RetireBlueprint Pro — Medicare Planner

Part 1: Before Medicare — The Coverage Gap (Ages 55–64)

This is the part nobody talks about until it hits them. If you retire before 65, or your spouse retires before you, or you leave a job at any point before Medicare, you need to find your own health insurance. Here is exactly how that works.

The Pre-Medicare Gap — Common Scenarios

One partner retires early, one still works:
The retired partner can join the working spouse's employer plan as a dependent (usually cheapest), use COBRA for up to 18 months, or get an ACA Marketplace plan.

Both partners retire before 65: ACA Marketplace is almost always the answer once COBRA expires.

Your 3 options before Medicare:
1. Employer dependent coverage — if spouse is still working, usually cheapest
2. COBRA — keeps your old plan, up to 18 months, but YOU pay the full premium
3. ACA Marketplace — likely best value, especially with subsidy

When you retire before 65: You enroll at healthcare.gov during Open Enrollment (Nov 1–Jan 15) or within 60 days of losing employer coverage.

The 3 Ways to Get Coverage Before 65

1. Stay on employer plan as dependent
If your spouse is still working and their employer allows it, this is usually the cheapest option.

2. COBRA
Keep your old employer plan for up to 18 months. Same coverage, but YOU pay the full premium the employer was paying. Often $1,500–2,000+/mo for a family.

3. ACA Marketplace
Healthcare.gov plans. Subsidized based on income. Usually the best option once COBRA expires.

The ACA Marketplace — Plain English

Also called "Obamacare" or "healthcare.gov" — it is simply a government-run website where you shop for private health insurance.

How it works:

• You go to healthcare.gov (or your state exchange)

• Enter your ZIP code, household size, and estimated income

• See plans side by side (Bronze, Silver, Gold, Platinum)

• If income qualifies, you get a tax credit subsidy that reduces your premium

• Pay the reduced premium monthly — insurance starts Jan 1 (or mid-year if life event)

• Use it like normal insurance — doctors, specialists, ER

The subsidy — this is the key:

The government pays part of your premium if your income is between 100%–400% of the federal poverty level.

For a couple, that's roughly $21,000–$85,000/yr in 2026 (100%–400% of the federal poverty level — the figure rises a little each year). At $60K income, a couple might pay $400–700/month for a Silver plan instead of $1,500+/month full price.

⚠️ Roth conversion trap: Roth conversions count as income on the ACA. Converting $80K in a year can eliminate your subsidy and cost you $15,000+ extra in premiums. Plan conversions carefully if you are on ACA.

The 4 Plan Tiers (Metal Levels):

Bronze

Lowest premium
Highest deductible
($5,000–8,000)
Best if healthy,
rarely need care

Silver

Middle ground
Moderate deductible
($2,000–5,000)
Best for most
Subsidy applies here

Gold

Higher premium
Lower deductible
($500–2,000)
Best if you use
healthcare often

Platinum

Highest premium
Lowest deductible
(<$500)
Best if chronic
conditions

Estimated ACA Monthly Premiums (2026, couple age 60, Silver plan):

Annual Income	Full Premium	Subsidy	You Pay/Month	You Pay/Year	Notes
$40,000/yr	~$1,500	~$1,100	~$400	~$4,800	Large subsidy
$60,000/yr	~$1,500	~$850	~$650	~$7,800	Good subsidy
$80,000/yr	~$1,500	~$500	~$1,000	~$12,000	Shrinking subsidy
$100,000/yr	~$1,500	$0	~$1,500	~$18,000	No subsidy (over 400% FPL)
$120,000+/yr	~$1,500	$0	~$1,500	~$18,000	No subsidy

Estimates for a couple both age 60 in a mid-cost state. Actual premiums vary significantly by location and insurer. Get your actual quote at healthcare.gov.

Shop Plans at Healthcare.gov → KFF Subsidy Calculator → COBRA Guide →

Dental & Vision — The Coverage Nobody Talks About

Here is the uncomfortable truth: neither Original Medicare nor most ACA plans cover routine dental and vision. You have to plan for these separately.

While on ACA (Before 65)

✅ Children under 19: dental+vision REQUIRED on ACA plans

❌ Adults: dental+vision NOT required — most plans don't include it

Your options:

• Standalone dental plan — $30–60/mo per person. Covers cleanings, X-rays, basic fillings. Major work (crowns, implants) covered at 50% after deductible.

• Standalone vision plan — $10–20/mo per person. Covers annual exam + glasses or contacts allowance ($150–200).

• Dental discount plans (e.g. Careington, Aetna Dental Access) — $8–15/mo. NOT insurance — just negotiated rates. Works well if you pay cash.

