The complex rules governing Medicare income-based premium surcharges can increase higher-income clients' health insurance costs by more than 200% percent during retirement. There are ways to alter a client's investment mix to generate income that is excluded from Medicare's income calculation, but the time to plan is now.
Medicare's income-based surcharges are not currently indexed for inflation, and, because they can often take income earned in the years prior to retirement into account, a growing number of clients will find themselves facing higher-than-expected premium costs in retirement.
Fortunately, there are ways to alter a client's investment mix to generate income that is excluded from Medicare's income calculation, but because Medicare looks to income earned prior to retirement in determining whether the surcharge applies, the time to plan is now. 
1. Medicare Income-Based Surcharges
Medicare income-based surcharges essentially increase the cost of premiums for Medicare Parts B and D for those clients who have modified adjusted gross income (MAGI) that exceeds $85,000 for individuals or $170,000 for married clients filing jointly. The surcharge is imposed based on a sliding scale, with the highest surcharge imposed upon single clients with MAGI exceeding $214,400 and couples whose MAGI exceeds $428,000.
While these income levels may seem relatively high for most retirees, they have not been adjusted for inflation since 2007 and have begun to impact a growing number of Medicare applicants, especially those who have not yet retired when they qualify for Medicare at age sixty-five.
Importantly, Medicare uses a two-year look-back period that is often overlooked by both clients and advisors.
The two-year look-back period means that the client's MAGI from two years prior is used in determining whether the client is subject to the income-based surcharges in the current year. Because MAGI includes most types of traditional income—including wages, Social Security, IRA and 401(k) distributions, dividends, earned interest, and capital gains—the risk that a client will be liable for Medicare surcharges, at least in the early years of retirement, is very high.
2. Planning Tools for Avoiding the Surcharge
3. Surcharges and health coverage
