Quick question: when's the last time someone actually checked whether you're already at the top of the Medicare IRMAA scale, before warning you that a Roth conversion might push you into it? For most surgeons, the answer is never, and the warning doesn't apply to them anyway.

In this episode, Jared walks through why the standard Roth conversion advice breaks down at surgeon income. The IRMAA surcharge tops out around $750,000 in household income for a married couple. If you're earning $1.1 million, your regular income already put you at the ceiling years ago, a conversion adds nothing further on top of it. Once that's off the table as a deciding factor, Jared lays out the three-branch framework that actually applies: when conversion helps, when deferral wins, and when a partial conversion timed to a low-income window beats both.

He works two side-by-side examples, same age, same income, same $150,000 conversion, opposite answers, because the underlying goals were different, to show the framework produces a personal answer, not a universal rule.