Typical annual cost: Dental ~$600/yr + Vision ~$240/yr = ~$840/yr per person for decent standalone coverage.

On Medicare (Age 65+)

❌ Original Medicare does NOT cover routine dental, vision, or hearing

Your options:

• Medicare Advantage (Part C) — Most Advantage plans include dental, vision, and hearing. This is a major reason people choose Advantage over Medigap.

• Standalone dental plan — Same as above. $30–80/mo. Companies like Humana, Aetna, United sell Medicare-age dental plans.

• Standalone vision plan — $10–30/mo. EyeMed, VSP sell individual plans.

• Medicare Supplement + standalone — If you choose Plan G, add separate dental (~$45/mo) + vision (~$15/mo) = ~$60/mo extra per person.

Typical annual cost: Dental ~$540/yr + Vision ~$240/yr = ~$780/yr per person on top of Medicare premiums.

⚠️ The Real Dental Cost Risk in Retirement

Dental insurance is expensive and has low annual caps ($1,000–2,000/yr). A single crown costs $1,500–3,000 out of pocket. A full set of implants can run $30,000–60,000. Most retirees find that dental insurance breaks even at best — many financial planners recommend self-insuring dental by keeping $3,000–5,000 in a dedicated dental/medical fund and only buying insurance if you have known upcoming dental work.

What to put in your Inputs page: Add $600–1,200/yr per person for dental/vision to your Medicare annual cost estimate (field B53). A couple should budget $1,200–2,400/yr for dental and vision on top of Medicare premiums.

Medicare Dental Options → ACA Dental Coverage → Compare Medicare Plans →

What Numbers Go in Your Inputs Page

Both fields are ANNUAL amounts — multiply your monthly estimate by 12.

Field B52 — Pre-Medicare Annual ($)

Healthcare costs BEFORE age 65.
Include: ACA premium + dental + vision

Examples:
ACA Silver ($650/mo) + dental ($50) + vision ($20) = $720/mo × 12 = $8,640/yr

On employer plan as dependent: just your share of premium, typically $200–500/mo = $2,400–6,000/yr

Field B53 — Medicare Annual ($)

Healthcare costs FROM age 65 onward.
Include: Part B + Medigap/Advantage + Part D + dental + vision

Examples:
Plan G ($365/mo) + dental ($50) + vision ($15) = $430/mo × 12 = $5,160/yr per person

Medicare Advantage ($200/mo) + standalone dental ($45) + vision ($15) = $260/mo × 12 = $3,120/yr per person

Part 2: Medicare at 65 — Full Coverage Guide

Now that the ACA bridge is covered — here is everything you need to know about Medicare itself.

First: Take a breath. Medicare is simpler than you think.

Medicare and Medicaid sound similar but are completely different things. Medicare is health insurance for people 65+ — everyone gets it, regardless of income. Medicaid is a welfare program for people with very low income — most retirees with savings never use it.

This page is only about Medicare. You do not need to worry about Medicaid unless your assets drop very low.

Start Here: What Actually Happens When You Turn 65

Part A turns on automatically — it is FREE

If you or your spouse worked and paid Medicare taxes for at least 10 years (40 quarters), Part A costs you $0/month. It covers hospital stays. You do not sign up — Social Security automatically enrolls you if you're already collecting SS. If not collecting SS yet, you sign up at ssa.gov during your enrollment window.

Part B — you must sign up and pay $202.90/month

Part B covers doctor visits, lab tests, preventive care, outpatient services. The standard premium is $202.90/month per person in 2026 (deducted from your Social Security check or billed directly). This is NOT optional if you want healthcare coverage. You have a 7-month window to sign up (3 months before your birthday month, your birthday month, 3 months after). Miss the window → permanent 10% penalty per year you delayed, forever.

Now you have "Original Medicare" — Parts A + B

With just A + B, you are covered for most medical needs. BUT — Original Medicare only pays 80% of approved costs. You pay the other 20% with no cap. That 20% could be tens of thousands of dollars if you have a serious illness. This is the "gap" that Medigap fills.

Choose your path: Medigap or Medicare Advantage

You now make one big decision. You can either add a Medigap supplement (private insurance that covers your 20% gap — predictable costs, any doctor) OR switch to Medicare Advantage (Part C) (a private HMO/PPO that replaces A+B — lower premium, but restricted networks). See the comparison below.

Add Part D for prescriptions

Part D is a separate prescription drug plan you purchase. Costs $20–$100/month depending on your drugs. If you use Medicare Advantage (Part C), it usually includes drug coverage. Don't skip Part D even if you take no medications. The late enrollment penalty is 1% per month you delay, and it stacks permanently.

