If you’re approaching 65, already on Medicare, or helping a parent navigate coverage, you’ve probably noticed two things:
-
The rules change often, and 2) small choices can have big cost consequences. The good news? With a little structure—and the right partner—you can reduce surprises, protect your income, and keep your care simple.
Below are seven advisor-tested moves to get more value out of Medicare and the insurance options that wrap around it.
1) Start with the “Three Numbers” Audit
Before comparing plans, gather three numbers from the last 12 months:
-
Total premiums you paid (Medicare + any supplemental coverage).
-
Out-of-pocket costs (copays, deductibles, coinsurance, prescriptions).
-
Household Modified Adjusted Gross Income (MAGI) (affects IRMAA surcharges).
Why it matters: These numbers set your baseline and reveal where you’re overspending—premiums, pharmacy, or point-of-care costs. An advisor can spot quick wins (moving drugs to preferred pharmacies, tier exceptions, or plan changes) that you might miss.
2) Map Your Care Team and Meds—Then Match the Plan
Create a current list of:
-
Primary & specialists (with addresses)
-
Facilities & labs you prefer
-
Prescriptions (drug name, dosage, frequency; add any vaccines you plan this year)
Action: Verify provider networks and pharmacy tiers before switching plans. A plan can look great on paper until you realize your cardiologist or infusion center is out-of-network. Your list is your non-negotiable filter.
3) Choose Your Medicare “Chassis”: Advantage vs. Medigap
Think about your preferences:
-
Medicare Advantage (Part C): Often lower or $0 premiums, extra benefits (dental/vision/hearing/OTC), managed networks, and an annual out-of-pocket maximum. Great for people who want care coordinated in one place and don’t mind staying in-network.
-
Medigap (e.g., Plan G) + Part D: Higher predictable premium, minimal medical bills, broad access to providers that take Medicare, fewer prior authorizations. Good for heavy travelers or those wanting maximum provider freedom.
Pro tip: If you’re healthy today but value freedom of choice, calculate the “sleep-at-night premium” of Medigap vs. your realistic Advantage costs. If you choose Advantage, confirm the specialist access and referral rules for your specific conditions.
4) Don’t Sleep on Part D (Even If You Take Few Drugs)
Part D differences can mean hundreds to thousands of dollars a year—even for the same meds. Look for:
-
Preferred pharmacies and mail order pricing
-
Tiering & step therapy rules
-
Insulin and specialty drug handling
-
Vaccine coverage (shingles, RSV, etc.)
Action: Run a medication comparison annually. One new prescription can make your old plan the wrong fit.
5) Fill the Gaps Strategically (Dental, Vision, Cancer, Hospital Indemnity)
Original Medicare doesn’t cover routine dental, vision, or hearing, and even Advantage extras may be modest. Consider:
-
Stand-alone dental/vision plans with strong local networks
-
Cancer or critical illness coverage to offset high-cost treatments and travel
-
Hospital indemnity to cushion daily inpatient copays on certain Advantage HMOs/PPOs
Goal: Align these add-ons with your actual risk (family history, personal health, budget), not just a brochure of benefits.
6) Watch the Tax Tail: IRMAA, HSAs, and Roth Conversions
Medicare premiums can rise with higher MAGI due to IRMAA. Coordinate with your tax pro on:
-
The timing of Roth conversions
-
Managing capital gains and RMDs
-
Reporting a life-changing event if your income legitimately dropped (retirement, marriage changes, etc.)
Bonus: If you’re still working and on a qualifying high-deductible plan before enrolling in any part of Medicare, consider maxing your HSA. Once enrolled in any part of Medicare, you must stop new HSA contributions—but you can keep spending existing HSA dollars tax-free on qualified medical costs.
7) Put Annual Reviews on Autopilot
Plans change every year—formularies, networks, and costs. An annual review helps you:
-
Re-price your meds
-
Confirm doctor access
-
Check new benefits that matter to you
-
Update travel or seasonal residence needs
-
Re-evaluate add-ons (dental/vision, indemnity, cancer)
Set it and forget it: Put a yearly reminder on the calendar with your advisor. Five minutes of prep saves hours of headaches later.
Mini-Case Studies (Real-World Wins)
-
The Traveler: A couple who split time between two states moved from an Advantage HMO to Medigap + Part D. Outcome: higher monthly premium, but fewer “out-of-area” hassles, better access on the road, and lower total cost once ER and specialist visits were counted.
-
The New Rx: A client added a specialty medication mid-year. A plan review found a same-carrier Part D with better tiering and a different preferred pharmacy—saving ~$1,400 over the next 12 months.
-
The IRMAA Squeeze: Recent retirees’ income dropped sharply. Filing a life-changing event reduced IRMAA brackets, cutting monthly premiums significantly.
Common Mistakes to Avoid
-
Choosing a plan solely for the $0 premium without checking networks and meds
-
Assuming last year’s Part D is still the best for this year’s prescriptions
-
Enrolling in any part of Medicare while still contributing to an HSA
-
Ignoring dental/vision until a large expense hits
-
Skipping annual reviews because “nothing changed” (something always changes)
Quick Checklist
-
List your doctors, facilities, and meds
-
Price plans with your exact list (not averages)
-
Decide on your chassis: Advantage vs. Medigap
-
Add targeted coverage (dental/vision, hospital indemnity, cancer)
-
Coordinate with your tax pro on IRMAA and Roth timing
-
Schedule an annual review with your advisor
FAQ
Q: When should I start planning if I’m turning 65?
A: About 3–6 months before your 65th birthday to set up timing, HSA rules, and coverage choices.
Q: Can I change plans later?
A: Yes—there are specific windows each year (and special circumstances) to switch Advantage or Part D plans, and limited opportunities to change Medigap without underwriting, depending on your state.
Q: What if my doctor leaves the network mid-year?
A: You may qualify for a special enrollment period. Document the change and contact your advisor quickly to discuss options.
Call to Action
Ready for a no-pressure coverage review? Bring your doctor list and meds, and we’ll run the numbers side-by-side so you can see exactly what you’d pay—before you switch.
Book a 15-minute Medicare checkup » (link to your scheduling page or contact form)
Prefer a call? (xxx) xxx-xxxx
In-person or virtual appointments available.
Compliance & Disclosure
This information is for educational purposes only and is not a guarantee of coverage or cost. Plan availability, networks, premiums, copays, coinsurance, deductibles, and prescription drug formularies vary by carrier and county and are subject to change. Enrollment in a plan may be limited to certain times of the year unless you qualify for a Special Enrollment Period. Consult your licensed insurance professional and tax advisor for guidance specific to your situation.