IRMAA increases Medicare Part B and Part D premiums for higher-income beneficiaries. The adjustment is based on modified adjusted gross income from two tax years earlier, so a 2024 asset sale affects Medicare premiums starting in January 2026. After a sale, the gain is reported on the 2024 tax return, processed by the IRS, and then used by Social Security to determine IRMAA levels. In an example, $80,000 baseline income plus a $300,000 capital gain produces modified adjusted gross income of $380,000. For a single filer in 2026, this falls into a tier that adds about $406 per month for Part B and $77 per month for Part D, totaling about $483 per month above standard premiums. For a married couple, the surcharge applies to both spouses, roughly doubling the annual impact.
"IRMAA is the extra premium higher-income Medicare beneficiaries pay on top of standard Part B and Part D costs. The Centers for Medicare and Medicaid Services sets it each year using modified adjusted gross income from two tax years earlier. Your 2026 premium is based on your 2024 tax return. That timing is the entire problem. A 2024 asset sale lands on the 2024 return, gets reported to the IRS in spring 2025, flows to Social Security in fall 2025, and shows up as a higher Medicare premium starting January 2026."
"Run the numbers on the example. Baseline retirement income of $80,000 plus a $300,000 capital gain pushes modified adjusted gross income to $380,000. For a single filer in 2026, that lands in the $205,000 to $500,000 tier tier. The surcharge that year is roughly $406 per month for Part B plus $77 per month for Part D, which comes out to about $483 a month above the standard premium, or roughly $5,796 for the year."
"A married couple where both spouses are on Medicare pays that surcharge twice, so the household hit is closer to $11,592. The IRMAA cliff matters because"
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