Quick Read – $200k from traditional 401(k) keeps MAGI below $218k IRMAA cliff, avoiding $1,783 annual Medicare surcharges per couple. – Use Roth withdrawals tax-free to fill spending gap; never tap brokerage in high-MAGI years to prevent capital gains triggering IRMAA penalties….
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The Couple, the Cliff, and the $200,000 Spend A married couple, both 65, sits on $2.4 million in a traditional 401(k), $750,000 in a Roth IRA, and $400,000 in a taxable brokerage. They plan to spend $200,000 a year and delay Social Security until 70. The retirement math looks tidy until the first withdrawal hits the Medicare premium worksheet two years later.
The trap sits in the Income-Related Monthly Adjustment Amount, or IRMAA, which uses a two-year lookback on modified adjusted gross income to set Medicare Part B and Part D premiums. For 2026, the first IRMAA tier for married filing jointly begins at roughly $218,000 of MAGI. Cross it by one dollar and both spouses carry surcharges for a full calendar year.