Inherited IRA and Medicare IRMAA: How Mandatory Distributions Affect Your Premiums
If you inherited a traditional IRA from a parent or other non-spouse, you likely face mandatory distributions under the SECURE Act's 10-year rule — and every dollar of those distributions counts toward IRMAA MAGI. A retiree with $95,000 of Social Security and pension income who inherits a $400,000 IRA can find themselves paying $1,148–$2,884 in extra Medicare premiums per year for the next decade, with no qualifying event to appeal.
How inherited IRA distributions count toward IRMAA
IRMAA (Income-Related Monthly Adjustment Amount) is the Medicare surcharge on your Part B and Part D premiums, determined by your MAGI two years before the premium year. MAGI = adjusted gross income (AGI) plus tax-exempt interest. Distributions from an inherited traditional IRA are fully taxable and flow directly into AGI — which means they flow fully into IRMAA MAGI.
There is no carve-out, exclusion, or averaging for inherited IRA distributions. Whether the distribution is $10,000 or $80,000, 100% of it is MAGI in the year it is taken. And because of the two-year look-back, a distribution taken in 2024 affects your 2026 Medicare premiums.2
| Income source | Counts toward IRMAA MAGI? | Notes |
|---|---|---|
| Distributions from an inherited traditional IRA | Yes — 100% | Fully taxable; included in AGI |
| Qualified distributions from an inherited Roth IRA | No | Tax-free if the original Roth was opened ≥5 years before distribution; not included in AGI or MAGI |
| Unqualified distributions from an inherited Roth IRA (earnings portion, before 5-year holding) | Yes — earnings only | Only the taxable earnings portion counts; basis (contributions) does not |
This distinction matters enormously when evaluating an inheritance: an inherited Roth IRA of the same size creates no IRMAA exposure at all (assuming the 5-year clock has run), while an inherited traditional IRA creates mandatory taxable income for up to 10 years.
The SECURE Act 10-year rule and when annual distributions are required
The SECURE Act (2019) replaced the prior "stretch IRA" rules for most non-spouse beneficiaries with a 10-year rule: the account must be fully distributed within 10 years of the original owner's death. Whether annual distributions are required during those 10 years depends on whether the original owner had already reached their Required Beginning Date (RBD) — currently April 1 of the year following the year the IRA owner turns 73 (for those born 1951–1959) or 75 (for those born 1960+).1
| Scenario | Annual distributions during years 1–9? |
|---|---|
| Original owner died before their RBD (had not started RMDs) | No annual distributions required. You can take distributions in any pattern — including nothing in years 1–9 and the full balance in year 10. This gives maximum flexibility for IRMAA planning. |
| Original owner died after their RBD (had started or was required to start RMDs) | Annual distributions ARE required in years 1–9, calculated using your Single Life Expectancy (IRS Table I, Pub. 590-B). Account must be fully depleted by year 10. |
Most people who inherit IRAs from elderly parents are inheriting from someone who had already reached their RBD — which means mandatory annual distributions, and mandatory IRMAA exposure, are built in.
Who is subject to the 10-year rule?
The 10-year rule applies to non-eligible designated beneficiaries (NEDBs) — most commonly adult children who are not disabled. Eligible designated beneficiaries (EDBs), who are exempt from the 10-year rule, include: surviving spouses, minor children of the owner (until they reach majority), disabled or chronically ill individuals, and individuals not more than 10 years younger than the original owner. If you are an adult child inheriting from a parent more than 10 years older than you, you are almost certainly subject to the 10-year rule.
Worked example: how a $400,000 inheritance creates a decade of IRMAA
Margaret is 66 and on Medicare. Her MAGI from Social Security and a pension is $95,000/year — comfortably below the $109,000 IRMAA threshold. Her father, who was 81 (past RBD), dies in 2023 and leaves her a $400,000 traditional IRA. Margaret is subject to the 10-year rule with annual distributions required.
