🩺 Medicare 101: Navigating Your Benefits with Confidence

Whether you’re approaching Medicare for the first time or reviewing your current coverage, this Medicare 101 session breaks down the basics and helps you understand your options.

In this video, we cover:

✔️ Medicare Parts A, B, C & D and what each covers
✔️ Enrollment periods and important deadlines
✔️ How to choose a plan that fits your healthcare needs and budget
✔️ Cost-saving strategies and available benefits

We believe understanding your healthcare options is an important part of planning for retirement. We hope this conversation helps you feel more informed and confident about your next steps!

» Full Transcript:

Shean: Hello, everyone, and welcome to our 2026 Medicare 101 webinar. We appreciate you taking the time to join us.

Our goal is to help you develop a basic understanding of Medicare: what your options are, the pros and cons of each option, and the process for signing up. We are not Medicare experts. We want to help you prepare for a conversation with a Medicare expert so you have some baseline knowledge to build on.

Let’s introduce Will, our Director of Financial Planning. Most of you already know him, but if you’re joining us for the first time, Will leads the financial planning side of things and is our foremost expert here. He’ll walk us through the details.

First, let’s talk about the challenge ahead for those turning 65. At that age, you could still have around $370,000 in after-tax healthcare expenses ahead of you, including premiums, out-of-pocket expenses, and prescriptions. That is a significant hurdle. You need money set aside to afford what has become a rapidly increasing cost in retirement.

When Should I Enroll?

Shean: This is probably the question we hear most often, so let’s walk through your options.

Your initial enrollment period is centered around your 65th birthday. You can sign up for Medicare and make your selections three months before the month you turn 65. The specific day of your birthday doesn’t matter. For example, if you turn 65 in April, you can sign up in January.

You also have three months after your birthday month to enroll, but we recommend getting started early and making those selections ahead of time.

The annual open enrollment period runs from October 15 through December 7. That gives you an opportunity each year to make changes if needed.

Will, let’s get into the details of the different parts of Medicare and what they mean.

Medicare Parts A and B

Will: We’ll start at a high level with Part A and Part B.

Part A is hospital insurance. It covers inpatient care, skilled nursing facilities, hospice care, and similar services. The premium is $0. This is also the part we’re discussing for people who continue working beyond age 65: signing up during that initial enrollment period to avoid late enrollment penalties or fees.

Part B is medical insurance. This takes over when you stop working and no longer have employer-sponsored health insurance. It covers outpatient care, doctor visits, medical equipment, and preventive services. Think of Part B as your traditional health insurance replacement.

The amount shown on the slide starts at $202 per month, or almost $203 per month. Your cost depends on your income. If you’ve heard of IRMAA, that determines how much you pay for Part B. We’ll discuss that in more detail shortly.

Shean: Let’s pause there. As account balances and incomes grow, interest and dividends can grow as well. We’re seeing more people move into higher tax brackets, and many of the high-net-worth individuals we work with already find themselves there.

Can you explain why managing IRMAA is important and how we address it through our annual year-end checklist?

Will: The IRMAA brackets are published, so we can plan around them. Depending on your situation, we may be able to use withdrawals from different accounts or other tax planning strategies to stay below certain brackets.

At the end of the year, we review your taxable income and adjusted gross income to see whether adjustments could help you avoid higher brackets. At a minimum, we want to prepare you for how your bracket will affect your Medicare costs and what may come out of your Social Security check.

We also look for strategies that could reduce what you pay for Part B. Later, we’ll show the brackets and costs so you can get a more concrete idea of how this works.

Part A and Part B Deductibles

Will: Although Part A has a $0 premium, it does have a deductible for inpatient hospital care. The amount shown here is $1,736 before Medicare starts paying those hospital benefits.

As described on the slide, this deductible can apply more than once. There is no limit to the number of times you may have to pay it, depending on your inpatient care needs.

Part B has a smaller deductible of $283. This deductible works differently because it applies once per year. After you meet it, there is usually 20% coinsurance.

Supplemental coverage can help reduce that coinsurance amount, which we’ll discuss next.

Part B Costs and IRMAA

Shean: Let’s take a closer look at Part B costs and those income brackets.

Will: The slide shows the IRMAA brackets and the monthly premiums associated with each one. It includes individual, joint, and married-filing-separately income ranges, along with the corresponding monthly costs. These figures are presented as the 2026 amounts.

One important detail is that the income used to determine your bracket comes from two years earlier. Your income in 2026 will affect your IRMAA costs in 2028.

That makes advance tax planning important. If you’re 63, your income this year will directly affect your first Part B premium when you start Medicare at 65. Knowing that relationship helps you prepare for a potential surcharge.

Shean: This is a good example of why we do detailed financial planning and encourage clients to review it annually. These rules can be unfamiliar to the average person, but the decisions you make two years before retiring at 65 could create a $120 monthly difference in healthcare costs per person.

