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Can a Roth Conversion Increase Your Medicare Premiums?
Last Modified: 10/05/2026 | Reviewed by Keith Armbrecht (NPN 634015)
Quick Summary
Yes. A Roth conversion can increase your future Medicare Part B and Part D premiums because the taxable portion of the conversion generally increases adjusted gross income.
Medicare’s IRMAA surcharge is based on modified adjusted gross income.
Because Social Security normally looks back two tax years, a Roth conversion completed in 2026 could generally affect your 2028 Medicare premiums.
This doesn’t necessarily mean a Roth conversion is a bad idea. It means the potential Medicare cost should be included in your tax-planning decision.
Key Facts
- Taxable Roth conversions generally increase adjusted gross income.
- Higher AGI can increase Medicare MAGI.
- Higher MAGI can trigger IRMAA.
- IRMAA applies to Part B and Part D.
- Medicare generally uses a two-year lookback.
- A 2026 conversion could generally affect 2028 Medicare premiums.
- IRMAA brackets create “cliffs” where additional income can move you into the next tier.
- A Roth conversion itself isn’t one of SSA’s eight IRMAA life-changing events.
- Partial conversions may help manage taxable income.
- Medicare consequences should be coordinated with a tax advisor.
Why Does a Roth Conversion Affect Medicare?
When you convert pre-tax Traditional IRA or retirement money to a Roth account, the taxable portion of that conversion is generally included in gross income.
That can increase:
Adjusted Gross Income
which can increase:
Medicare MAGI
and potentially:
IRMAA.
A Simple Example
Suppose your normal Medicare MAGI would be:
$200,000
for a married couple.
You convert:
$100,000
from a Traditional IRA to a Roth IRA.
Assuming the full amount is taxable for illustration:
New MAGI could be approximately:
$300,000
That could move you into a higher IRMAA tier.
Why the Two-Year Lookback Matters
Suppose you complete a large Roth conversion in:
2026
Social Security normally uses 2026 tax information when setting:
2028 Medicare IRMAA.
So the Medicare impact may not appear immediately.
Should You Avoid Roth Conversions Because of IRMAA?
Not necessarily.
A conversion may still produce important long-term advantages, such as:
- Reducing future pre-tax retirement balances
- Reducing future taxable distributions
- Increasing Roth assets
- Improving future tax flexibility
- Potentially reducing future IRMAA exposure
The right comparison is:
Short-term tax + IRMAA cost
versus
potential long-term benefit.
The IRMAA Cliff Problem
Suppose a conversion pushes your MAGI only slightly above an IRMAA threshold.
That additional dollar of income can place you into the next IRMAA tier.
Because each Medicare beneficiary in a married couple can owe IRMAA, the effect can be multiplied.
Video Explanation from Keith
Roth Conversions Can Raise Your Medicare Premiums
Keith's Take
I like Roth conversions as a retirement-planning tool.
But I don’t like doing them in a vacuum.
If you’re converting $100,000 or $200,000, I want someone looking at:
Federal tax
state tax
and
Medicare IRMAA
before deciding how much to convert.
Sometimes paying one or two years of higher Medicare premiums is worth the long-term tax benefit.
But it should be intentional—not a surprise two years later.
Keith Armbrecht
Medicare on Video
Frequently Asked Questions
Q. Does a Roth conversion count toward IRMAA?
A. The taxable portion can increase AGI and therefore Medicare MAGI.
Q. When would a 2026 conversion affect Medicare?
A. Generally 2028 under the normal two-year lookback.
Q. Is IRMAA based on taxable income?
A. Not exactly. It uses modified adjusted gross income under Medicare rules.
Q. Can I appeal because I voluntarily made a Roth conversion?
A. A Roth conversion itself isn't one of SSA's eight standard life-changing events.
Q. Would smaller conversions help?
A. Potentially. Partial conversions may allow better management of tax and IRMAA thresholds.
Q. Does a Roth withdrawal later affect IRMAA?
A. Qualified Roth IRA distributions generally aren't included in federal taxable income, which is one reason Roth assets can provide retirement tax flexibility.
Official Government Sources
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