Yes, either can increase income used for Medicare’s income-related premium adjustment (IRMAA). In a taxable investment account, a sale generally creates gain or loss measured against adjusted basis; the entire cash proceeds are not income. Traditional IRA distributions are generally taxable, except for the properly calculated nontaxable portion. Qualified Roth IRA distributions are tax-free.
Social Security defines IRMAA income as adjusted gross income plus tax-exempt interest. Taxable gains and taxable IRA withdrawals can therefore affect premiums. SSA generally uses tax information from two years earlier: for example, its 2026 assessment ordinarily uses tax year 2024.
Compare options using the same net cash needed after tax and the potential later premium effect. Do not apply 2026 premium thresholds to an assumed 2028 bill; future thresholds must be checked when available. A home repair budget does not by itself tell you which account produces the lowest combined cost.
Primary sources
Topic no. 409, Capital gains and losses | Internal Revenue Service