Advance tax planning becomes especially important when your income is in the low hundreds of thousands on an individual return or the low $200,000s on a joint return. While you’re working, that income could simply be your salary. It doesn’t have to be retirement income to affect your future Medicare costs.

What counts toward that income figure? We’re talking about wages, capital gains, dividends, interest—everything, correct?

Will: Correct. It is based on modified adjusted gross income. That includes the different income sources you mentioned and takes certain above-the-line deductions into account.

This is before your standard deduction or itemized deductions. Contributions to a 401(k) or an IRA while you’re working may reduce that income figure. As we’re describing it here, think of it as your gross income less eligible retirement contributions and certain other adjustments, before the standard or itemized deduction.

Shean: That’s a helpful clarification. So, are Parts A and B all we need?

Additional Coverage Options

Will: There are additional coverage options we recommend discussing with a Medicare professional.

Whether you choose Part C, also called Medicare Advantage, or a Medigap plan paired with Part D prescription coverage depends on your situation and retirement goals.

We can explain these options at a high level, but when you meet with your Medicare agent, tell them how much you plan to travel, who your doctors are, and what your current healthcare needs look like. That helps them tailor the coverage to you.

Medicare Advantage traditionally has lower premiums and higher cost sharing. There are no health questions, and many services may require prior authorization. Some people find that process inconvenient because approval may be needed before receiving certain procedures or services.

Medigap is a supplement that traditionally has higher premiums and lower cost sharing. When we talk about cost sharing here, we’re referring to deductibles and the expenses you pay before insurance covers the remaining amount.

Medigap also offers more flexibility around providers. As the slide explains, no referrals are necessary, and you can see participating providers nationwide.

Shean: That flexibility matters when you’re asking, “Can I see the doctors I want?” or “What happens if I spend part of the year in Florida or Arizona?” It’s also important for people who plan to travel frequently.

Will: One other piece is Part D prescription coverage, which helps cover prescription drug costs. Medicare Advantage generally includes prescription coverage. Medigap generally does not, so you would pair it with a separate Part D plan.

Shean: Let’s recap that. Medicare Advantage typically combines your additional coverage and prescription coverage into one plan. It generally has lower premiums, a more local network, and higher cost sharing.

With Medigap, you typically pay higher premiums in exchange for lower cost sharing and greater provider flexibility. Prescriptions are not included, so you still need to consider Part D separately.

Will: Correct.

Shean: This is why travel matters. If your Medicare Advantage plan uses a Kansas City network and something happens while you’re in Arizona, that could potentially become costly. With a Medigap plan accepted wherever Medicare is accepted, you have coverage across the country.

Understanding those potential network limitations is an important part of making your decision.

Original Medicare With Medigap

Shean: How do these different parts work together?

Will: You have Part A and Part B as the foundation. Additional coverage is optional, but we recommend considering it. As we discussed, Part B alone could leave you responsible for 20% of costs with no out-of-pocket maximum. Additional coverage helps manage the financial exposure from a major medical event.

Looking at the Original Medicare options on the slide, you could have:

• Parts A and B only.

• Parts A and B with a Part D prescription plan.

• Parts A and B with Medigap.

• Parts A and B with both a Part D prescription plan and Medigap.

The last option, highlighted on the slide, is what we most commonly see and recommend in this discussion: Parts A and B, a prescription plan if you need prescription coverage, and a Medigap supplement.

This can be a good fit for someone who plans to travel, wants flexibility beyond a local network, and is comfortable paying higher premiums for lower deductible costs.

Medicare With Medicare Advantage

Shean: Now, what about Medicare Advantage?

Will: You still have Parts A and B, but you use Part C, Medicare Advantage, for your coverage. The slide shows an option without built-in drug coverage, an option with built-in drug coverage, and an option involving separate Part D coverage when drug coverage is not included.

The most common approach we see and recommend within the Medicare Advantage options is a plan with built-in prescription coverage.

Medicare Advantage generally offers lower premiums and a defined network in your area. If you don’t expect to travel frequently, it can be a less expensive monthly option than Medigap.

However, there are considerations if you plan to travel or anticipate specific medical needs. Certain surgeries or procedures may require approval before they are covered.

Choosing a Medigap Plan

Shean: Once you’ve decided between Medigap and Medicare Advantage, there’s another decision to make. You may choose Medigap and then realize there are another 10 options to sort through. How do you choose the actual plan?

Will: The short answer is to work closely with your Medicare agent. They should listen to your needs and help you select a plan that fits your specific situation.

Be prepared to discuss your travel plans, potential procedures, current health, and the doctors you want to continue seeing. There are many options, and those details help your agent guide you.

For Medigap policies with the same letter, the coverage is standardized. Whether you buy that lettered plan from Blue Cross Blue Shield or another provider, the covered benefits are the same. As discussed here, the premium is the difference to compare between those policies.

That makes shopping around important. Consider working with a broker who can compare multiple companies rather than someone who represents only one insurer.

