Our Role in Medicare Planning
As financial planners, we help clients understand how Medicare fits into their overall retirement income and tax planning strategy. We analyze the financial impact of different Medicare options and coordinate Medicare decisions with Social Security claiming, retirement account withdrawals, and tax planning. However, we are NOT licensed to sell Medicare plans or provide Medicare enrollment services. For plan selection and enrollment, you must work with a licensed insurance agent or contact Medicare directly.
When Should I Start Planning for Medicare?
You should start planning about 6 months before turning 65. This gives you time to understand your options and enroll during your Initial Enrollment Period to avoid potential penalties.
Key Timeline
- 6 months before age 65: Begin researching Medicare options
- 3 months before age 65: Initial Enrollment Period begins
- Month of your 65th birthday: Enrollment window remains open
- 3 months after age 65: Initial Enrollment Period ends
Starting early gives you time to compare plans, understand prescription drug coverage needs, and make informed healthcare coverage decisions.
How Does Medicare Interact With My Retirement Income Planning?
Medicare Part B and Part D premiums are means-tested through Income-Related Monthly Adjustment Amount (IRMAA) surcharges. Higher income can result in higher premiums.
Key Considerations
- IRMAA is based on your tax return income from two years prior
- Roth conversions, IRA withdrawals, and capital gains can affect IRMAA
- Social Security claiming decisions can impact IRMAA calculations
- Appeals may be available following certain life-changing events such as retirement, marriage, or divorce
This is an area where financial planning and Medicare intersect. We help clients coordinate retirement income strategies with Medicare premium management as part of comprehensive financial planning. For IRMAA appeals and Medicare-specific questions, contact Social Security or Medicare directly.
What's the Difference Between Original Medicare and Medicare Advantage?
Original Medicare (Parts A & B)
- Administered by the federal government
- Freedom to see any doctor or specialist who accepts Medicare
- Predictable costs when paired with a Medigap supplement
- Requires a separate Part D plan for prescription drug coverage
- No network restrictions
Medicare Advantage (Part C)
- Offered by private insurance companies approved by Medicare
- Includes Part A and Part B, and usually Part D
- Typically uses HMO or PPO provider networks
- Lower monthly premiums, sometimes as low as $0
- Includes an annual out-of-pocket maximum
- May include additional benefits such as dental, vision, and fitness programs
When working with clients who engage our services, we provide financial analysis of how different Medicare options affect your retirement strategy and budget. Specific Medicare plan recommendations and enrollment must be handled through a licensed insurance professional.
Can I Change My Medicare Plan If I Don't Like It?
Yes. Medicare provides several opportunities to change coverage.
Annual Open Enrollment (October 15 – December 7)
You can:
- Switch between Original Medicare and Medicare Advantage
- Change Medicare Advantage plans
- Change Part D prescription drug plans
Changes take effect January 1.
Medicare Advantage Open Enrollment (January 1 – March 31)
If you are enrolled in a Medicare Advantage plan, you can:
- Switch to another Medicare Advantage plan
- Return to Original Medicare
Special Enrollment Periods
Available for qualifying life events such as:
- Moving
- Losing other health coverage
- Qualifying for Extra Help with prescription drug costs
Important Note
If you return to Original Medicare and want a Medigap policy outside your initial enrollment period, you may be subject to medical underwriting unless you qualify for guaranteed issue rights.
When working with clients who engage our services, we help evaluate whether coverage changes may be beneficial.
Do You Enroll Clients in Medicare Plans?
We provide education and analysis to help you understand Medicare options, but we do not enroll clients in Medicare plans or sell Medicare products.
What We Do Provide
- Education about Medicare plan types
- Analysis of available plan options
- Assistance understanding coverage features
- Coordination between Medicare and retirement planning
- Guidance when evaluating plan changes
What You’ll Need From Other Professionals
- Licensed insurance agents for plan enrollment
- Medicare.gov or 1-800-MEDICARE (1-800-633-4227) for official enrollment
- OSHIIP (Ohio Senior Health Insurance Information Program) for free counseling
We maintain relationships with licensed insurance professionals who specialize in Medicare. We do not receive referral fees or compensation from insurance professionals we recommend. Referrals are based solely on qualifications and fit.
