Medicare surcharges can be frustrating.
If your income goes over certain thresholds, your Medicare premiums can increase two years later. And unlike federal income tax brackets, where only the dollars above the next bracket line are taxed at the higher rate, going even $1 over an IRMAA threshold can move your Medicare premiums into a higher tier.
So yes, IRMAA matters.
But it should not always drive the whole decision.
In this video, I walk through a sample case where a couple wants to sell some concentrated stock, but they are worried the capital gain will increase their Medicare premiums.
That is a real cost to consider. But the bigger question is whether avoiding that cost is worth keeping more money tied up in one stock than they are comfortable with.
Sometimes it may make sense to stay under the threshold.
Other times, paying the surcharge may be the better tradeoff if the decision still improves the overall plan.
The point is not simply to avoid IRMAA.
The point is to understand what crossing a threshold would actually cost, then decide whether avoiding that cost is worth changing what you were otherwise trying to accomplish.
If you are retired or close to retirement, this video will help you think through Medicare surcharges in a more practical way.