For years 1–9, Margaret uses her age in the year of the first distribution (2024, age 67) and counts down the Single Life Expectancy factor by 1 each year (IRS Table I, Pub. 590-B).3
| Year | Margaret's age (dist. year) | IRS factor (Table I) | IRA balance (est.) | Required dist. | Total MAGI | IRMAA tier |
|---|---|---|---|---|---|---|
| 2024 (Year 1) | 67 | 21.2 | $400,000 | $18,868 | $113,868 | Tier 1 ($109K–$137K) |
| 2025 (Year 2) | 68 | 20.2 | $408,000 | $20,198 | $115,198 | Tier 1 |
| 2026 (Year 3) | 69 | 19.2 | $412,000 | $21,458 | $116,458 | Tier 1 |
| 2029 (Year 6) | 72 | 16.2 | $380,000 | $23,457 | $118,457 | Tier 1 |
| 2033 (Year 10 — full depletion) | 76 | — | ~$200,000 | ~$200,000 | ~$295,000 | Tier 3–4 (year 10 spike) |
Assuming Margaret's base income stays at $95,000 and she stays in Tier 1 for years 1–9, her extra IRMAA cost is roughly $1,148/year for nine years — about $10,332 in total additional Medicare premiums just from the inherited IRA. In year 10, she must take the entire remaining balance at once (if she hasn't already), which could spike her MAGI dramatically and push her into a much higher tier for that one look-back year.
2026 IRMAA surcharges: what tiers mean in dollars
Your 2026 IRMAA is based on your 2024 MAGI. The brackets below apply to single filers and show the total extra cost from Part B and Part D combined.4
| 2024 MAGI (single) | 2024 MAGI (married) | Part B premium | Part D surcharge/mo | Extra IRMAA/yr (per person) |
|---|---|---|---|---|
| ≤$109,000 | ≤$218,000 | $202.90 | — | $0 |
| $109,001–$137,000 | $218,001–$274,000 | $284.10 | +$14.50 | +$1,148/yr |
| $137,001–$171,000 | $274,001–$342,000 | $406.10 | +$37.50 | +$2,888/yr |
| $171,001–$205,000 | $342,001–$410,000 | $527.90 | +$60.40 | +$4,625/yr |
| $205,001–$500,000 | $410,001–$750,000 | $609.50 | +$83.30 | +$5,875/yr |
| $500,001+ | $750,001+ | $689.90 | +$91.00 | +$6,936/yr |
Five strategies for managing inherited IRA IRMAA exposure
1. QCDs from the inherited IRA — if you are 70½ or older
A Qualified Charitable Distribution (QCD) is a direct transfer from an IRA to a qualified 501(c)(3) charity. QCDs are excluded from AGI entirely — they do not appear in your income at all, so they do not count toward IRMAA MAGI. Critically, QCDs may be made from an inherited IRA if the beneficiary has reached age 70½.5 The 2026 annual QCD limit is $111,000 per person.
For a beneficiary who is 70½ or older, redirecting all or part of the annual inherited IRA distribution to charity via a QCD eliminates the IRMAA exposure from that portion entirely. The distribution still counts toward the annual RMD requirement. If Margaret (age 70+) has $20,000 of required distributions and donates $20,000 to charity as a QCD, she owes no income tax and adds $0 to her IRMAA MAGI — saving her $1,148/year in Medicare premiums while also getting her charitable deduction automatically built in.
If you are younger than 70½, this strategy is not available. In that case, consider the distribution-timing strategies below.
2. Front-load distributions in low-MAGI years (pre-RBD inheritance only)
If the original owner died before their RBD, you are not required to take annual distributions. This gives you full flexibility over the 10-year distribution schedule. The optimal approach is to identify which years have the lowest base MAGI and concentrate distributions there — avoiding years when you have Roth conversions, capital gains, or other income events layering on top.
For example, if you inherit in 2024 and retire from your job in 2027, taking larger distributions in 2027–2029 (low income, still below the IRMAA threshold) and smaller distributions in 2030–2033 (when Social Security and RMDs from your own IRAs kick in) can keep you in lower IRMAA tiers throughout the 10-year window.
3. Avoid stacking Roth conversions in the same years as inherited IRA distributions
Many retirees plan Roth conversions to reduce future RMDs from their own IRAs. If you are also taking inherited IRA distributions, both amounts count toward MAGI — and they can combine to push you over an IRMAA bracket cliff that neither one alone would cross.
A $15,000 inherited IRA distribution plus a $30,000 Roth conversion on top of $90,000 in base income = $135,000 MAGI — just inside Tier 1. A $15,000 distribution plus a $50,000 Roth conversion on the same base = $155,000 MAGI — Tier 2. The inherited IRA distribution is mandatory; the Roth conversion is discretionary. Treat the inherited IRA as the floor and build your voluntary income events around it, staying away from IRMAA cliff edges whenever possible.
