Does a Roth Conversion Raise Your Medicare Premiums? The 2026 Two-Year Rule, Explained

At a glance: Yes — a Roth conversion can raise your Medicare premiums. The taxable part of a conversion counts as income in the year you convert, raising your MAGI, the exact number Medicare uses to set premiums. Because Medicare looks back two years, a conversion in 2026 does not touch your 2026 or 2027 premiums — it sets your 2028 premiums. Cross an income line and the surcharge, IRMAA, can cost a couple $2,296.80 for that year. Time it early, size it to the line, or spread it out, and the surcharge can be $0.

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A Roth conversion is one of the smartest moves in retirement tax planning: pay tax once, at a rate you choose, and the money grows — and comes out — tax-free for life. Thousands of retirees do one every December.

Then, two years later, a letter arrives. Their Medicare premiums have jumped, and nobody mentioned this part.

The conversion was not a mistake. The surprise was optional. Here are the mechanism, the two-year delay, and the dollars — plus how to plan so the letter never surprises you.

The short answer: yes — and here is exactly how it happens

A conversion moves money out of a traditional IRA or 401(k) and into a Roth IRA. The IRS treats the taxable amount as income in the year you convert — added to your gross income like a paycheck from your own retirement account.

That income lands inside your adjusted gross income (AGI). And Medicare's yardstick, MAGI, is simply:

MAGI = your adjusted gross income (AGI) + your tax-exempt interest

On your Form 1040, that is line 11 plus line 2a — the same formula we break down in our Medicare IRMAA Brackets 2026 guide. Cross one of Medicare's income lines and Social Security adds a surcharge — IRMAA — to your Part B and Part D premiums. About 8% of enrollees pay it in any given year.

Notice the beautiful asymmetry — it is the whole strategy in one sentence: the conversion is the one moment Roth money counts as income. Money that later comes out of the Roth as a qualified distribution is not income at all, so it can never raise your MAGI or your premiums. You pay the toll once, on the way in. Everything after that is free.

One more hard fact: a conversion cannot be undone. Since 2018, the IRS has not allowed conversions to be recharacterized — there is no "oops" filing that puts the money back. That is why this planning happens before December, not after.

The two-year delay: why a 2026 conversion sets your 2028 premiums

Medicare does not use your current income. Social Security prices each year's premiums off the tax return from two years earlier. Trace one conversion through the machine:

When	What happens
2026	You convert by December 31. The taxable amount joins your 2026 income.
Early 2027	Your 2026 return is filed. The IRS shares your MAGI with Social Security.
Fall 2027	Social Security sets 2028 premiums — using that 2026 return.
All of 2028	If the conversion crossed a line, the surcharge applies for all twelve months.

That two-year echo cuts both ways. Nothing you convert in 2026 can change the premiums you are paying now. And a surcharge caused by a 2026 conversion cannot ambush you until 2028 — two full years of warning, if you know to look.

It also has a mercy built in: IRMAA is re-decided every year. One high-income year produces one year of surcharge — not a life sentence. Convert in 2026 and stay under the lines in 2027, and by 2029 your premiums are back to standard. But convert every year, and you create a fresh surcharge every year, on a rolling delay — each conversion year must be planned on its own.

What it costs, in dollars

One honest caution first: the lines that will judge a 2026 conversion are the 2028 lines, not published until fall 2027. The table below uses the current published 2026 brackets — the closest honest guide available today.

Here is the combined Part B + Part D surcharge at each tier (official 2026 CMS figures):

Your MAGI — single	Your MAGI — married filing jointly	Extra per month, per person	Extra per year, per person	Extra per year, couple (both on Medicare)
$109,000 or less	$218,000 or less	$0	$0	$0
$109,001–$137,000	$218,001–$274,000	$95.70	$1,148.40	$2,296.80
$137,001–$171,000	$274,001–$342,000	$240.40	$2,884.80	$5,769.60
$171,001–$205,000	$342,001–$410,000	$385.00	$4,620.00	$9,240.00
$205,001–$499,999	$410,001–$749,999	$529.60	$6,355.20	$12,710.40
$500,000 or more	$750,000 or more	$578.00	$6,936.00	$13,872.00

That is the whole menu: $0, or as much as $13,872 for a couple for one year — decided by how much income you stack into a single year. For the full Part B and Part D tables and how to find your own row, see the companion hub: Medicare IRMAA Brackets 2026: The $1 Cliff That Can Cost a Couple $2,296.80 a Year.

Meet Mark and Julie: the $60,000 conversion

Mark and Julie are a made-up example, but every figure below uses the real 2026 brackets above.

