Medicare B + G + Part D drug in NYC = $1k per month?

[Indeterminacy]

I'm seeking your sanity check on my medical expenses in retirement.

I plan to retire in 2026 at age 69, and DW will be 65. We live in New York City and plan to retire there.

We are both in good health and use only a few commonly prescribed medications covered under Medicare Part D.

When preparing my retirement expense estimate, I used a $1,000 monthly medical coverage cost for DW and an additional $1k/mo for myself. This totals $2,000 monthly = $24,000 in annual medical expenses.

Expected coverage: Medicare B + Medicare G-HD + Medicare Part D drug for two people in NYC (including deductibles and out-of-pocket expenses) = budgeted at $2,000 per month.

Does this seem like a reasonable estimate?

Anything else to watch for?

Maxifi estimates IRMAA MAGI at under $190k annually and Medicare B at $250/mo. each, $500/mo. for both, $6,000 annually.

My updated portfolio and income can be viewed here: viewtopic.php?p=8195077#p8195077.

Thank you!

[Carol88888]

I am in NYC and my part D plan for AARP went up over $100/month this year with about a $550 deductible. I don't know if you included drug plan cost in your estimates.

I found a cheaper drug plan from Cigna and switched. It, too, has about a $550 deductible, I think. You can compare plans and see what they cost and if they cover your drugs at medicare.gov.

Also, did you included the deductible for plan G? It runs about $283, I think.

[ClaycordJCA]

This topic is now in the Personal Finance (Not Investing) forum.

[quantAndHold]

That seems like a lot. All in, my 77 year old wife’s big city (VHCOL, but not NY) Medicare Advantage plan costs about a third of that.

[Tom_T]

I think $500/month per person is reasonable. Let's use ballpark numbers from today: Medicare $185, Medigap G-HD $130, Part D $25. That's $340/month. Medicare deductible is $20/month. Medigap G-HD deductible, I don't know your health care usage, but let's say $40/month average. Now the total is $400. And don't forget that you won't have dental nor vision coverage.

[yankees60]

I am in Western Massachusetts (low / medium cost of living area) and I am NOT subject to IRMAA.

Medicare: $185

Medigap: $263

Plan D: Drug $12

Total: $460 / month

Notes:

1) Went on Medicare April 2016

2) Been on Blue Cross Blue Shields most expensive Medigap plan continuously since then. No deductible or copays.
I've never paid a penny for medical expenses in the almost 9 plus intervening years.

3) Since I am still on no drugs I always chose the least cost plan. That has resulted in me spending about $50 in drugs in total since April 2016.

Seems as though your total monthly cost if going to be driven by:

1) Your income -- if you will be subject to IRMAA

2) Where you live

3) What level of drug coverage you need.

[Indeterminacy]

I am in NYC and my part D plan for AARP went up over $100/month this year with about a $550 deductible. I don't know if you included drug plan cost in your estimates.

What is your new Plan D monthly cost, including the $100/mo increase? Yes, I'm including drug costs in my estimates.

Thank you for your feedback.

[Indeterminacy]

And don't forget that you won't have dental nor vision coverage.

I had not considered dental and vision costs. A good reminder; I need to build these in.

Thank you.

[Indeterminacy]

Seems as though your total monthly cost if going to be driven by:

1) Your income -- if you will be subject to IRMAA
2) Where you live
3) What level of drug coverage you need.

Thank you, I'm going to dig in deeper.

[Indeterminacy]

That seems like a lot. All in, my 77 year old wife’s big city (VHCOL, but not NY) Medicare Advantage plan costs about a third of that.

Thanks for the information. I will review Medicare Advantage plans again next year. So far, I'm planning on using original Medicare B.

[TheEleven]

That seems like a lot. All in, my 77 year old wife’s big city (VHCOL, but not NY) Medicare Advantage plan costs about a third of that.

The op is asking about original Medicare - very different from an Advantage plan.

[yankees60]

And don't forget that you won't have dental nor vision coverage.

I had not considered dental and vision costs. A good reminder; I need to build these in.

Thank you.

I forgot to add that in my Medigap plan, for about an additional $3 per month, I get some vision and hearing coverage.

