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Paying off a mortgage with a 401(k) lump sum can trigger higher Medicare premiums due to IRMAA rules.

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12 Jun 2026
247 Wallst
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Retirees who use a large lump sum withdrawal from a traditional 401(k) to pay off their mortgage may face unexpected higher Medicare Part B premiums due to the Income-Related Monthly Adjustment Amount (IRMAA). This happens because Medicare bases premiums on income reported two years prior, and a big withdrawal can push income above IRMAA thresholds, causing a surcharge. The surcharge is temporary and recalculated annually, but retirees can avoid it by spreading withdrawals over two tax years or mixing Roth and taxable accounts. Consulting a tax advisor before large withdrawals can prevent costly surprises.

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