How can I avoid IRMAA?

You cannot avoid it if your income is genuinely above the threshold — but you can control which side of a line a particular year lands on. The only thing that matters is your modified adjusted gross income in that year, so the levers are the ones that change MAGI: qualified charitable distributions, sizing a Roth conversion to your remaining headroom, spreading capital gains across years, and drawing from Roth rather than traditional accounts.

Do municipal bonds help avoid IRMAA?

No. Tax-exempt interest is added back when Medicare works out your MAGI — Form SSA-44 asks for it explicitly, from line 2a of your 1040. Municipal bond income is free of income tax but still counts toward IRMAA.

Does charitable giving reduce IRMAA?

Only if it is a qualified charitable distribution made directly from an IRA. A QCD is excluded from income, so it lowers AGI and therefore MAGI. An ordinary itemised charitable deduction reduces taxable income but not AGI, so it does not move your IRMAA bracket at all.

Managing the cliff

How to avoid IRMAA — with the arithmetic

If your income is genuinely high, you cannot avoid IRMAA and nobody honest will tell you otherwise. What you can control is which side of a threshold a particular year lands on — and whether that is worth doing depends entirely on a number almost nobody publishes: what crossing actually costs.

What each threshold costs to cross

These are 2026 figures, Part B and Part D surcharges combined, for a full year. One dollar of income decides each of them.

Crossing (single)	Or jointly	Per month	Per year	Couple, both on Medicare
$109,000	$218,000	$95.70	$1,148.40	$2,296.80
$137,000	$274,000	$144.70	$1,736.40	$3,472.80
$171,000	$342,000	$144.60	$1,735.20	$3,470.40
$205,000	$410,000	$144.60	$1,735.20	$3,470.40
$500,000	$750,000	$48.40	$580.80	$1,161.60

Computed from the published 2026 surcharges — see the full table and where the figures come from. Each spouse pays separately, so a couple crossing together pays twice.

Why this table matters

Being $1 over the $137,000 line costs $1,736.40 for the year — $3,472.80 for a couple. That is the number to weigh a lever against. A tactic that saves you $200 of tax while pushing you over a line has cost you money, and no list of tactics can tell you that without the arithmetic.

The only thing that actually moves the needle

Every genuine lever does the same thing: it lowers your modified adjusted gross income in a specific year. MAGI here is your adjusted gross income plus tax-exempt interest. Nothing else enters the calculation — not deductions below the AGI line, not your tax bracket, not your net worth.

So the useful question is never “how do I pay less tax”. It is “how much headroom do I have before the next line, and what would fill it”.

What works

Qualified charitable distributions

A QCD goes straight from an IRA to the charity and is excluded from income — so it lowers AGI, and therefore MAGI, pound for pound. It is the cleanest lever available to someone already taking distributions, and it satisfies a required minimum distribution at the same time. There is an annual cap, indexed yearly; check the current figure with the IRS.

Sizing a Roth conversion to the headroom

Converting is not the mistake — converting blindly is. Work out the distance to your next threshold and convert up to it rather than through it. Crossing the $109,000 line to convert an extra $1,000 costs $1,148.40 in surcharges on top of the conversion tax.

Spreading capital gains across years

A single large sale can clear several tiers at once. Splitting a disposal across two tax years, or using instalment treatment where it is available, keeps each year under a line. Realised losses offset gains and reduce AGI directly.

Drawing from Roth rather than traditional

Qualified Roth withdrawals are not income, so they do not appear in MAGI at all. In a year when you are close to a line, taking the marginal spending money from a Roth account rather than a traditional IRA changes nothing about your lifestyle and everything about your bracket.

What does not work

Commonly suggested	Why it does not help
Municipal bonds	Tax-exempt interest is added back for MAGI. Form SSA-44 asks for it explicitly, from line 2a of your 1040. Free of income tax, still counts here.
Itemised charitable deductions	They reduce taxable income, not AGI — so they do not move your IRMAA bracket. Only a QCD, which is excluded from income in the first place, does.
Most other deductions below the line	Same reason. IRMAA is set from AGI plus tax-exempt interest, which sits above most of what people think of as deductions.
HSA contributions	They do reduce AGI — but you cannot contribute to an HSA once you are enrolled in Medicare, so this is not available to the people IRMAA applies to.
Appealing a high-income year	A large income year is not a life-changing event, however much it raised your MAGI. SSA-44 is for circumstances that changed your income going forward — retirement, bereavement, divorce — not for one-off gains.
Waiting it out	The year that set your current surcharge is already filed and unchangeable. Waiting works only in the sense that a one-off year falls away on its own after twelve months.

Which year to act in

This is where most of the advice on this subject quietly misleads. Because IRMAA uses a two-year lookback, the year you can still change is not the year you are being charged for. Your 2026 surcharge came from your 2024 return. Nothing you do now touches it.

What today’s decisions set is the surcharge two years out. So the conversion you are weighing this December, the property you are thinking of selling, the IRA you are about to draw down — those land in a bracket in 2028, not next month.

One practical consequence: December is the deadline that matters. Once the calendar year closes, that year’s MAGI is fixed, and with it a premium two years later.

If you are already over

If your income fell because of a life-changing event — retirement, reduced hours, a spouse’s death, divorce, a lost pension — you can ask Social Security to use a more recent year instead of waiting two years for the surcharge to unwind. That is what Form SSA-44 is for, and it is free.

If your income simply had a big year, there is no appeal — but there is also no permanence. The surcharge applies for twelve months and then falls away, provided the following year is back to normal.

What this page is and is not

This explains mechanisms and does the IRMAA arithmetic. It is not tax advice, and the specific limits attached to QCDs, capital losses and retirement accounts change from year to year — check the current figures with the IRS, and talk to a tax professional about your own position. What we can tell you precisely is what a threshold costs, because that comes straight from CMS.