Medicare Cost Estimator

How to Use the Medicare Estimator

Medicare — The US Retirement Health Plan and Its Hidden Costs

Your 2026 premium is set by your 2024 income

Frequently Asked Questions

• When do I have to enroll in Medicare?+
  Initial Enrollment Period: 3 months before through 3 months after your 65th birthday month (7 months total). If you miss it AND don't have creditable employer coverage, you owe a lifetime late-enrollment penalty (10% per 12 months delayed). Still working with employer-group health coverage at 65? You can defer Part B without penalty, but must enroll within 8 months after employment ends. Don't miss either window.
• Original Medicare + Medigap or Medicare Advantage?+
  Original + Medigap: any Medicare provider nationwide, predictable cost, no prior authorization, higher monthly premium (about USD 450 on the default inputs above). Medicare Advantage: lower or USD 0 premium, often includes dental/vision/hearing, network restrictions, prior auth common. Choose Original + Medigap if you value provider freedom + predictability; Medicare Advantage if you want lower monthly cost + bundled benefits and your preferred providers are in-network. The switch-back from MA to Original Medicare can be hard later — Medigap can decline you for pre-existing conditions after the initial 6-month open enrollment.
• What is IRMAA and how do I avoid it?+
  Income-Related Monthly Adjustment Amount: extra premium for higher-income retirees. 2026 brackets start at USD 109K MAGI (single) / USD 218K (joint), based on 2024 income. Tactics to manage: spread Roth conversions across multiple years instead of one large one; use Qualified Charitable Distributions to reduce RMD-driven MAGI; coordinate with capital gain harvesting; appeal via SSA-44 if you had a "life-changing event" (work stoppage, divorce, spouse death, loss of pension).
• Do I really need Medigap?+
  Original Medicare has NO out-of-pocket maximum. One bad year (hospitalization + cancer treatment + specialist visits) could leave you owing tens of thousands in 20% coinsurance. Medigap caps that exposure — Plan G covers nearly everything except the Part B deductible (USD 283/year in 2026). For most retirees with significant assets to protect, Medigap is essential. The alternative is Medicare Advantage, which has a built-in OOP max but the network/prior-auth trade-offs.
• Which Medigap plan should I pick?+
  Plan G is the most popular for new Medicare beneficiaries (Plan F was retired for new enrollees in 2020). Plan G covers all Medicare gaps except the Part B deductible. Cheaper alternatives: Plan N (similar to G but copays on some services), High-Deductible Plan G (much lower premium in exchange for an annual deductible that CMS sets each year). All Medigap plans with the same letter offer IDENTICAL benefits regardless of carrier — shop on price alone within the same plan letter.
• What about Part D — how do I pick a plan?+
  Use Medicare.gov's Plan Finder during Open Enrollment (Oct 15 - Dec 7) — enter your current medications and the tool ranks plans by total cost (premium + deductible + copays). Each year you should re-shop because formularies change. The cheapest premium isn't always the cheapest plan — a USD 50 premium plan with your drugs on Tier 1 can beat a USD 0 plan that puts your drugs on Tier 4. Part D out-of-pocket drug costs are capped at USD 2,100 for 2026.
• What's NOT covered by Medicare?+
  Routine dental, routine vision, routine hearing, long-term care (Part A covers at most 100 days of skilled-nursing care per benefit period, with USD 217 a day coinsurance from day 21 in 2026), cosmetic procedures, most care outside the US. Long-term care is the largest uncovered exposure — a nursing-home room runs well over USD 100,000 a year at national median rates. Plan for these explicitly — Medicare Advantage often includes dental/vision/hearing; separate dental/vision insurance available; for LTC see the long-term care insurance calculator.
• When can I change Medicare plans?+
  Annual Open Enrollment Period: Oct 15 - Dec 7 every year. You can switch Part D plans, switch from Original to MA or vice versa, switch between MA plans. Medicare Advantage Open Enrollment: Jan 1 - Mar 31 (MA-to-MA or MA-to-Original only). Special Enrollment Periods exist for moves, losing employer coverage, qualifying for Extra Help, etc. Medigap has its own rules — guaranteed-issue only during the first 6 months after Part B enrollment; medical underwriting can apply later.
• I'm still working at 65 — should I enroll?+
  It depends on your employer plan size and coverage type. Companies with 20+ employees: their group health is primary, Medicare can be secondary or deferred. Companies under 20: Medicare is primary; usually enroll. ALWAYS sign up for Part A (free if 40 quarters) — it's automatic if you're already getting SS. Part B can be deferred if you have "creditable coverage" via employer; coordinate with HR before turning 65. Late enrollment penalty (10% per 12 months delayed) is lifetime if you miss the SEP window after leaving.
• I'm planning to retire abroad — does Medicare follow me?+
  Mostly NO. Medicare covers very limited situations outside the US (emergencies in border areas; cruise ship in US territorial waters; medical emergency in Canada en route to Alaska from another US state). For routine care abroad you'd need a separate international medical insurance plan. Many US retirees abroad buy an international medical plan AND keep Part B enrolled as backup for US-trip emergencies. Dropping Part B and trying to re-enroll later triggers the lifetime 10% penalty — don't drop hastily.

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