How to Stay in IRMAA Tier 0 with $210k of Joint MAGI
Sample case: married couple, both 66, joint MAGI typically $190,000-$220,000 from pensions, taxable interest, and traditional IRA RMDs. Goal: stay below the $216,000 joint Tier 1 line. The math gets close enough that one $10,000 RMD or one extra dividend payment can flip them.
Why it matters
Tier 1 adds $74.10 to Part B and $14.10 to Part D per beneficiary per month. For a couple with both Part B and Part D, that is $176.40 per month or $2,116.80 per year of extra premiums. Stay below $216,000 and they pay zero IRMAA.
Lever 1: HSA-funded medical spending
Both spouses still have HSA balances from working years. Spending $4,000 of medical bills out of HSA instead of after-tax cash does not lower MAGI directly, but it preserves taxable account dollars that would have generated dividends and interest. Net effect over five years: about $800 less interest income to report.
Lever 2: QCDs from the IRA
Both spouses have RMDs of about $18,000 each. Sending the first $10,000 of each RMD directly to charity as a Qualified Charitable Distribution satisfies the RMD without adding to AGI. The couple was already donating $20,000 to their church, so this is the same charitable spend with a better tax form. Result: $20,000 of the combined $36,000 RMD never touches MAGI.
Lever 3: Bunch capital gains
They had been selling $15,000 of appreciated mutual funds annually to fund travel. Switching to selling $30,000 every other year and using cash reserves in the off year keeps one of every two years comfortably below the line. Two-year rotation: Year 1 lower MAGI ($202k), Year 2 higher MAGI ($224k). Year 2 they pay one year of Tier 1; Year 1 they pay zero. Average cost: $1,058 vs $2,116 every year.
Lever 4: Roth conversion timing
They have a small $80,000 traditional IRA they want to convert. Doing $20,000 per year for four years is tempting but each conversion lifts MAGI by $20k. Instead they sized one $40,000 conversion in a year their pension started but RMDs had not yet (gap year). MAGI in conversion year hit $215,500, just under the line.
Result after three years
Average annual MAGI $213,000, average annual IRMAA paid $530. Without these moves they had been hitting $230k MAGI and paying $2,116 per year, a $1,586/yr swing or $4,758 over three years.