000 and $250,000 respectively. This provision does not change the legal formula for Social Security taxability: the senior deduction reduces taxable income after the taxable benefit amount is already computed, so it has no effect on how much of a Social Security benefit gets pulled into the taxable column. That makes the Roth’s provisional-income advantage most valuable for higher-income retirees who earn too much to benefit fully from the new deduction.

Consider a concrete example. A $30,000 kitchen remodel funded from a traditional IRA adds $30,000 to AGI, potentially pushes more Social Security into the taxable zone, and can lift Medicare premiums into a higher tier two years later. Funding that same remodel from a qualified Roth adds nothing to income, creates no taxability shift, and carries 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 59.5 is easy to clear at 70, but verify the five-year clock on the specific Roth account. Assuming qualification that does not yet exist is the hardest mistake to undo.
2. Use the Roth where it does the most work. Reach for it in any 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 different, and the thresholds that matter most depend on where the year is already landing. A conversation with a tax preparer before a large withdrawal typically pays for itself several times over.

Editor’s note: The 2026 COLA figure was updated to reflect the SSA’s confirmed 2.8% adjustment and the corresponding average monthly benefit increase of about $56 (bringing the average retired-worker check to roughly $2,071). The OBBBA senior deduction phase-out range was expanded to include the full elimination points ($175,000 for single filers and $250,000 for joint filers), sourced from IRS guidance and multiple tax authorities.

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