Medicare Planning for High-Net-Worth Individuals in South Florida

Why Medicare belongs in the broader retirement plan

Medicare can reduce healthcare uncertainty in retirement, but it does not eliminate premiums or out-of-pocket costs. A complete projection may include Part B premiums, a Medicare Supplement or Medicare Advantage plan, Part D prescription coverage, dental and vision costs, and possible IRMAA surcharges.

For 2026, the standard Medicare Part B premium is $202.90 per month and the annual Part B deductible is $283. Higher-income beneficiaries may pay more for both Part B and Part D. For a married couple, each Medicare-enrolled spouse has individual Medicare premiums and may have an individual IRMAA adjustment.

IRMAA: the two-year Medicare income lookback

IRMAA stands for Income-Related Monthly Adjustment Amount. It is an additional amount paid by beneficiaries whose modified adjusted gross income exceeds the applicable threshold. It can affect both Medicare Part B and Part D.

For 2026, Social Security generally uses 2024 tax-return information. That delay explains why someone may retire, experience a significant income reduction and still receive a notice showing higher Medicare premiums based on an earlier high-income year.

For Medicare IRMAA purposes, modified adjusted gross income generally means adjusted gross income plus tax-exempt interest. This is one reason municipal-bond interest can matter even when it is not subject to federal income tax.

2026 IRMAA brackets at a glance

The amounts below apply to most people filing an individual return or a joint return. The Part D adjustment is added to the premium charged by the selected prescription drug plan. Different rules apply to some married people who file separately.

• $109,000 or less individually / $218,000 or less jointly: $202.90 Part B premium and no Part D IRMAA.
• More than $109,000 through $137,000 individually / more than $218,000 through $274,000 jointly: $284.10 Part B premium and $14.50 Part D adjustment.
• More than $137,000 through $171,000 individually / more than $274,000 through $342,000 jointly: $405.80 Part B premium and $37.50 Part D adjustment.
• More than $171,000 through $205,000 individually / more than $342,000 through $410,000 jointly: $527.50 Part B premium and $60.40 Part D adjustment.
• More than $205,000 but below $500,000 individually / more than $410,000 but below $750,000 jointly: $649.20 Part B premium and $83.30 Part D adjustment.
• $500,000 or more individually / $750,000 or more jointly: $689.90 Part B premium and $91.00 Part D adjustment.

Income events that can affect future Medicare premiums

A financially sound transaction can still have a Medicare premium consequence. The point is not that these transactions should be avoided. It is that the potential IRMAA effect should be included when evaluating their timing and total cost.

• Roth conversions and large traditional IRA distributions
• Required minimum distributions
• Realized capital gains from investments
• The sale of a business or investment property
• Bonuses, deferred compensation or a large final working-year income
• Tax-exempt interest included in Medicare MAGI

Can IRMAA be reduced after retirement?

Possibly. Social Security permits certain beneficiaries to request a new IRMAA determination after a qualifying life-changing event causes household income to decrease. Examples include work stoppage, work reduction, marriage, divorce, death of a spouse, loss of income-producing property, loss of pension income and certain employer settlement payments.

The request is generally made using Form SSA-44 with supporting evidence and an estimate of the more recent income. A lower investment return or an ordinary market fluctuation by itself is not necessarily a qualifying event. Social Security—not an insurance company or Medicare broker—makes the determination.

Working past 65 and the HSA timing issue

Many South Florida professionals, executives and business owners continue working after 65. Some can delay Part B without a late penalty while covered by an eligible employer group plan based on current employment, but the correct timing depends on the employer, plan and household situation.

HSA eligibility is a separate concern. Once enrolled in Medicare, a person generally can no longer contribute to an HSA. Anyone planning to work past 65 and continue HSA contributions should coordinate Medicare and Social Security timing with the employer benefits team and a qualified tax professional before applying.

• Confirm whether coverage is based on current employment
• Ask how the employer plan coordinates with Medicare
• Verify whether the prescription coverage is creditable
• Review the final permitted HSA contribution date before Medicare enrollment

COBRA does not extend the Part B enrollment clock

COBRA is generally not treated as coverage based on current employment for the Medicare Part B Special Enrollment Period. Medicare states that you generally have up to eight months after employment or active-employment coverage ends, whichever happens first, to enroll in Part B without a late penalty—even if you elect COBRA.

Waiting until an 18-month COBRA period ends can therefore create a coverage gap or lifetime Part B penalty. Medicare planning should take place before the final day of active employment, not shortly before COBRA expires.

Choosing coverage around lifestyle—not net worth alone

High-net-worth individuals follow the same Medicare coverage rules as other beneficiaries. The appropriate coverage path still depends on doctors, hospitals, prescriptions, travel, budget and tolerance for variable out-of-pocket expenses.

Someone who prioritizes broad provider access and predictable medical cost sharing may compare Original Medicare with Plan G or Plan N plus a standalone Part D plan. Someone comfortable with a plan network and plan-specific rules may consider Medicare Advantage. Neither path is automatically better simply because someone has a higher income or larger portfolio.

• Check every physician, specialist and preferred health system
• Review prescriptions and pharmacies separately from medical coverage
• Consider frequent travel or living in more than one state
• Compare premiums with maximum potential out-of-pocket exposure

Why local planning matters in South Florida

Medicare Advantage and Part D availability can vary by county, while Medicare Supplement premiums can vary by carrier, location and applicant characteristics. A client in Broward County may see different private-plan options from a client in Miami-Dade or Palm Beach County.

Local provider systems also matter. Before enrolling, confirm the exact plan network for the doctors and hospitals you expect to use. This is especially important for clients who split time between Florida and another state or who want access to specific specialists and facilities.

A coordination checklist for clients and financial advisors

A Medicare specialist does not replace a CPA, attorney, financial advisor or employer benefits professional. The best result often comes from identifying the questions early and keeping each professional focused on their area of expertise.

• Begin the Medicare conversation three to six months before age 65 or retirement
• Identify major taxable events that occurred two years earlier or may occur soon
• Review employer coverage, spouse coverage, HSA contributions and COBRA timing
• List doctors, prescriptions, pharmacies, travel needs and preferred hospitals
• Estimate both recurring premiums and potential out-of-pocket costs
• Confirm every effective date before existing coverage is cancelled