Your Medicare Premiums Could Cost Almost $700 a Month in 2026. Here's Why.

Once you retire, you should expect healthcare to become one of your biggest ongoing expenses. This may hold true even if your health is in great shape.

A big reason healthcare can be so expensive for seniors is the cost of Medicare. While most enrollees do not have to pay a premium for Part A, which covers hospital care, there are premiums that need to be paid for Part B, which covers outpatient care.

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In 2026, the standard monthly Part B premium is $202.90. That actually marks a $17.90 increase from 2025, when the standard monthly Part B premium was only $185.

But some Medicare enrollees could find themselves paying almost $700 a month for Part B this year. Here's why.

It's a matter of IRMAAs

You may not realize this, but the cost of Medicare Part B hinges on your income. If you have a moderate income, you generally pay the standard monthly premium for Part B. But if you're a higher earner, you could face surcharges on your Part B premiums known as income-related monthly adjustment amounts, or IRMAAs.

IRMAAs are based on your modified adjusted gross income (MAGI) from two years prior. And they can add hundreds of dollars a month to your Part B costs.

In 2026, for example, if you're a single tax-filer with a MAGI above $109,000 but below $137,000, you'll face an IRMAA of $81.20, bringing your monthly Medicare Part B cost to $284.10.

Now that's a pretty big jump above the standard monthly cost in its own right. But IRMAAs also increase with income. And if you're subject to this year's highest IRMAA of $487, your total monthly Part B costs could come to $689.90. Ouch.

Now to be assessed a $487 IRMAA each month, your income has to be $500,000 or higher as a single retiree. If you're that wealthy, it may be that you can afford to pay almost $700 a month for Medicare Part B.

But even if you have the money, IRMAAs can really sting. So it's important to know what steps you can take to avoid them.

How to get out of IRMAAs

Depending on your income, you may not be able to avoid IRMAAs completely. But one way to potentially get around them is to convert savings in a traditional IRA or 401(k) to a Roth before you enroll in Medicare.

Roth IRA withdrawals don't count toward MAGI. So you could take a $500,000 distribution from your account, and if that's your only income, you shouldn't have to pay more than the standard monthly premium for Part B.

Be careful doing Roth conversions, though. IRMAAs are based on your income from two years prior. If you're 63 now and plan to enroll in Medicare in two years, a large Roth conversion this year could leave you paying a lot more for Part B in 2028. It's often wise to spread Roth conversions out over multiple years when you're dealing with a large sum.

Don't get stuck paying more

The last thing you want to do is budget for healthcare costs in retirement only to have them come in much higher than expected because of IRMAAs. Even if you're not subject to the highest IRMAAs, those surcharges can still be a blow. So it's best to do what you can to avoid them.

In some cases, a few thousand dollars' worth of income could make the difference between having to pay more for Medicare or not. So it's important to familiarize yourself with IRMAA thresholds every year.

Even if you don't want to do a Roth conversion, you can try to withdraw from a traditional IRA or 401(k) strategically each year to keep your MAGI right below the threshold where IRMAAs kick in -- or at least try to keep yourself in a lower IRMAA tier. The more strategic you are, the more savings you might reap in the course of paying for Medicare.

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