Mark, 67, and Julie, 66, are both on Medicare and file jointly. Their income is steady by design: two pensions, two Social Security checks, and some interest — a MAGI of about $196,000 before any conversion. Comfortably under the $218,000 joint line. No IRMAA.

In December 2026, on their advisor's sound advice, they convert $60,000 of Mark's traditional IRA to a Roth. Their 2026 MAGI becomes $196,000 + $60,000 = $256,000 — the second tier ($218,001–$274,000). Now watch the delay do its work:

• 2026 and 2027 premiums: unchanged. The conversion has not been "seen" yet.
• 2028 premiums: each owes $81.20 more a month for Part B and $14.50 more for Part D — $95.70 a month each, $1,148.40 per person for the year, $2,296.80 for the household.
• 2029 premiums: back to standard, assuming no new spike in 2027.

Check your own room before you convert with our free Roth Conversion Room Checker.

Was the conversion worth $2,296.80? Quite possibly — we take that question seriously below. But the number was never a penalty or a surprise tax: it was a knowable part of the conversion's price, printed in a table two years before the bill arrived. It only shocks if nobody does the arithmetic in advance.

Which is why our free one-page Roth Conversion × IRMAA Safe-Zone Worksheet exists: your base MAGI, your distance to the next line, and your room before the cliff — finished before you convert. Get the free worksheet (PDF) → or have it sent to your inbox →.

The $1 version of the same story

Mark and Julie had a smaller option on the table. Their conversion room — the distance from their base MAGI to the first line — was $218,000 − $196,000 = $22,000:

• Convert $22,000: 2026 MAGI is exactly $218,000. Surcharge: $0.
• Convert $22,001: 2026 MAGI is $218,001. Surcharge: the full second tier — $2,296.80 in 2028.

IRMAA is a cliff, not a slope. That last one dollar of conversion is the most expensive dollar in this article. Nobody is saying "never cross a line" — sometimes crossing is worth it, as a later section shows. But crossing by accident, by one dollar, is indefensible.

Who a conversion does NOT touch

Plenty of readers can convert with zero Medicare consequences:

• You are not on Medicare yet — and you convert early enough. Premiums are charged only for enrolled years, using the return from two years before that premium year. Enroll at 65, and Social Security typically prices your first premiums off the return from the year you turned 63 — so conversions at 60, 61, or 62 never surface in any premium year. (The precise version of "convert before 65": the real deadline is the tax year you turn 63.)
• Your MAGI stays under the first line even with the conversion. Base income plus conversion of $109,000 or less (single) or $218,000 or less (joint) means IRMAA is $0, whenever you convert.
• You convert in the low-income "gap years." Between retirement and the start of Social Security and required minimum distributions, income is often at its lifetime low — the cheapest conversion years in tax and IRMAA terms alike.

The readers who need this article most are the mirror image: already on Medicare, or within two years of enrolling, with income anywhere near a line. For you, every conversion year is a premium year two years later.

Three ways to keep the surcharge at $0 (or close to it)

1. Convert before the lookback window closes

The early 60s — after work income stops, before Medicare starts reading your returns — are the natural conversion window. Heavy converting at 60–62 means arriving at 65 with a large Roth balance and premium statements that never mention IRMAA. At 63 or older and not yet enrolled, the window has not fully closed — but every conversion from here on lands in a premium year, so it has to be sized. Which is the next move.

2. Size the conversion to the line, not just the tax bracket

Most conversion advice stops at the tax bracket: "fill the 22% bracket." But an IRMAA line often sits below the top of the bracket — so a conversion can be perfectly sized for taxes and still trip a premium cliff. The correct ceiling is whichever comes first: the top of your tax bracket, or the next IRMAA line. The math is one subtraction: line − base MAGI = your $0-surcharge conversion room ($218,000 − $196,000 = $22,000 for Mark and Julie).

3. Spread one big conversion across several years

Same couple, same goal — move $66,000 to Roth — two ways to do it:

• All at once (2026): MAGI $196,000 + $66,000 = $262,000. Second tier. $2,296.80 of surcharge in 2028.
• $22,000 a year for three years: MAGI lands at exactly $218,000 each year. Surcharge: $0, $0, and $0.

Same money in the Roth — and a $2,296.80 difference in Medicare costs, bought with nothing but patience and a calendar. Spreading is not always possible, but when it is, it is the closest thing to a free lunch.

One standing warning: these are general-education levers, not a plan for your household. A conversion also interacts with your tax bracket, state taxes, and the taxation of your Social Security benefits — a wrong move can cost more in tax than it saves in premiums. Run a big conversion past a qualified tax professional who sees your whole return, before December.

