Heck, I pay in the neighborhood of $200+ a month for Part B Medicare every year since I started taking RMD.

Yep, the extra Medicare cost is yet another aspect of Required Minimum Distributions from your IRA beginning at age 70-1/2.

That's a reminder that doing a Roth conversion on your IRA if you have low tax years is a good deal. But of course coughing up an extra $20K or more in income taxes to convert a large IRA is hard to take. But they will probably get you for more in income taxes on RMDs.

Another thought is that if you do not have long term care insurance, I hear nursing home is a deductible medical expense. Hence, paying your nursing home fees out of your IRA effectively gets you a 30+% discount (on reduced fed and state income taxes).