Your First Required IRA Withdrawal at 73 Can Push You Past the IRMAA Cliff for a Full Year

Quick Read

• Deferring the first RMD to April 1 stacks two distributions into one tax year, potentially adding $70,000 onto existing retirement income for a $900,000 IRA holder.

• IRMAA's two-year lookback locks 2028 Medicare premiums to 2026 income, and tax-exempt municipal bond interest counts toward MAGI with no correction after filing.

• Crossing the first IRMAA tier costs a couple roughly $2,300 more per year; the second tier pushes the household Medicare bill to nearly $6,000.

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A retiree who turns 73 this year has a deceptively simple decision: take the first required minimum distribution by December 31, or use the one-time option to delay it until April 1 of the following year. The delay can look harmless. But it may put two RMDs into one tax year, push modified adjusted gross income across an IRMAA bracket, and raise Medicare premiums two years later.

Only about 8% of Medicare beneficiaries with Part B pay any IRMAA surcharge at all. The risk is concentrated among retirees whose household MAGI is near the 2026 thresholds of $218,000 for joint filers or $109,000 for single filers. If a first RMD lands on top of Social Security, pension income, and taxable interest, one calendar-year timing decision can add thousands of dollars in Medicare premiums.

The two-year lookback is the trap

IRMAA generally uses MAGI from two years back. Your 2026 tax return will usually drive your 2028 Part B and Part D premiums. That means an RMD taken this year, based on the December 31, 2025 account balance, can shape the Medicare bill you pay 24 months from now. For a voluntary RMD, there is usually no appeal simply because income later falls.

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MAGI here is AGI (Form 1040 line 11) plus tax-exempt interest (line 2a). Municipal bond income that feels tax-free still counts. Readers routinely miss this and land a bracket higher than they modeled.