Choosing Wisely: Medicare Open Enrollment Basics

Описание: This month the Balance team teams up with Simple Medicare to unpack the Medicare “basics” that trip up most people turning 65—and plenty who keep working past it. Guest speaker Kevin Shay, retired CPA and independent insurance broker, joins Bob Gavlak, Shaun Carney, and Ryan Mannen to explain how Parts A, B, C (Advantage), and D fit together, what Medigap (supplement) plans actually cover, how premiums and out-of-pocket costs work, and the enrollment windows that matter. The discussion also tackles IRMAA (income-related Part B/D surcharges), travel considerations, HSAs, and real-world tradeoffs between Traditional Medicare + Supplement vs. Medicare Advantage.

Key Takeaways

📌 Medicare Parts: A = hospital; B = doctors/outpatient; D = drugs; C = Advantage (private plan that bundles A/B, often D).

📌 Not Covered by A/B: routine dental, vision, hearing, annual physicals, most OTC, gym; no long-term custodial care.

📌 Costs: Part A usually $0 premium (40 quarters). Part B has a monthly premium; higher income can trigger IRMAA surcharges.

📌 Still Working at 65: If employer has 20+ employees, you can delay Part B without penalty. If contributing to an HSA, don’t enroll in any part of Medicare yet.

📌 Key Deadlines: Initial 7-month window around your 65th birthday; Special 8-month window after losing employer coverage; Annual Enrollment Oct 15–Dec 7.

📌 Travel & Big Centers: Original + Medigap often includes foreign travel emergency; some top hospitals don’t take certain Advantage plans.

📌 Switching “Trial Right”: One-time 12-month chance to try Advantage and return to Medigap without underwriting.

📌 Quick Tips: Verify your doctors & meds in any plan, compare drug costs on Medicare.gov Plan Finder, and coordinate tax moves (Roth conversions, RMDs) to manage IRMAA.

ⓘ Why It Matters ⓘ

Medicare choices affect your care access, costs, and flexibility for decades. The right path depends on your health, providers, travel, budget, and tax picture. Understanding how Parts A/B/C/D work—and when to enroll—helps you avoid penalties, surprises, and IRMAA pitfalls, and align healthcare decisions with your broader retirement plan.

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