✅ What's Automatic vs What You Choose

You Get This Automatically

✅ Part A — Hospital — $0/mo

Auto-enrolled if collecting SS. Otherwise sign up at ssa.gov.

✅ Free preventive services

Annual wellness visit, flu shots, cancer screenings — $0 copay

✅ No denial for pre-existing conditions

Medicare cannot refuse you or charge you more for existing health issues

You Must Sign Up & Pay For

Part B — $203/mo per person

Doctor visits, outpatient care. Required to have any coverage.

Part D — $20–100/mo

Prescriptions. Separate plan. Don't skip even with no meds.

Medigap or Advantage — $0–200/mo

Fills the 20% gap. Your choice — see comparison below.

🆚 The Big Decision: Medigap vs Medicare Advantage

This is the one choice that matters most. There is no universally right answer — here is how to think about it.

Medigap Supplement

✅ Any doctor in the US who accepts Medicare

✅ No referrals needed for specialists

✅ No prior authorization needed

✅ Predictable costs — almost no surprises

✅ Best for travelers, complex health needs

❌ Higher monthly premium ($70–200/mo each)

❌ Separate Part D plan needed (add $20–60/mo)

❌ No dental/vision usually included

Most Popular Plans

Plan G — ~$100–130/mo · Covers everything except Part B deductible ($257/yr). Best value for most people.
Plan N — ~$70–90/mo · Covers most things, small copays ($20 doctor visits). Good if you're healthy.
Plan F — ~$130–180/mo · Covers everything. Only available if you turned 65 before 2020.

Medicare Advantage (Part C)

✅ Low or $0 monthly premium

✅ Usually includes dental, vision, hearing

✅ Often includes Part D drug coverage

✅ $2,000–$8,500 out-of-pocket maximum/yr

❌ Restricted network — must use their doctors

❌ Prior authorization often required

❌ May not cover out-of-area emergencies well

❌ Plans change yearly — benefits not guaranteed

❌ Harder to switch back to Original Medicare

Best for: People who want lower monthly costs, stay in one area, are generally healthy, and don't mind using a network of doctors. Not ideal if you have complex conditions, travel frequently, or want to see any specialist without a referral.

What Most Financial Planners Recommend for Retirees with Savings

Original Medicare + Plan G Medigap + Part D is the most popular choice for people with retirement savings. Yes, the premium is higher — but you get total freedom (any doctor, any specialist, any hospital that accepts Medicare nationwide), no surprise bills, no network restrictions, no prior authorizations. The peace of mind alone is worth the premium difference for most people. The total cost is predictable: ~$385–420/month per person (Part B $203 + Plan G ~$100–130 + Part D ~$30–50). That is ~$740–800/month for a couple, or about $9,000–10,000/year.

What You'll Actually Pay Per Month — Real Scenarios

All amounts per person/month unless noted. Income below $218K/yr (married) — no IRMAA surcharge.

Coverage Path	Part A	Part B	Supplement	Part D	Total/Person	Couple/Month	Couple/Year
Bare minimum Not recommended	$0	$203	None	None	$203	$406	$4,872
Medicare Advantage Budget option	$0	$203	$0–50 (replaces A+B)	Included	$203–253	$406–506	$4,872–6,072
Plan N + Part D Budget Medigap	$0	$203	~$70–90	~$30–50	$285–325	$570–650	$6,840–7,800
Plan G + Part D Most popular choice	$0	$203	~$100–130	~$30–50	$315–365	$630–730	$7,560–8,760
Plan F + Part D Pre-2020 enrollees only	$0	$203	~$130–180	~$30–50	$345–415	$690–830	$8,280–9,960
Plan G + IRMAA Tier 1 Income $218K–274K (MFJ)	$0	$284 (+$81 IRMAA)	~$115	~$55 (+IRMAA)	$454	$908	$10,296
Plan G + IRMAA Tier 2 Income $267K–334K (MFJ)	$0	$370 (+$203 IRMAA)	~$115	~$68 (+IRMAA)	$553	$1,106	$13,272

2026 estimates. Medigap premiums vary by state, age, and insurer — shop at least 3 quotes. Part D varies by plan and medications.

What to Enter in Your Inputs Page

On your Inputs page under the Healthcare section, you have two fields per partner:

Pre-Medicare Annual ($) — field B52

Enter your annual healthcare cost BEFORE age 65 — health insurance premiums, copays, deductibles if retiring early. Example: $12,000/yr for marketplace insurance.