Two hard "no"s: you cannot appeal it, and you cannot undo it

Appeal? Social Security re-prices premiums early only for a listed life-changing event — marriage, divorce, a spouse's death, stopping or reducing work, losing income-producing property or pension income, or an employer settlement payment. A Roth conversion is not on that list; it is a choice, not an event, so its surcharge cannot be appealed away. One exception: if your income also dropped because of a qualifying event — you retired, for instance — the appeal can still work on that basis, and our companion guide covers it step by step: Retired and Hit With a Medicare Surcharge? How to Appeal IRMAA With Form SSA-44.

Undo? No — conversions have been irreversible since 2018. Your last real checkpoint is a fall estimate: project your MAGI in October or November, while the year is still open, and convert in stages if you are unsure of the final number.

When paying IRMAA is worth it anyway

Let us be honest in the other direction, because fear of this surcharge does its own damage.

A conversion's surcharge is one year of higher premiums. Its benefits compound for decades: the money grows tax-free; qualified withdrawals never count as income again, protecting every future year's MAGI; and a Roth IRA has no required minimum distributions during the owner's lifetime, while the traditional IRA it came from would have forced taxable income — and possible IRMAA — on you every year from your early 70s on.

So the real test is a comparison, run on your own numbers:

One year of surcharge (from the table above — knowable to the cent) vs. the long-run tax saving your conversion is projected to produce.

If the saving wins by a wide margin, cross the line on purpose and budget the surcharge as part of the conversion's price. We will not quote you a "typical" saving — there isn't one; it depends on your brackets, balances, and years. But do the comparison. "Avoid IRMAA at all costs" is a slogan, not a strategy, and it has cost some retirees more than the surcharge ever would have.

Frequently asked questions

Does a Roth conversion count as income for Medicare?

Yes. The taxable amount is income in the year you convert, so it sits inside your AGI — and inside MAGI (AGI plus tax-exempt interest), the figure Medicare uses to set premiums.

How long do the higher premiums last?

One premium year per conversion year. A 2026 conversion affects only 2028 premiums; IRMAA is recalculated annually from the return two years back. Convert again in 2027, and 2029 gets its own surcharge year.

I converted at 62 and I enroll in Medicare at 65. Am I safe?

Typically, yes. First premiums are usually set from the return for the year you turned 63, and later years read later returns — so a conversion at 62 is never the return Medicare reads for an enrolled year.

Can I appeal a conversion-caused IRMAA with Form SSA-44?

No — an appeal requires a qualifying life-changing event, and a conversion is not one. If a qualifying event also lowered your income, the appeal may work on that ground instead; our SSA-44 appeal guide walks through it.

I overshot the line. Can I undo the conversion?

No — conversions have been irreversible since 2018. The protection is before the fact: estimate your MAGI in the fall and size the conversion to your room.

Do withdrawals from my Roth IRA raise my premiums later?

No. Qualified Roth distributions are not income at all, so they never enter MAGI. The conversion year is the one and only time Roth money can touch your premiums.

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Plan it on one page, before December: the free Roth Conversion × IRMAA Safe-Zone Worksheet gives you the 2026 lines, the room-under-the-line calculation, and the three pre-conversion checks from Mark and Julie's story — one printable page for your tax folder. Get the free worksheet (PDF) → or have it emailed to you →.

Sources & official figures

• CMS — 2026 Medicare Parts A & B Premiums and Deductibles (2026 standard Part B premium and all IRMAA amounts and thresholds; released November 14, 2025): https://www.cms.gov/newsroom/fact-sheets/2026-medicare-parts-b-premiums-deductibles
• Social Security Administration — POMS HI 01101.010, Modified Adjusted Gross Income (MAGI) (MAGI = AGI + tax-exempt interest; premiums set from the return of two years earlier): https://secure.ssa.gov/apps10/poms.Nsf/lnx/0601101010
• Social Security Administration — Request to lower an IRMAA (Form SSA-44 and the qualifying life-changing events): https://www.ssa.gov/medicare/lower-irmaa
• Internal Revenue Service — Topic No. 309, Roth IRA contributions, and Treasury Regulation §1.408A-4 (converted amounts are includible in gross income in the conversion year; conversions after 2017 may not be recharacterized; qualified distributions are not included in income): https://www.irs.gov/taxtopics/tc309

Last updated: October 24, 2026 — figures checked against CMS, Social Security, and IRS sources on October 23, 2026.

Disclaimer: The Retirement Desk publishes education, not financial, tax, or legal advice. Mark and Julie are a hypothetical example; your figures will differ. The 2028 IRMAA lines that will apply to a 2026 conversion are published in fall 2027 — confirm your situation with Social Security, the IRS, or a qualified professional before you act.

Filed under: Medicare & IRMAA — The Retirement Desk, the situation-first retirement money desk for Americans 60–75.