Medicare is not, as it’s often called, free healthcare starting at 65. It has a cost, and that cost rises with income in a way that catches many by surprise. Most retirees assume Medicare premiums are fixed. You sign up, the premium is deducted from Social Security, and it becomes just another background expense. For many people that assumption holds. For others, it does not. And when it does not, the surprise can be costly.
The reason is IRMAA, the Income-Related Monthly Adjustment Amount. IRMAA is an added surcharge applied to Medicare Part B and Part D premiums once income crosses certain levels. The structure is not gradual. It works in sharp brackets. If income exceeds a threshold by even one dollar, the higher premium applies for the entire year. There is no phase-in and no smoothing.
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