This YouTube video (Craig Wear, CFP®) explains how strategic Roth IRA conversions can reduce long-term Medicare premiums. Craig contrasts traditional advice—spreading conversions over many years to avoid taxable income spikes—with accelerating conversions for very high-net-worth individuals (multi-millions) to maximize Medicare savings by paying taxes earlier and reducing future Medicare-related taxable income.
They pay a little bit more in the first few years, but by the time you net it all out by getting the conversions done on the front end, as opposed to just leaving them in there to grow, you actually are able to, in a lot of cases, save a lot of Medicare premiums over time. The traditional advice that you'll hear is that you want to spread those conversions out over a long period of time so that you do not have those spikes in taxable income. If you've got 7, 8, 9, or more well into the millions, then you're much better off to accelerate your Roth conversions over a shorter period of time so that you get the real benefits.
