Charlene G Moffatt, PC

📊 IRMAA stands for Income-Related Monthly Adjustment Amount — a Medicare surcharge added to Part B and Part D premiums for beneficiaries whose income exceeds certain thresholds.

The $1,148 annual figure for Tier 1 combines the Part B surcharge ($81.20/month) and the Part D surcharge ($14.50/month), totaling $95.70/month × 12. These are per-person costs — a married couple where both spouses are on Medicare each pays the surcharge independently.

For married filing jointly, the thresholds are roughly double: $218,000 for Tier 1, $274,000 for Tier 2, up through $410,000 for Tier 4, and $750,000 for Tier 5.

IRMAA is based on Modified Adjusted Gross Income, which includes adjusted gross income plus tax-exempt interest. Municipal bond income counts, even though it is not taxable.

The two-year lookback means income decisions you make today affect Medicare costs two years later. Selling a vacation home, doing a large Roth conversion, or taking an unusually large IRA distribution can all push MAGI over a threshold — and the surcharge applies for the full year.

If income dropped due to a qualifying life event — retirement, death of a spouse, divorce, or reduction in income — Form SSA-44 can be filed with Social Security to request a reduction based on more recent income.

The surcharges shown are above the standard Part B premium of $202.90/month. They are not the total premium — they are the extra amount per tier.

📋 A 401(k) gives you a tax break on contributions, but withdrawals are taxable. A Roth IRA gives you tax-free growth and withdrawals, but no upfront tax break. The HSA is the rare account that can do all three, as long as distributions go toward qualified medical expenses.

In retirement, HSA funds can pay Medicare Part B, Part D, and Medicare Advantage premiums tax-free. Medigap premiums do not qualify.

Qualified HSA withdrawals do not count as income, so unlike IRA distributions, they do not increase AGI, MAGI, or provisional income.

The reimbursement rule has a caveat the original post missed: expenses must have been incurred after the HSA was established, and you cannot use the same expense for another tax benefit.

The biggest misunderstanding in the comments was about Medicare. You can keep and use an existing HSA after enrolling in Medicare, but you generally cannot make new contributions once Medicare coverage begins.

For estate planning, a surviving spouse inherits the HSA and keeps the triple-tax treatment. A non-spouse beneficiary owes income tax on the full balance in the year of death.

HSA contributions through employer payroll can be even more efficient because cafeteria-plan salary reductions are generally excluded from both income tax and F**A.

2026 contribution limits are $4,400 individual, $8,750 family, with a $1,000 catch-up for those 55 and older.

⚖️ This is an updated version of a post I ran about a month ago. The previous version incorrectly suggested the Lady Bird deed's Medicaid protection applied only in Florida and Michigan. It applies in all five states that recognize the deed.

The reason: Florida, Texas, Michigan, Vermont, and West Virginia all use probate-only Medicaid estate recovery. A Lady Bird deed transfers the home outside of probate at death. If the home never enters probate, the state's recovery program cannot reach it.

This is different from states that use expanded estate recovery, where Medicaid can pursue assets that pass outside of probate. In those states, a Lady Bird deed would not provide the same protection, which is one reason the deed is only recognized in five states to begin with.

A TOD deed also avoids probate, but it does not protect against Medicaid recovery in most states. Several states with TOD deeds use expanded recovery definitions that can reach non-probate transfers.

All three tools provide a step-up in basis at death. Your heirs inherit the home at fair market value, not your original purchase price. This was the single most-asked question from the comments.

None of the three require a paid-off mortgage. The deed or trust transfers the property subject to the existing loan. The beneficiary either continues payments, refinances, or sells.

A revocable trust provides no Medicaid protection because you retain control of the assets.

If Medicaid planning is a priority and you live in one of the five Lady Bird states, that deed is the simplest and cheapest option at $200 to $800.

⏳ If you turned 73 in 2025, your first required minimum distribution is due by April 1, 2026. That is less than three weeks from today.

The calculation is straightforward. Take your IRA or 401(k) balance as of December 31, 2024, and divide it by 26.5. That is the IRS divisor for age 73 under the Uniform Lifetime Table. On a $500,000 balance, the minimum withdrawal is $18,868.

The penalty for missing the deadline is 25% of the amount you should have withdrawn. That drops to 10% if you correct it within two years, but there is no reason to risk it.

Here is the part most people miss. If you wait until April 1, 2026 to take your first RMD, you also owe your 2026 RMD by December 31 of the same year. Both count as taxable income in 2026. On a $500,000 account, that is roughly $37,000 in taxable income in one calendar year. That can push you into a higher bracket or trigger IRMAA surcharges on your Medicare premiums two years later.

The RMD percentage increases every year. At 73, the IRS requires 3.77% of your balance. By 80 it is 4.95%. By 90 it is 8.20%. The divisor gets smaller each year, which means the required withdrawal gets larger as a percentage of whatever remains.

Roth IRAs have no RMDs for original owners. Roth 401(k)s also became exempt from RMDs starting in 2025 under SECURE 2.0. This is one reason Roth conversions before age 73 can reduce future RMD exposure.

The RMD age is scheduled to rise to 75 in 2033 for those born in 1960 or later. If you were born between 1951 and 1959, the current age is 73.

More information on the new Trump Accounts.

IR-2026-31: Treasury, IRS issue proposed regulations for Trump Accounts pilot program, Treasury Department to deposit $1,000 into the account of each eligible child IR-2026-31: Treasury, IRS issue proposed regulations for Trump Accounts pilot program, Treasury Department to deposit $1,000 into the account of each eligible child Internal Revenue Service (IRS) sent this bulletin at 03/06/2026 09:35 AM EST IRS Newswire March 6, 2026 Issue Number: IR-2026-31 Inside...