Hearing - annual exam covered

Visions - About $150 towards exams and another $150 for eyeglasses / contact lens purchases.

[exodusing]

You can price Medicare, Medigap and Part D for this year, including seeing deductibles and other terms. Use the lowest cost Medigap G-HD since plans are standard.

This would seem better than relying on Maxifi and random experiences. https://thefinancebuff.com/medicare-irm ... ckets.html is probably the best source for IRMAA brackets.

[Indeterminacy]

My updated estimates, NYC:
Applying 100% of co-pay and deductibles.

Medicare B: $200 each per month.
Plus some deductibles...

Medicare G-HD: $100 each per month.
Deductibles: $2,700 per year. $225/mo.

Medicare D Drug: $75 each per month.
Co-Pay: Now capped at $2,000 per year. $175/mo.

Totals per person, per month.
Medicare B: $200
Medicare G-HD: $100
Deductibles G-HD: $225
Medicare D Drug: $200
Co-Pay Drug: $175
Per Month: $900
Per Year: $11,000

Plus, from this thread... dental and vision care; another $1,000 per year?

How does this look?

Thank you

[Indeterminacy]

You can price Medicare, Medigap and Part D for this year, including seeing deductibles and other terms. Use the lowest cost Medigap G-HD since plans are standard.

This would seem better than relying on Maxifi and random experiences. https://thefinancebuff.com/medicare-irm ... ckets.html is probably the best source for IRMAA brackets.

Thank you. Will check.

[yankees60]

My updated estimates, NYC:
Applying 100% of co-pay and deductibles.

Medicare B: $200 each per month.
Plus some deductibles...

Medicare G-HD: $100 each per month.
Deductibles: $2,700 per year. $225/mo.

Medicare D Drug: $75 each per month.
Co-Pay: Now capped at $2,000 per year. $175/mo.

Totals per person, per month.
Medicare B: $200
Medicare G-HD: $100
Deductibles G-HD: $225
Medicare D Drug: $200
Co-Pay Drug: $175
Per Month: $900
Per Year: $11,000

Plus, from this thread... dental and vision care; another $1,000 per year?

How does this look?

Thank you

Your dental and vision care without insurance could be about what you are currently spending for both.

With dental insurance? It's really a form of prepaid expenses. The insurance company has to make a profit so insurance plus what it does pay might end up costing you more versus you paying for all of it without insurance.

I've only had dental insurance one year in my life (via an employer). Otherwise paying for it all on my own. However, for the last four years with my new, current dentist he has a plan wherein I pay $365 a year which covers the costs of certain items and 15% off other items.

[Tom_T]

Vision, you can get a bit of a break. Basic eye exam is on you. But, if you're also getting tests to check for possible glaucoma (even if you don't have it), then the doctor can submit that to Medicare as a normal medical expense.

Dental has been discussed many times here. Most agree that dental insurance is not worth it. Some dentists have a prepaid plan where, for an annual fee, you'll get a couple of cleanings, an X-ray, and a discount on other services. Other dentists don't have anything like that. (Edited: previous poster yankees60 described such a plan. )

[Leesbro63]

With regard to dental insurance, I agree that it doesn’t seem cost effective. But I’ve had good experience with this $8/month Aetna “fee schedule”, so I’m not blindly buying dental services:

https://www.aetnavitalsavings.com/

[yankees60]

Vision, you can get a bit of a break. Basic eye exam is on you. But, if you're also getting tests to check for possible glaucoma (even if you don't have it), then the doctor can submit that to Medicare as a normal medical expense.

Dental has been discussed many times here. Most agree that dental insurance is not worth it. Some dentists have a prepaid plan where, for an annual fee, you'll get a couple of cleanings, an X-ray, and a discount on other services. Other dentists don't have anything like that. (Edited: previous poster yankees60 described such a plan. )

Now that I know how to insert images here I have my exact plan below.

When I first went on it four years ago it seems that it cost me the same as now - $335 per year. At the time I compared all the services to what I'd be paying my prior dentist for the same and I'm remembering it would have been in the $800 range.

