Two RMDs in One Year Can Reprice Medicare Twice

A retiree who turned 73 and used the April 1 deadline to delay his first required minimum distribution took his second RMD in December of the same calendar year, and Medicare counted both withdrawals as a single year's income — a stacking effect that can raise premiums for two full years.

The rule looks like a gift. Turn 73, and the IRS lets you postpone your first required minimum distribution — the mandatory annual withdrawal from a traditional IRA or 401(k) — until April 1 of the following year. It buys time. It defers a tax bill. It costs nothing on paper.

Then the second RMD arrives in December of that same calendar year, because the second one is due on December 31 like every RMD after it. Two withdrawals, one tax return. And Medicare, which does not care why the money landed when it did, reads the combined figure as a single year's income.

That is the sequence described in a case reported by 24/7 Wall St: a retiree turned 73, delayed his first RMD to April 1 to buy himself room, and found that the calendar move he made for tax reasons repriced two full years of Medicare premiums.

Why the April 1 grace period is a trap door, not a shelter

The first-year deferral is not an extra year. It is a shift. The distribution that would have gone out in the year you turn 73 moves forward into the next calendar year — where the regular December deadline is already waiting for that year's own withdrawal.

So the taxpayer who defers does not skip anything. He compresses. Year one of RMDs shows zero. Year two shows two. Income tax works the same way: the deferred dollars are simply taxed in the later year, and if that year's total pushes into a higher bracket, the deferral costs money rather than saving it.

What most retirees miss is that the income tax bracket is only half the exposure. The other half is a Medicare surcharge that operates on its own schedule, with its own lag, and with no partial credit at the edges.

Medicare's income test does not know what a deferral is

Medicare Part B and Part D premiums are not flat for everyone. Above certain income thresholds, beneficiaries pay an income-related adjustment on top of the standard premium. The determination is made from a tax return filed for an earlier year — a lookback — which is why a spike in reported income shows up on the premium bill well after the withdrawal itself.

Two features make this unforgiving in a double-RMD year:

It reads the return, not the intent. There is no line on a tax return that says one of these two distributions logically belonged to the prior year. Medicare sees a single year's modified adjusted gross income.
The brackets are cliffs, not ramps. Crossing a threshold by a small amount applies the full surcharge for that tier. A deferral that lifts income over a line can cost far more than the last dollar of income itself.
The effect is priced for a full twelve months. Once a determination is set, it governs premiums for that year of coverage, which is why a single stacked year can leave a mark on more than one premium cycle.

The person in this case ended up with a repricing that touched two full years of premiums — the practical result of a one-year income spike meeting a system that looks backward and adjusts forward.

Running the arithmetic before December, not after

The decision point is narrow and it is early. Anyone who turns 73 and is weighing the April 1 option should be doing the math on the following year's total income, not the current year's tax saving.

Questions worth answering on paper:

What does modified adjusted gross income look like in the year that would carry two distributions — including Social Security, pensions, capital gains, dividends and any Roth conversions already planned?
Does that combined figure cross a Medicare income-adjustment threshold that a single distribution would not have crossed?
Is there a reason the deferral genuinely helps — an unusually high income year at 73 that will fall away, a large deductible medical expense, a business loss?

If the answer to the last question is no, the deferral is usually working against the retiree. The default — take the first RMD in the year you turn 73 — keeps one distribution per tax year and keeps the income test on a steady line.

Appeals exist, but not for a calendar choice

Medicare allows beneficiaries to request a new determination when a qualifying life-changing event has cut their income: retirement itself, the death of a spouse, divorce, loss of pension income. A voluntary decision to defer a distribution is not one of those events. There is no relief line for a planning mistake.

That is the cost asymmetry at the center of this. The upside of the April 1 deferral is a deferred tax payment for a few months. The downside is a surcharge that can attach to premiums, that arrives on a delay long enough that most retirees no longer connect it to the withdrawal, and that cannot be argued away.

The wider pattern for people drawing down tax-deferred accounts

The stacked-RMD problem is one instance of a broader issue: decades of pre-tax saving concentrate a tax event in later life, and several government programs price off the same single number — modified adjusted gross income — in the same year.

Markets are a reminder of why account balances keep growing into the RMD years rather than shrinking. The S&P 500 tracker SPY closed at $770.19, down 0.39% on the day, as of the last trade on September 4, 2026; the Nasdaq 100 fund QQQ closed at $718.96, up 0.18%; the Dow tracker DIA closed at $534.08, down 0.53%. Balances that keep compounding produce larger mandatory withdrawals, and larger withdrawals interact more violently with income cliffs.

The practical takeaways for anyone approaching or past 73:

Treat the April 1 option as a rare-use tool, not a default. It creates a two-distribution year unless you have a specific reason to want one.
Model income two years forward, because that is the horizon on which Medicare prices the result.
Consider whether qualified charitable distributions or earlier Roth conversions can reduce the size of the required withdrawal before the cliff becomes relevant.
Check the premium notice when it arrives and confirm which tax year it was based on.

The retiree in this case did nothing improper. He used a rule the IRS wrote. The problem is that the rule was written by one agency and the consequence was priced by another, and neither one sends a warning before the withdrawal is made.

Key facts

First RMD deadline: April 1 of the year after turning 73
Second RMD deadline: December 31 of that same calendar year
Medicare treatment: Both distributions counted as one year's income
S&P 500 tracker (NYSEARCA: SPY): $770.19 at the Sept. 4, 2026 close, -0.39%

Frequently asked questions

Why does delaying the first RMD create two distributions in one year?

The first required minimum distribution can be postponed to April 1 of the year after you turn 73. But the second RMD is still due by December 31 of that same calendar year, like every RMD after it. The deferral does not skip a withdrawal — it moves the first one into the same tax year as the second, so both appear on one return.

How does Medicare use RMD income?

Medicare Part B and Part D premiums include an income-related adjustment for beneficiaries above certain income thresholds. The determination is drawn from a tax return filed for an earlier year. Because RMDs from traditional IRAs and 401(k)s are taxable income, a year with two stacked distributions can push reported income across a threshold and raise premiums.

How long can the higher premium last?

In the case reported, delaying the first RMD to April 1 repriced two full years of Medicare premiums. Because the income test uses a lookback to an earlier tax return and then governs a full year of coverage, a single spike in reported income can affect more than one premium cycle before it drops back out.

Can you appeal a Medicare premium surcharge caused by an RMD?

Medicare permits a request for a new determination after a qualifying life-changing event that reduced income — retirement, the death of a spouse, divorce, or a loss of pension income. A voluntary decision to defer a required minimum distribution into the following year is not a qualifying event, so there is generally no relief available for the timing choice itself.

Is deferring the first RMD ever the right move?

It can be, if the year you turn 73 is an unusually high-income year that will not repeat — a large one-time gain, a final year of employment income, or an already-planned Roth conversion. In that situation, moving the distribution into a lower-income year may help. Otherwise, taking it on schedule keeps one distribution per tax year.

What can reduce the size of a required minimum distribution?

Qualified charitable distributions sent directly from an IRA to a charity can satisfy part or all of an RMD without adding to taxable income. Roth conversions done in earlier, lower-income years shrink the pre-tax balance that future RMDs are calculated from. Both need to be arranged before the year the income cliff becomes relevant.

Sources

He Turned 73 and Delayed His First RMD to April 1 to Buy Time. The Second One Was Due in December. Medicare Read Both as One Year’s Income. — 24/7 Wall St

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