Don’t Miss This Medicare Season: What Every Retiree Should Know

Welcome back to Fuchs Around & Cal Them Out. Today we’re joined by a giant of the Medicare world, Josh Kerchis. We sat strategically so you can tell Josh is by far the tallest in the office—we all look up to him for Medicare news. Clearly, he’s a foot and a half taller, though he insists he’s not. We’re all standing behind the desk, by the way. Of course, my co-host Alex Cal is here too. It’s Medicare season, which means Josh basically eats, sleeps, and repeats at the office. No time for friends or family. What’s happening this year in Medicare? Nothing too crazy changes year over year. There are usually price increases as everything else goes up, but the official numbers and new plans typically aren’t released until the start of the annual enrollment period, which runs from October 15 through December 7. Premiums and final plan details often publish around then, sometimes into November. Healthcare is one of the biggest expenses in retirement and yet one of the least understood. Today we’re breaking down Medicare, the process, and what you need to know so you don’t get blindsided. As we age, we generally don’t get healthier, and with costs rising, having the right coverage helps lower your out-of-pocket expenses over time. Many people think Medicare is free and covers everything, but that’s not true. Original Medicare has two main parts: A and B. Part A, hospital insurance, is typically premium-free and covers inpatient care. Part B, medical insurance, has a monthly premium—base price in 2025 is $185 a month, though some are billed quarterly—and covers most medical care outside the hospital. It’s not free and doesn’t cover everything. Fidelity estimated in 2022 that the average 65-year-old couple may need around $315,000 for healthcare in retirement, so if you don’t choose the right plan, you could be putting yourself in a tough spot. There are also Parts C and D. Part D is prescription drug coverage; if you’re on Original Medicare and don’t want to pay full price at the pharmacy, you enroll in a Part D plan. Part C, Medicare Advantage, is coverage through private insurers and often feels like traditional employer insurance, with copays for specialists and free primary care visits. Many Advantage plans include dental, vision, hearing, and prescriptions, and often cost $0 extra beyond your Part B premium. It’s like an umbrella that bundles everything together. But is Advantage always best? Not necessarily. It can be the best bang for your buck in a normal, healthy year, but in a worst-case scenario—say a major surgery—you could hit the plan’s maximum out-of-pocket limit, around $10,000 depending on the plan. That’s when other options, like a Medigap plan, might make more sense. Health status, provider access, and expected usage matter. Denials are rare, but they can happen; we’ve seen only one case where an MRI was denied until the doctor confirmed medical necessity, which was then corrected. Dental is another hidden cost—Original Medicare doesn’t cover it. You can buy standalone plans or use Advantage plans that include dental benefits, but waiting periods are common, usually around one year before major work is covered. Another area that surprises retirees is IRMAA, the Income-Related Monthly Adjustment Amount. If you take large withdrawals from retirement accounts, two years later your Medicare premiums can increase. Go one dollar over a bracket and premiums jump significantly—anywhere from $1,000 for a single person up to $11,000 for a married couple. Planning withdrawals and Roth conversions carefully is key. Even if you’re happy with your plan, it’s worth reviewing every year. New plans come out, drug formularies change, and coverage networks shift. At Fuchs Financial, we use software to plug in your doctors, prescriptions, and pharmacies to estimate your annual out-of-pocket cost based on usage and help you decide what’s best. Medicare is full of misconceptions, and that’s why meeting with a specialist like Josh matters. Consultations are free, and here at Fuchs Financial, Josh is salary-based, not commission-based, which means his recommendations are objective and in your best interest. Sometimes he even recommends plans that don’t pay commissions because they’re better for the client. The goal is always to put clients first—whether it’s finances, taxes, estate planning, or healthcare. I’m Ben Fuchs with Josh Kerchis and Alex Cal. Thanks for joining us, and we’ll see you next time. This transcript was generated automatically and may contain minor errors.