Medicare Annual ($) — field B53

Enter your estimated annual Medicare cost AFTER age 65. Use the table above to estimate. Example for Plan G: $315–365/mo × 12 = ~$3,780–4,380/yr per person. For a couple: ~$7,560–8,760/yr. Enter each partner's share in their respective field. These are ANNUAL amounts.

Medicare vs Medicaid — Once and For All

Medicare

• Federal health insurance program

• Everyone gets it at age 65 (or earlier if disabled)

• NOT based on income or assets

• You pay premiums ($203+/mo Part B)

• This is what this page is about

→ You WILL use this

Medicaid

• State-run assistance program

• Only if you have very low income AND assets

• Income limit typically $1,400–2,500/mo

• Asset limit typically $2,000 (individual)

• Mainly for nursing home coverage (if you spend down assets)

→ Most retirees with savings do NOT use this

Your Numbers

P1 Current Age

P2 Current Age

Expected Retirement Income (Annual)Include SS, pension, Roth conversions, RMDs

Medigap Plan

Part D Drug Plan (monthly)

P1 Life Expectancy

P2 Life Expectancy

The Parts of Medicare — Plain English

Part A — Hospital

$0/mo

Hospital stays, skilled nursing, hospice. Free if you or spouse paid Medicare taxes for 10+ years (most people qualify). Still has deductibles per hospital stay.

Part B — Medical

$202.90/mo

Doctor visits, outpatient care, preventive services, lab tests. The standard premium in 2026 is $202.90/month per person. Subject to IRMAA surcharges if income exceeds $218K/yr (married).

Part C — Medicare Advantage

$0–$200/mo

Private insurer alternative to Original Medicare. Bundles Parts A, B, and usually D. Often includes dental and vision. Lower premium but restricted networks and prior authorization.

Part D — Prescriptions

$20–$100/mo

Prescription drug coverage. Separate plan you add to Original Medicare. A yearly out-of-pocket cap (about $2,000, adjusted up slightly each year) now limits your annual drug costs no matter how expensive your medications are.

Medigap Supplement

$70–$200/mo

Private policy that fills the "gaps" in Original Medicare — deductibles, copays, coinsurance. Plan G is the most popular for new enrollees. Cannot be used with Medicare Advantage.

Key Medicare dates to know: You have a 7-month enrollment window (3 months before your 65th birthday, your birthday month, 3 months after). Miss it and you may pay a 10% permanent penalty on Part B for every 12-month period you were eligible but not enrolled. If you have employer coverage through age 65, you have a special enrollment period.

⚠️ IRMAA Surcharge Calculator

Income-Related Monthly Adjustment Amount — extra Medicare charges for higher incomes

IRMAA is calculated on your income from 2 years ago (the "look-back" period). So the income you report this year sets your Medicare premium two years from now — a large Roth conversion in a single year can trigger IRMAA surcharges two years later. Your Tax Engine page shows the exact thresholds.

Income — Married Filing Jointly (MAGI)	Part B Surcharge (per person/mo)	Part D Surcharge (per person/mo)	Total Extra (couple/yr)	Your Status

Lifetime Medicare Cost Breakdown

Your Medicare Enrollment Timeline

Medicare Strategy Tips

Official Resources — Go Straight to the Source

Medicare.gov

Official Medicare site — enroll, compare plans

SSA.gov/medicare

Plan Finder

Compare Advantage and Part D plans in your area

Medigap Info

Official Medigap comparison and enrollment guide

Healthcare.gov

ACA marketplace — get subsidy estimate and enroll

KFF Medicare Resource

Non-profit explainers, cost calculators, research

SHIP Counseling

Free Medicare counseling in every state — real humans

COBRA vs Medicare

Official guide on coordinating COBRA with Medicare

Keep your income below $218K (married) in retirement if possible. Even one dollar over the IRMAA threshold adds $888/year per person. Time large Roth conversions to avoid crossing thresholds.

Enroll in Part B on time. The late enrollment penalty is 10% per year forever — a $203/mo premium becomes $204/mo permanently if you're 1 year late.

Consider Plan G Medigap. Plan F was closed to new enrollees after 2020. Plan G covers everything Plan F did except the Part B deductible ($283/yr) — often the better value.

HSA dollars can pay Medicare premiums. Part B, Part D, and Medicare Advantage premiums are all qualified HSA expenses — but NOT Medigap premiums. Build your HSA before 65 for this purpose.

If you retire before 65, you need bridge coverage. Budget for ACA marketplace insurance — with income management, you may qualify for significant subsidies. See Healthcare Bridge on your Inputs page.

IRMAA can be appealed if your income drops due to a "life-changing event" (retirement, divorce, death of spouse). File Form SSA-44 with Social Security to request a reduction.

Healthcare in Retirement Planner