A Roth conversion increases your modified adjusted gross income (MAGI), which Medicare uses to determine whether you owe Income-Related Monthly Adjustment Amount (IRMAA) surcharges. The system looks back two years, so a conversion you do in 2026 affects your Medicare premiums in 2028. Because IRMAA uses a cliff structure, crossing a threshold by even one dollar triggers the full surcharge for both spouses for the entire year.
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