Updated

Updated · thedo.osteopathic.org · Sep 30

Physician Author Urges Saving 10% and Delaying Social Security to 70 for Retirement Security

Updated

Updated · thedo.osteopathic.org · Sep 30

Physician Author Urges Saving 10% and Delaying Social Security to 70 for Retirement Security

Q: How could a simple Roth conversion during your retirement gap years secretly trigger massive healthcare surcharges?

A Roth conversion in your retirement gap years can sharply raise your modified adjusted gross income, and Medicare uses that income from two years earlier to decide whether to impose IRMAA surcharges on Part B and Part D premiums. That means a conversion done at 63 or 64 can raise Medicare costs at 65 or 66, even if your regular retirement income later falls. The trap is that IRMAA works like a cliff. If your income goes even slightly above a threshold, you pay the full higher premium tier for the year. For 2026 premiums, the first joint-filer threshold is $218,000 and the next is $274,000; crossing them can add thousands of dollars annually for a couple. A Roth conversion counts as ordinary income for this purpose, just like wages or IRA withdrawals. A common mistake is converting “up to the top of the tax bracket” without checking IRMAA thresholds. In the example provided by advisors, a retired 63-year-old couple with about $130,000 of other income did a $150,000 conversion, pushing 2026 MAGI to $280,000. That moved them into a higher IRMAA tier when they enrolled in Medicare two years later, increasing premiums by about $3,473 a year. A $140,000 conversion would have avoided that jump. The same income spike can also reduce ACA subsidies before age 65 and increase taxation of Social Security later. The practical fix is to size conversions year by year, using both tax brackets and IRMAA thresholds, with a safety margin for dividends or capital gains.

3 articles · Updated · thedo.osteopathic.org · Sep 30

Two to three years before retirement, the physician author says doctors should map expenses, build dedicated savings buckets and prepare for income to shift from paychecks to dividends and other fixed income.
Key steps include paying off mortgages, student loans and credit-card debt before leaving work, buying major items such as a car or laptop in advance, and budgeting for healthcare if retiring before Medicare.
The author also warns retirees to handle quarterly tax estimates themselves and to max out IRA contributions in the final working year, saying both can be easy to overlook.
For guidance, physicians can use advisors, fiduciaries, books or peer networks; the author says Social Security pays more at full retirement age—66 or 67—and reaches its maximum monthly benefit at 70.
Drawing on personal experience of once saving 10% and later restarting in their 50s, the author’s broader message is to track spending, save first, avoid debt and learn basic finance early.