4. Consider capital gain and income deferral in inherited IRA years
If you have a taxable brokerage account with unrealized gains and you're already going to take an inherited IRA distribution this year, consider whether to defer the gain to a different year. Similarly, if you have flexibility over when to take a pension lump sum or other discretionary income, years with higher inherited IRA distributions are not the best years to layer on additional income events. Use our IRMAA bracket calculator to map your expected MAGI year by year over the 10-year distribution window.
5. SSA-44 appeal: not available for inherited IRA income
The SSA-44 (IRMAA appeal) lets you substitute current-year income when a qualifying life event — retirement, marriage, divorce, death of a spouse — caused your income to drop from the look-back year. Inheriting an IRA is not a qualifying life event. The distributions are ordinary income you chose to take (or were required to take) and there is no formal appeal mechanism. If the distributions are mandatory under the 10-year-with-annual-RMD rule, your only lever is the QCD strategy or income smoothing over multiple years.
For a full overview of the SSA-44 process and the seven qualifying life events, see our IRMAA appeal guide.
The inherited Roth IRA: no IRMAA, but still subject to the 10-year rule
Inherited Roth IRAs are subject to the same SECURE Act rules — the 10-year rule and, if the original owner was past RBD, annual distribution requirements. But qualified distributions from inherited Roth IRAs are income-tax-free and do not appear in AGI or IRMAA MAGI. The five-year clock for "qualified distribution" status is measured from the year the original owner first funded the Roth, not from when you inherited it. If you inherit a Roth IRA that was opened in 2010, all distributions are qualified regardless of your age — no IRMAA impact at all.
This asymmetry — traditional IRA creates 10 years of mandatory MAGI, Roth IRA creates zero MAGI — is a powerful argument for encouraging parents with large traditional IRAs to convert to Roth while they're alive, if their own income permits. The Roth conversion is taxable in the year done, but it converts a legacy that would cost their beneficiaries $1,148–$6,936/year in Medicare premiums into one that costs nothing.
When to involve a Medicare-specialist advisor
The interaction between inherited IRA distributions and IRMAA is one of the more complex planning situations in retirement finance — combining two different sets of rules (inherited IRA law and Medicare premium calculation) on a multi-year timeline. It is worth specialist attention when:
- The inherited IRA is large enough that annual distributions alone would push you over an IRMAA threshold
- You also have your own IRAs approaching RMD age and need to sequence distributions across both accounts
- You are considering Roth conversions from your own IRA while also taking inherited IRA distributions
- The original owner's RBD status is unclear and affects your planning flexibility
- You inherited a mix of traditional and Roth IRAs and want to optimize which accounts to draw from and when
A fee-only advisor who specializes in Medicare can model the full 10-year inherited IRA distribution schedule alongside your Social Security, pension, own-IRA RMDs, and Roth conversion plans to minimize the total IRMAA you pay — which on a large inherited IRA can easily amount to $15,000–$50,000 over the distribution period.
- IRS, Treasury Decision T.D. 10001 (July 2024) — final regulations under IRC § 401(a)(9) confirming annual RMD requirements for inherited IRA beneficiaries when decedent died after RBD; 10-year rule under SECURE Act (Pub. L. 116-94, 2019). IRS Retirement Topics — Beneficiary.
- IRS, Publication 590-B (2025) — taxability of inherited IRA distributions; definition of MAGI for IRMAA purposes (AGI + tax-exempt interest per IRC § 62 and § 36B).
- IRS Publication 590-B, Appendix B, Table I — Single Life Expectancy Table (updated 2022, effective for distributions after Jan. 1, 2022). Factors: age 67 = 21.2, age 68 = 20.2, age 69 = 19.2 (decrease by 1.0 each subsequent year). Available at Fidelity — IRS Single Life Expectancy Table.
- CMS, "2026 Medicare Parts A & B Premiums and Deductibles" (November 2025) — Part B premiums by IRMAA tier; SSA POMS HI 01101.020 (December 2025) — IRMAA sliding scale tables. Part D surcharges per CMS 2026 announcement and Kiplinger. 2026 IRMAA brackets based on 2024 MAGI per IRS data provided to SSA.
- IRS Publication 590-B (2025), "Qualified Charitable Distributions" — QCDs may be made from inherited IRAs by beneficiaries who have reached age 70½; 2026 annual QCD limit $111,000 per individual. See also Fidelity — QCDs and RMDs.
IRMAA bracket values verified as of November 2025 (2026 premium year). Single Life Expectancy Table factors from IRS Pub. 590-B (2025 edition). Inherited IRA distribution rules under SECURE Act and T.D. 10001.