[quantAndHold]

That seems like a lot. All in, my 77 year old wife’s big city (VHCOL, but not NY) Medicare Advantage plan costs about a third of that.

The op is asking about original Medicare - very different from an Advantage plan.

I understand that. Just presenting an alternative. In places where there's competition (and I'm assuming that NYC, being a big city, is one of those places), there are usually several good, cost effective MA plans available. I find it interesting that people will drive a 20 year old Camry, then plan on spending the equivalent of a new car payment every month for the rest of their lives to keep from using the same HMO that they had when they were working.

[Dottie57]

In Minneapolis, Mn. I pay

Part d 97
Part b 185
Medigap 178
= 460 a month.

Not close to Op’s.

[CrossOverGuy]

Medicare G-HD: $100 each per month.
Deductibles: $2,700 per year. $225/mo.

That $225/month doesn't come into play if your utilization of doctors and hospital expenses and billings doesn't reach the maximum. If you didn't use any doctors in a year, you'd just be out the premium x 12 and that would still cover you for major illness/accident/hospital, at which point you'd start getting bills for the 20% reduced rate up to the now $2,870 year High-Deductible maximum. If you saw one doctor that Medicare allowed $200, you'd just be out 20% or $40 of that, for example. If that was all you used in a year, that $2870 you wouldn't have to pay -- it's just a possible maximum out-of-pocket in a bad (or high medical use) year.

[Indeterminacy]

Now that I know how to insert images here I have my exact plan below.

When I first went on it four years ago it seems that it cost me the same as now - $335 per year. At the time I compared all the services to what I'd be paying my prior dentist for the same and I'm remembering it would have been in the $800 range.

Thanks for sharing this information.

[Indeterminacy]

In Minneapolis, Mn. I pay

Part d 97
Part b 185
Medigap 178
= 460 a month.

Not close to Op’s.

Dottie57. Thank for sharing these numbers. My math is for NYC and includes the maximum copays and deductibles. Hopefully, my numbers represent the worst-case scenario.

[Indeterminacy]

Medicare G-HD: $100 each per month.
Deductibles: $2,700 per year. $225/mo.

That $225/month doesn't come into play if your utilization of doctors and hospital expenses and billings doesn't reach the maximum. If you didn't use any doctors in a year, you'd just be out the premium x 12 and that would still cover you for major illness/accident/hospital, at which point you'd start getting bills for the 20% reduced rate up to the now $2,870 year High-Deductible maximum. If you saw one doctor that Medicare allowed $200, you'd just be out 20% or $40 of that, for example. If that was all you used in a year, that $2870 you wouldn't have to pay -- it's just a possible maximum out-of-pocket in a bad (or high medical use) year.

A good callout. I guess my math represents a bad-case year. Thank you.

[Dottie57]

That $225/month doesn't come into play if your utilization of doctors and hospital expenses and billings doesn't reach the maximum. If you didn't use any doctors in a year, you'd just be out the premium x 12 and that would still cover you for major illness/accident/hospital, at which point you'd start getting bills for the 20% reduced rate up to the now $2,870 year High-Deductible maximum. If you saw one doctor that Medicare allowed $200, you'd just be out 20% or $40 of that, for example. If that was all you used in a year, that $2870 you wouldn't have to pay -- it's just a possible maximum out-of-pocket in a bad (or high medical use) year.

A good callout. I guess my math represents a bad-case year. Thank you.

I don’t have high deductible. Every 5-10 years I seem to have large medical expense. Multiple non critical health problems that need doctors appointments. So I go with higher cost, complete plans.

[Dottie57]

That $225/month doesn't come into play if your utilization of doctors and hospital expenses and billings doesn't reach the maximum. If you didn't use any doctors in a year, you'd just be out the premium x 12 and that would still cover you for major illness/accident/hospital, at which point you'd start getting bills for the 20% reduced rate up to the now $2,870 year High-Deductible maximum. If you saw one doctor that Medicare allowed $200, you'd just be out 20% or $40 of that, for example. If that was all you used in a year, that $2870 you wouldn't have to pay -- it's just a possible maximum out-of-pocket in a bad (or high medical use) year.

