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For retirees who booked a large capital gain in 2024, the Income-Related Monthly Adjustment Amount is now adding thousands of dollars to their Part B and Part D Medicare premiums.
The surcharge stems fromMedicare's two-year lookback rule, which pulls modified adjusted gross income (MAGI) from a prior tax return to calculate current-year costs.
A married couple filing jointly with a $210,000 taxable gain layered on top of roughly $130,000 in otherretirementincome could face combined surcharges exceeding $5,600 for the year,24/7 Wall St.
The surcharge applies even though the gain was a one-time event, because Medicare treats it the same as recurring income.
The Social Security Administration uses MAGI from the tax return filed two years prior to set surcharge levels.
Your 2024 return, filed in early 2025, determines the premiums you pay throughout 2026, theCenters for Medicare and Medicaid Servicesconfirmed.
Mike McCracken, president and founder of Wealth Guide Financial,told Fortunethat Medicare's two-year lookback means a property sale at 64 can trigger higher premiums at 66, catching retirees who did not run the numbers before closing.
You see, Medicare looks back two years at your tax return to calculate IRMAA…If you sell in 2025 at age 64, and that capital gain shows up on your 2025 return, it can trigger higher premiums starting in 2027 when you are already on Medicare For joint filers, the first surcharge tier kicks in when MAGI exceeds $218,000.
A couple whose combined income reaches roughly $340,000 after adding a rental sale gain and depreciation recapture lands in the second surcharge tier.
At that level, each spouse owes an additional $202.90 per month for Part B, according to 2026 CMS premium tables.
A Part D surcharge of $37.50 per person per month layers on top, with both spouses on Medicare paying the surcharge separately.
The surcharge operates as a cliff rather than a graduated scale, which means crossing a threshold by even one dollar triggers the full premium increase for that tier.
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