What Is the Medicare Part B Premium Penalty?
If you do not enroll in Medicare Part B when first eligible (and do not qualify for a Special Enrollment Period), you may be required to pay a permanent late enrollment penalty.
Penalty Calculation
Your monthly premium increases by 10% for every full 12-month period you were eligible but did not enroll.
Example
If you delayed enrollment for two years, your premium would increase by approximately 20% for life.
How to Avoid the Penalty
- Enroll during your Initial Enrollment Period
- Qualify for a Special Enrollment Period through employer coverage or other creditable coverage
When working with clients who engage our services, we help clients understand enrollment deadlines and avoid penalties.
Penalty calculations are general examples based on current Medicare rules. Actual penalties depend on your specific circumstances and enrollment history. For official guidance, contact Medicare at 1-800-MEDICARE or Social Security at 1-800-772-1213.
How Should I Evaluate Medicare Prescription Drug Coverage?
Medicare Part D prescription drug coverage is highly individualized.
Key Considerations
- Every plan has its own formulary (covered drug list)
- Drug tiers affect your out-of-pocket costs
- Preferred pharmacies can lower copays
- Coverage gap (“donut hole”) rules may apply
- Some medications require prior authorization
Use Medicare’s Plan Finder tool or work with a licensed insurance professional to compare plans based on your specific medications and pharmacies.
We can help evaluate the financial impact of prescription drug costs as part of retirement budgeting, but we do not recommend specific Part D plans.
What If I'm Still Working at 65 or Have Employer Coverage?
If you or your spouse have employer-sponsored health coverage when you turn 65, you may be able to delay Medicare enrollment without penalties.
Key Rules
- Employers with 20+ employees: Coverage is generally creditable, and Part B may be delayed
- Employers with fewer than 20 employees: Medicare is generally primary, and Part B enrollment is typically recommended
- COBRA is not considered creditable coverage for delaying Medicare
- HSA contributions must stop the month before Medicare enrollment
Coordination between employer coverage and Medicare can be complex. Mistakes may result in penalties or coverage gaps.
Consult your HR benefits department and Medicare before making enrollment decisions. We can help analyze the financial implications but do not provide Medicare enrollment advice.
What About Dental, Vision, and Hearing Coverage?
Original Medicare generally does not cover routine:
- Dental care
- Vision care
- Hearing services
Medicare Advantage plans may include these benefits.
Standalone dental and vision insurance policies are available but often include limitations, exclusions, and waiting periods.
Evaluate whether premium costs justify the benefits based on your anticipated healthcare needs.
Does Medicare Cover Long-Term Care?
No.
Medicare may cover limited skilled nursing care following a qualifying hospital stay, but it does not cover long-term custodial care, such as assistance with daily living activities.
Long-term care expenses generally require:
- Separate long-term care insurance
- Personal savings and investments
- Other funding strategies
Long-term care planning is an important component of comprehensive retirement planning and is a topic we regularly discuss with clients.
Important Disclosure:
The information provided on this page is for educational purposes only and does not constitute insurance advice, Medicare enrollment assistance, or personalized recommendations. Medicare rules, premiums, and plan options change annually and vary by location. Information is current as of [date] but may not reflect recent changes. We are not licensed Medicare insurance agents and do not enroll clients in Medicare plans. For personalized Medicare assistance and enrollment, please contact a licensed insurance agent, call 1-800-MEDICARE (1-800-633-4227), or visit your State Health Insurance Assistance Program (SHIP). In Ohio, contact OSHIIP at 1-800-686-1578.
We are a fee-only fiduciary financial advisors here to help Ohio families approaching and in retirement navigate complex decisions. We bring specialized expertise in retirement income planning, tax strategy, and wealth preservation.
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