A good callout. I guess my math represents a bad-case year. Thank you.

I don’t have high deductible. Every 5-10 years I seem to have large medical expense. Multiple non critical health problems that need doctors appointments. So I go with higher cost, complete plans.

[CrossOverGuy]

Depends really where you live. In NYC, lowest price HD-G is about $68/month while Regular G is about $300, which is a difference of $232/month x 12 = $2,784 one would be paying before even seeing one doctor. The Regular G would avoid lots of smaller bills throughout the year if one had numerous doctor and or hospital expenses, but otherwise, with HD-G, up to $2,784 is not having to be paid out in a good year (without much health utilization).
Only if you had a higher medical utilization year (bad year) would you have to pay out up to the maximum, which approaches just the Regular G premium itself without any doctor visits. Some other areas of the country there just might be a $50/month or so difference between the two Medigap plans where it might more sense and easy to go with the Regular G (or Plan N).

I get it that simplicity wins for some people -- but here at Bogleheads, where people have been, like me, looking for bargains over saving $20-40 or so since the holidays over the latest Turbotax software, $2,784 in possible savings, while otherwise being fully covered against catastrophic illness or accident, isn't a token amount.

[Carol88888]

I am in NYC and my part D plan for AARP went up over $100/month this year with about a $550 deductible. I don't know if you included drug plan cost in your estimates.

What is your new Plan D monthly cost, including the $100/mo increase? Yes, I'm including drug costs in my estimates.

Thank you for your feedback.

I was not being very clear. What I intended to convey was that with 2025 increases my old AARP Drug Plan from UNH was going to cost over $100. I switched to a plan from Cigna that costs roughly $41/month and best of all it covers one of my drugs with a zero copay. This same drug was costing me $238 for 90 days from UNH/AARP so it saves me almost $1000 a year.

[gips]

Depends really where you live. In NYC, lowest price HD-G is about $68/month while Regular G is about $300, which is a difference of $232/month x 12 = $2,784 one would be paying before even seeing one doctor. The Regular G would avoid lots of smaller bills throughout the year if one had numerous doctor and or hospital expenses, but otherwise, with HD-G, up to $2,784 is not having to be paid out in a good year (without much health utilization).
Only if you had a higher medical utilization year (bad year) would you have to pay out up to the maximum, which approaches just the Regular G premium itself without any doctor visits. Some other areas of the country there just might be a $50/month or so difference between the two Medigap plans where it might more sense and easy to go with the Regular G (or Plan N).

I get it that simplicity wins for some people -- but here at Bogleheads, where people have been, like me, looking for bargains over saving $20-40 or so since the holidays over the latest Turbotax software, $2,784 in possible savings, while otherwise being fully covered against catastrophic illness or accident, isn't a token amount.

Exactly right! So far hi deductible has saved me thousands and worst case, I hit my max out of pocket deductible and it costs the same as regular plan g.

[Leesbro63]

What is "Dentegra"? I'm looking at UnitedHealthcare Plan G supplements. For about $4/month more, I can get this with a "Dentegra" dental plan. Is this as good or better than my Aetna Vital Savings Dental Plan for about $8/month? I get it that these are "fee schedule" plans and not actually insurance.
I've heard of Delta Dental and United Concordia but never "Dentegra".

[Leesbro63]

Also, on the Medicare.gov site I see Medicare supplement Plan G AARP UnitedHealthcare Insurance Company (Level 2) for $569/month. The regular UHC supplement is about $175/month on the same page. What is "Level 2" that makes it more than double the cost and why might someone want that? I Googled this but I could only find Medicare claims appeals level 2, which, I'm pretty sure, is something totally different.

[yankees60]

I went back to your original post and see no indication that you would be having any Schedule C type business income in your business.

However, if you or anyone, did have Schedule C type business income then your health related premiums would all end up reducing all taxes - federal, state, self-employment while, usually, no one gets the benefits of taking tax deductions on Schedule A for paying medical expenses.

That can tilt towards paying for a highest cost premium plan which requires you to pay minimal medical expenses. You get the government to share in the cost of your premiums.