[PODCAST] What Everyone is Missing about IRMAA Planning with Sara Grillo

Join Sara Grillo, Dan McGrath, and Paul Morrison as they discuss IRMAA, the Medicare income-related monthly adjustment amount. It is a bit of a missed opportunity for many financial advisors — and this episode digs into exactly why.

Recorded in the fall of 2023, the conversation brings together three distinct perspectives: Sara Grillo's marketing-and-communication lens on how advisors position their value, and Dan McGrath and Paul Morrison's deep specialization in Medicare costs and healthcare-aware retirement planning through the IRMAA Certified Planner education program.

For those who are new to her work, Sara Grillo is a CFA® charterholder and financial advisor marketing consultant. She publishes a newsletter covering financial advisor lead generation topics that is best described, in her own words, as "fun and irreverent."

That combination matters for this topic. IRMAA is a technical subject — premium surcharges, modified adjusted gross income, two-year lookbacks — and technical subjects are exactly where advisors tend to lose prospects' attention. Sara's angle throughout the episode is practical: if IRMAA planning is genuinely valuable, how does an advisor communicate that value in a way clients actually understand and act on?

The discussion ranges across the full retirement income landscape, but it keeps returning to one theme: most financial plans stop at accumulation and never seriously model what happens when income is distributed in retirement. Key topics include:

• Why advisors overlook IRMAA: Many practices are still built around maximizing assets under management rather than optimizing how income is actually drawn down in retirement.
• The taxation of Social Security: How provisional income rules pull Social Security benefits into taxable income, and how that interacts with Medicare premiums.
• Software blind spots: Why traditional financial planning tools often fail to display taxable Social Security or Medicare premium deductions — leaving clients with an incomplete picture of retirement cash flow.
• Tax planning levers: Where Roth conversions, life insurance, and annuities fit into managing the income that drives Medicare surcharges.
• The direction of tax rates: Why the guests believe future tax increases make proactive distribution planning more valuable, not less.
• IRMAA's staying power: Why eliminating IRMAA is fiscally unrealistic given Medicare's funding pressures — meaning advisors should plan for it, not hope it disappears.

One of the episode's more pointed arguments comes from Dan McGrath, who contends that planning tools which ignore Medicare premiums and the taxation of Social Security leave advisors exposed: "if you allow your clients to distribute their income incorrectly, the government is going to take all of it." Strong language — but it captures the stakes the guests see in getting distribution planning right.

To understand the episode's core claim, it helps to remember what IRMAA actually is. The Income-Related Monthly Adjustment Amount is a surcharge that higher-income Medicare beneficiaries pay on top of their standard Part B and Part D premiums. At the time this episode aired in 2023, the standard Part B premium was $164.90 per month, and IRMAA surcharges kicked in once modified adjusted gross income exceeded $97,000 for single filers or $194,000 for married couples filing jointly. You can see how those thresholds have moved over time in our historical IRMAA brackets (2007–2023) guide.

Here is the part advisors miss: IRMAA is one of the few retirement costs that is directly a function of decisions advisors control. Which account a withdrawal comes from, when a Roth conversion happens, how capital gains are realized, when Social Security starts — every one of those choices flows into the MAGI number that determines a client's Medicare premiums two years later.

• IRMAA brackets are cliffs, not phase-ins. Crossing a threshold by a single dollar triggers the full surcharge for both spouses on Medicare.
• The surcharge applies to Part B and Part D, and it compounds year after year in retirement.
• Because the determination uses a two-year lookback, the planning window opens well before a client ever enrolls in Medicare.

An advisor who can show a client the exact Medicare premium consequence of a proposed withdrawal strategy is demonstrating value that most of the industry simply never surfaces. That is the "missed opportunity" in the episode's title.

Distribution Planning Beats Accumulation-Only Thinking

The guests argue that the traditional model — grow the portfolio, charge on assets, and treat retirement income as an afterthought — is aging badly. In the decumulation phase, the order and source of every withdrawal has tax and Medicare consequences. Advisors who plan distributions deliberately can often keep clients under key IRMAA thresholds in the years that matter most.

Social Security and Medicare Are Linked

For most retirees, Medicare Part B premiums are deducted directly from Social Security benefits. That means an IRMAA surcharge quietly shrinks the Social Security check a client actually receives — and because up to 85% of Social Security benefits can be taxable depending on provisional income, the same income decisions hit clients twice. The episode treats these as one interconnected system, not separate topics.

The Two-Year Lookback Creates Both Traps and Opportunities

Because SSA bases IRMAA on the tax return from two years prior, a high-income year at 63 shows up as a Medicare surcharge at 65. The reverse is also true: clients who retire and see their income drop can file Form SSA-44 to request a redetermination based on a life-changing event, rather than paying surcharges based on peak earning years. Knowing when to appeal an IRMAA determination is a concrete, high-gratitude service advisors can deliver.

Tools Matter

A recurring frustration in the episode is that conventional planning software often does not show Medicare premiums or taxable Social Security in its projections at all. If the plan a client sees never includes those line items, neither the advisor nor the client can manage them. Purpose-built tools — like RetirementAdvisorPro's IRMAA and retirement income modeling — exist precisely to put those costs on the page where decisions get made.

This episode and article date from 2023, so the dollar figures reflect that year: a $164.90 standard Part B premium and IRMAA thresholds beginning at $97,000 (single) / $194,000 (joint), based on 2021 tax returns. Brackets and premiums are adjusted annually.

For current numbers, see our regularly updated IRMAA brackets page, or explore strategies to reduce MAGI if you are helping clients manage the income that drives these surcharges. The principles discussed in the episode — the two-year lookback, the bracket cliffs, and the value of distribution planning — remain just as relevant today.