A $122,000 required minimum distribution triggered $42,000 in Medicare premium surcharges over three years for a retired couple.
A retired couple faces $42,000 in Medicare income-related monthly adjustment amount (IRMAA) surcharges after a $122,000 required minimum distribution (RMD) from a $3 million 401(k) pushed their modified adjusted gross income above the top IRMAA threshold. The surcharges apply for three consecutive years due to Medicare’s two-year income lookback rule.
The top IRMAA tier for couples begins at $750,000 in modified adjusted gross income, adding $487 per month to each spouse’s Part B premium, raising it to $689.90. The couple’s combined income, including pensions, Social Security, and dividends, exceeded the threshold, locking in the surcharges.
A qualified charitable distribution of up to $111,000 per person in 2026 could reduce their income below the IRMAA cliff, avoiding future surcharges. The couple was unaware of the tax implications until after the first RMD was withdrawn.