Educational Content Only: This page is for educational purposes only and does not constitute financial advice, investment advice, or a recommendation to buy or sell any financial product or security. Michael Gurr is a Medicare and retirement specialist, not a registered investment advisor. Through our office, clients have access to a team of specialized financial advisors who have tailored training specific to common retirement accounts and are built to work with folks 65+. For personalized investment, tax, or portfolio guidance, please consult a qualified financial advisor or tax professional.
The couple in Gig Harbor did a Roth conversion the year before they retired. It was a sensible strategy — converting while income was still manageable, before required distributions began. Their financial planner recommended it. The math made sense on its own.
The following year, their Medicare Part B and Part D premiums increased by about $3,600 combined. The Roth conversion had pushed their income over an IRMAA threshold.
The conversion was a sound strategy. It was not coordinated with the Medicare side of the picture. One decision in one pillar produced an unexpected cost in another.
That is the IRMAA problem — and it is the clearest illustration of why retirement income planning and Medicare planning cannot live in separate conversations.
Medicare Premiums Are Retirement Income Items
The standard Medicare Part B premium in 2026 is $202.90 per month per person. For a couple, that is approximately $4,870 per year before any supplemental coverage is added. A Medicare Supplement plan or Medicare Advantage plan adds more. Part D adds more.
These are retirement budget items as real as housing and utilities. A retirement income plan that does not include them is working from incomplete numbers.
The IRMAA Surcharge — The Cliff Most People Never See Coming
For retirees whose income exceeds certain thresholds, Medicare adds a monthly surcharge to both Part B and Part D premiums. This is the IRMAA, or Income-Related Monthly Adjustment Amount.
In 2026, IRMAA surcharges begin at:
$109,000 of modified adjusted gross income for single filers
$218,000 for married couples filing jointly
IRMAA is calculated using income from two years prior. A decision made in 2024 affects 2026 Medicare premiums.
2026 IRMAA surcharge tiers. Thresholds indexed annually.
These amounts are per person per month. A couple at the first IRMAA tier pays an additional $1,776 per year in combined Medicare premiums compared to the standard rate.
The cliff is the part that catches people. A single dollar of income over a threshold triggers the full surcharge for the entire tier — not a gradual increase. One transaction can push a household from the standard premium to a significantly higher tier for a full year.
The Survivor IRMAA Trap
When one spouse dies, the survivor shifts from married filing jointly to single filing status. The IRMAA thresholds for single filers are roughly half the joint thresholds. A surviving spouse with the same income the couple had previously may find themselves at a higher IRMAA tier than they were in as a couple.
Same income. Higher Medicare costs. This is one of the less obvious financial impacts of losing a spouse, and one reason the survivor income scenario deserves explicit planning rather than assumptions.
Long-Term Care — The Largest Retirement Income Threat
Long-term care is the largest single threat to a retirement income plan. Washington nursing homes averaged over $13,000 per month in 2026. An extended care event lasting two to four years can deplete the retirement savings a couple spent decades building.
WA Cares, Washington's public long-term care benefit, provides $36,500 lifetime — approximately 2 to 3 months of nursing home care at Washington rates. It is a meaningful first layer. It is not a finished plan.
Long-term care planning and retirement income planning are not separate conversations. A care event is a retirement income event. Assets not protected against care costs cannot be counted on to generate income.
Healthcare Is Where All Four Pillars Connect
Medicare premiums come out of retirement income. IRMAA is triggered by income decisions. Long-term care depletes the assets retirement income depends on. Life insurance protects the income the surviving spouse needs. This is where all four pillars of the Washington Retirement Guidance Platform meet.
Washington's Tax Advantage — And Where It Ends
Washington has no state personal income tax. Social Security, pension income, IRA and 401(k) withdrawals, and most investment income are not taxed at the state level. This is a genuine advantage for Washington retirees, and it can mean more income available before hitting IRMAA thresholds compared to residents of high-income-tax states.
Washington does have a capital gains tax, which applies to long-term capital gains above a threshold, and an estate tax that applies to estates above approximately $3,076,000. Retirees with significant capital gains or large estates should consult a CPA and estate planning attorney familiar with Washington rules.
IRMAA Management and Tax Coordination
Keeping income below IRMAA thresholds requires coordinating IRA withdrawals, Roth conversions, required minimum distributions, and other income decisions in the context of a two-year lookback.
Qualified charitable distributions allow required minimum distributions up to $108,000 per year (2026 limit) to go directly to a qualified charity without the income counting toward IRMAA. For charitably inclined retirees, this is one of the most effective IRMAA-management tools available.
All of this is tax planning territory. A CPA or financial advisor familiar with IRMAA management is the right specialist for the specific analysis.
The Medicare and Income Connection Is Home Turf
The IRMAA surcharge sits exactly at the intersection of Medicare and retirement income — which makes it one of the most natural conversations in this ecosystem. Through our office, clients have access to a team of specialized financial advisors who have tailored training specific to common retirement accounts. They are built to work with folks 65+ navigating the transition from saving to spending. IRMAA management, tax coordination, and withdrawal planning that accounts for Medicare costs are the kinds of analyses this team handles alongside the Medicare guidance.
See How Your Income Affects Your Medicare Costs
A complimentary conversation looks at how your income decisions interact with Medicare premiums, IRMAA thresholds, and long-term care exposure — before a single transaction changes your costs for a year.
Michael Gurr is a Medicare and retirement specialist serving Pierce County and Western Washington.
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