Navigate Medicare Correctly To Save Tens Of Thousands
Medicare mistakes can cost you tens of thousands in retirement. Learn how to navigate enrollment, reduce costly surcharges, and choose the right coverage.
September 1, 2026 · 3 min read
Most doctors think that things are simpler in retirement. Unfortunately, there are more financial decisions to be made than ever, and a Medicare misstep can be costly! Navigating when to sign up, how to keep Income-Related Monthly Adjustment Amount (IRMAA) surcharges down, and which policies to sign up for can be confusing to say the least. Signing up timely and reducing IRMAA surcharges can save tens of thousands over a short span, while signing up for the wrong coverages can prove devasting down the line. Fortunately, with a good roadmap, the process is fairly straightforward.
When To Sign Up
Most doctors will be required to sign up for Medicare during in the three months prior to their 65th birthday, the month of, or the three months following, known as the 7-month Initial Enrollment Period. If you miss it, penalties will be 10% per 12-month period you delayed! This means if three years go by, you will pay an increased premium of 30% for life!
Exception For Group Health Plans
Some doctors can qualify to delay signing up if they are covered by a Group Health Plan (GHP) offered by a large employer, union, or association to its members while they are still working. Employers with 20 or more employees offering a GHP qualify. Employers with less than 20 employees do not qualify, even if the coverage is offered! This means if you’re employed at 65 by a one doctor office that offers health insurance, you don’t qualify for this delayed enrollment!
However, if you’re covered under your spouse’s GHP, you do qualify for this exception. There’s no requirement that you be the employee, only that you are covered and the active member is currently employed. This means COBRA coverage does not count! If you lose coverage, you can apply for Medicare online using a Special Enrollment Period. You have 8 months following the loss of group health coverage or the end of employment, starting on whichever date occurs first.
If you’ve been misled, we have good news for you. There is a form for Special Enrollment Period for Exceptional Circumstances that covers being misled by an insurance company or an employer available on the Medicare.gov website. If this is the case, you will need to file the correct form and check the box for Group Health Plan or employer misrepresentation. You’ll need to provide the evidence of misrepresentation or file the appropriate attestation form. You have 6 months to enroll from the day you notify the Social Security Administration of the mistake, but we recommend enrolling immediately in case they don’t agree.
Reducing the Income-Related Monthly Adjustment Amount (IRMAA) Surcharge
Most doctors are shocked to learn that they owe a surcharge on their Medicare Premiums. Your IRMAA is based upon your Modified Adjusted Gross Income from two years prior, meaning upon selling your practice you will pay higher premiums for at least two extra years, likely more depending on when you file! Fortunately, you can file form SSA-44 (Medicare Income-Related Monthly Adjustment Amount – Life-Changing Event) to reduce your IRMAA surcharge when your life changing event (including retirement) occurs, not when your tax returns catch up!
What Coverages to Buy?
Part A (hospital coverage) and Part B (outpatient care) are easy, other than navigating when to sign up and IRMAA amounts. You simply apply through the Medicare website or in-person. You will also need a Part D prescription drug policy as well as a Medigap policy, which covers out-of-pocket expenses not paid by Parts A and B.
This is where many doctors run into trouble. We recently had a client who purchased a “Medicare Advantage” plan. Unfortunately, the coverage wasn’t adequate and she struggled to change plans due to her age. The best way to handle this is to obtain adequate coverage right out of the gate, with a Part D policy that covers the drugs you’re prescribed and a Medigap policy that pays when you need it.
When purchasing Medigap and Part D Coverage, you’ll need an independent broker to help navigate the process. We recommend reaching out to George Walters of Medicare Plan Partners (george@medicareplanpartners.com) to obtain coverage. As always, we do not receive a dime from recommending George. He simply understands the Medicare market and takes great care of our clients.