Case Studies

Medicare's Income-Related Monthly Adjustment Amount (IRMAA) is easy to explain in the abstract: earn above a threshold, pay more for Medicare Parts B and D. But the abstract version rarely convinces anyone to plan ahead. What does is seeing IRMAA land on a real person — a retiree whose premiums nearly double two months into retirement, or a couple whose $927,000 rollover quietly sets up a Medicare premium spike two years down the road.

This case study library collects those stories. It was originally assembled by the IRMAA Certified Planner education program, which trained financial professionals on the rules and regulations surrounding Medicare's IRMAA, and it is preserved here as a resource for advisors and retirees alike. The library includes two kinds of material:

• Client case studies — what actually happens when IRMAA hits a household, and the concrete steps (including the appeal process) used to respond.
• Advisor success stories — interviews and first-hand accounts from financial professionals who built IRMAA planning into their practices and saw immediate results with clients, prospects, and referral partners.

Each entry below links to the full write-up. Historical premium and bracket figures inside each case are kept as of the year the case occurred — that context is the point of a case study.

The most common IRMAA story is this one: a newly retired client, Sherry, received a Pre-Determination Notification from the Social Security Administration within two months of enrolling in Medicare. Because IRMAA is determined from income reported two years prior — her final high-earning working years — her Medicare premiums were increased to nearly double the standard amount, with the surcharge deducted automatically from her Social Security benefit.

The mechanics behind that surprise are covered in depth in How Is IRMAA Calculated?, but the short version: the SSA looks at your Modified Adjusted Gross Income (MAGI) from the tax return filed two years earlier and compares it to that year's IRMAA brackets. Retiring does not reset the clock on its own — but it does open the door to relief, because work stoppage is a qualifying life-changing event under SSA rules. Filing Form SSA-44 asks the SSA to use your new, lower income instead.

The second client-side pattern is the one Don Graves describes in his account: a planned, tax-aware move — in that case a $927,000 rollover from a 401(k) — where the income tax consequences were fully understood but the Medicare consequence was invisible. As Don explained to the clients, Part B premiums of roughly $175 per person stood to rise to nearly $600 per person two years after that year's tax return — close to $425 more per person, per month, out of pocket. IRMAA is a cliff, not a slope: crossing a bracket by a single dollar triggers the full surcharge for the year.

The advisor interviews in this library share a common arc: an experienced professional adds IRMAA planning to an established practice, and it immediately changes client conversations.

• Hugh McDonald of Atlantic College Planning spent over 30 years in college planning before adding IRMAA planning — and found it helped him acquire new clients and enhance an already mature business.
• Ronald Burrow of Packerland Brokerage Services, also 30+ years into his career, used IRMAA seminars and relationships with CPAs to expand his financial planning practice.
• Don Graves, a well-known industry educator, describes applying IRMAA knowledge in a live client meeting — turning a routine rollover review into a moment that visibly demonstrated his value.

The strategic argument behind these stories is laid out in IRMAA Will Impact Your Clients and Your Business Model: as more retirees cross IRMAA thresholds each year, Medicare surcharge planning stops being a niche add-on and becomes part of core retirement income planning. Advisors who can answer "what will this decision do to my Medicare premiums?" hold an advantage over those who can't.

A few rules of the road explain nearly everything that happens in these case studies:

• The two-year lookback. Your IRMAA status this year is set by the MAGI on your tax return from two years ago. That is why new retirees get caught by their final working years, and why today's planning decisions surface as premium changes two years later.
• MAGI, not taxable income. IRMAA uses Modified Adjusted Gross Income — AGI plus tax-exempt interest. Strategies for managing it are covered in How to Reduce MAGI.
• Cliff brackets. Exceeding a threshold by even $1 triggers the full surcharge for that bracket. See the current 2025 IRMAA brackets for where the lines fall.
• Both spouses pay. When a married couple files jointly and both are enrolled in Medicare, an IRMAA determination raises premiums for each spouse — doubling the household impact.
• Appeals exist for life changes. Retirement, work reduction, marriage, divorce, and death of a spouse are qualifying life-changing events. The process runs through Form SSA-44, filed with the Social Security Administration.

One caution the case studies illustrate well: an appeal solves a mismatch between old income and new reality, but it cannot undo a surcharge caused by income you actually received. Sherry's retirement qualified her for reconsideration; a household that realizes a large rollover or conversion generally must plan around the brackets in advance instead.

The pattern across all five case studies is the same: the households that fared best were the ones whose advisor saw IRMAA coming before the tax year closed. That is fundamentally a modeling problem — projecting MAGI forward, checking it against future brackets, and testing how a Roth conversion, rollover, or withdrawal sequence changes the answer.

RetirementAdvisorPro was built for exactly this workflow. Advisors use it to model a client's IRMAA exposure year by year, compare planning scenarios side by side, and show clients — in the meeting, on screen — what a proposed move does to their future Medicare premiums. It turns the kind of insight Don Graves delivered from memory into a repeatable process any advisor can run.

Start with the case that matches your situation: facing a surcharge notice today, read the IRMAA appeal guide; building IRMAA planning into your practice, start with the business model overview and the advisor interviews.