How do I avoid the IRMAA surcharge on my Medicare premiums?

IRMAA is an income-related surcharge added to Medicare Part B and Part D premiums when your modified adjusted gross income exceeds thresholds the Centers for Medicare & Medicaid Services updates yearly. Critically, IRMAA uses your tax return from two years earlier, so income at 63 can raise premiums at 65. To manage it, watch how much taxable income you generate in those look-back years: large Roth conversions, big capital gains, or lumpy IRA withdrawals can push you over a threshold, and even one dollar over triggers the full surcharge tier. Spreading conversions across years, harvesting gains carefully, and drawing from Roth accounts can help. If a life event like retirement dropped your income, you can appeal using Form SSA-44.