Shean: On the slide, Plans C and F are marked in red and described as discontinued. Plan G is discussed as the replacement for Plan F.

This slide comes from a Medicare supplement brochure. Plan G is where we tend to lean in these conversations because of its extensive, well-rounded coverage.

It also includes a foreign travel emergency benefit, shown as 80% subject to plan limits. We’ve talked about traveling and avoiding network restrictions, and that benefit can be valuable if international travel is part of your retirement plans.

Medicare Advantage: HMO and PPO Plans

Shean: Let’s walk through the two primary Medicare Advantage plan types.

Will: Medicare Advantage often works more like the health insurance you may already have. You may be familiar with the terms HMO and PPO.

HMO plans are generally more restrictive. They typically have lower premiums and may involve higher out-of-pocket or deductible costs. They use a network and require a primary doctor. As described in this discussion, you need to use providers within that network.

This can suit someone who wants to work within a local network, has a doctor they’re comfortable with, and doesn’t expect to travel frequently.

PPO plans offer more flexibility. They don’t require a primary doctor or a referral to see a specialist. If the doctor you want to see participates in your PPO network, you can receive covered care from them.

If you travel frequently, a PPO may be worth discussing with your agent.

These are terms you’ll likely hear when reviewing Medicare Advantage options. Having a basic understanding helps you follow the conversation, but don’t hesitate to ask questions. Your agent should be able to explain the details clearly.

Shean: My main takeaway is that there is no one-size-fits-all solution. Your health, family circumstances, finances, and retirement plans all matter.

Don’t choose a plan simply because your sister, neighbor, or coworker likes theirs. Take ownership of your situation, speak with an expert, and be prepared to answer questions. They want to help you find the right fit, but everyone’s circumstances are different.

Questions to Consider Before Choosing Coverage

Shean: Will, can you recap the main questions people should answer before making a decision? Then we’ll talk about the costs.

Will: These are questions you should be ready to discuss with your Medicare professional:

• How often do you go to the doctor?

• What medications do you take?

• Do you need Part D coverage, or does your selected plan include prescription coverage?

• What can you comfortably pay in monthly premiums?

• How comfortable are you with potentially higher out-of-pocket costs?

• Are there particular doctors or hospitals you want to continue using?

• Will you travel frequently?

• Do you have other coverage through a previous employer or a retiree plan associated with a pension?

Your agent should ask about these things, but share the answers even if they don’t. You want to give them a clear picture so they can recommend a plan that checks the right boxes for you.

Comparing the Costs

Shean: Now for the million-dollar question: What is all of this going to cost?

We’re comparing two examples. The first is Parts A and B with Medigap Plan G and a separate prescription plan. The second is Parts A and B with a Medicare Advantage plan that includes prescription coverage.

In these examples, Part A costs $0 under either option. The transcript states a standardized Part B cost of $23 per month, a Plan G premium of $38.99, and a $27 average Missouri prescription plan premium.

The total presented for the Medigap option is approximately $450 per month, compared with about $217 per month for Medicare Advantage.

At face value, it’s easy to see why someone might lean toward Medicare Advantage. But the monthly premium doesn’t tell the whole story.

The Medigap example has lower out-of-pocket costs, nationwide provider flexibility, and some international emergency coverage. You can receive care wherever Medicare is accepted without navigating a local network.

The Medicare Advantage example has potential out-of-pocket costs of around $9,300. Some plans may have lower limits, but a larger out-of-pocket expense could more than offset the monthly premium savings if you need significant care. You also need to consider the provider network.

Will: Let’s describe the situations where each option might fit.

Someone considering Medigap may have a substantial emergency fund or enough assets to comfortably cover the higher monthly premiums. They may travel frequently, want flexibility beyond doctors in their home city, or expect to use providers outside a local network.

Someone considering Medicare Advantage may be healthy, visit the doctor less often, and not expect to reach the out-of-pocket maximum. They may travel less and prefer a lower monthly premium.

Shean: I’d also step beyond the dollars and cents and ask: What are your goals?

Is your priority to retire as early as possible, or to retire as comfortably as possible? The healthcare costs you’ll face throughout retirement are a major part of that decision.

If paying around $450 per month for more extensive coverage feels out of reach, I would ask whether you feel financially prepared to retire. Again, there is no one-size-fits-all answer, but it’s a question worth considering.

Sometimes we focus heavily on reaching a particular retirement number and choosing a lower monthly premium. It’s also important to think about how you want retirement to feel and how you would handle unexpected medical bills.

More extensive coverage and fewer out-of-pocket hurdles may bring value beyond the monthly cost. Consider both the financial tradeoffs and the comfort that coverage could bring to your retirement plan.

Shean: Will, thank you for your time and expertise. And to everyone who joined us, thank you for taking the time.

We hope we’ve answered some questions and helped you prepare for your next conversation with a Medicare professional.

If there’s anything we can do to help, please reach out. We’re happy to assist you as you navigate your next steps. Thank you again for joining us.