No one told you Medicare isn't free.
Most people do not pay a monthly premium for Part A, which mainly covers hospital care.
Part B has a monthly premium. Prescription coverage, supplemental coverage, deductibles and copays can add more.
Medicare and health insurance, without the alphabet soup
You hear "Medicare starts at 65" and it sounds simple.
Then you find out there are premiums, enrollment windows, penalties, income surcharges, prescription plans, supplements and things Medicare does not cover at all.
Start here.
No one told you...
No one told you that missing your Medicare enrollment window can cost you for years.
If you miss the Part B enrollment window and do not qualify for a special enrollment period, your monthly Part B premium can increase.
The penalty is generally 10% for each full 12-month period you could have had Part B but did not, and in many cases it lasts as long as you have Part B.
No one told you COBRA does not necessarily protect you from Medicare late-enrollment penalties.
COBRA feels like employer health insurance because it continues your old plan.
Medicare does not treat it the same as coverage from a job you or your spouse are still actively working at.
Your Medicare special-enrollment clock generally starts when active employment or the job-based coverage ends, not when COBRA eventually ends.
No one told you Medicare Part D has its own late-enrollment penalty.
Part D covers prescription drugs.
If you go 63 days or more without Part D or other creditable prescription coverage after becoming eligible, you may owe a late-enrollment penalty.
"Creditable" simply means the other drug coverage is expected to pay about as much as standard Medicare drug coverage.
No one told you your income can make Medicare cost more.
Higher-income retirees pay extra for Part B and Part D.
The surcharge is called IRMAA.
You do not need to memorize the acronym. The important part is that higher taxable income can increase Medicare costs.
No one told you Medicare usually looks back two years at your income.
A large Roth conversion, IRA withdrawal, investment gain or other income spike may increase Medicare premiums two years later.
No one told you Medicare does not pay for most long-term nursing-home care.
Medicare may cover certain short-term skilled nursing or rehabilitation.
It generally does not pay for years of custodial care, meaning everyday help with bathing, dressing, eating or getting around.
No one told you Medicaid may help pay for long-term nursing-home care.
Medicaid can cover long-term nursing-facility care for people who meet the financial and other eligibility rules.
Those rules vary by state.
It is not as simple as "Medicare will pay" or "you have to sell everything first."
No one told you that you have health-insurance options if you retire before 65.
If you lose job-based insurance before Medicare begins, ACA Marketplace coverage may bridge the gap.
Losing employer coverage also creates a special enrollment period.
No one told you where your spending money comes from can affect what you pay for ACA insurance.
ACA financial help is based partly on household income.
Money from a traditional IRA usually adds taxable income.
Qualified Roth withdrawals generally do not.
That makes early-retirement healthcare and retirement-account withdrawals a balancing act.
No one told you Medicare changes your HSA contribution rules.
Once you are enrolled in Medicare, you generally cannot keep making HSA contributions for those Medicare-covered months.
Enrollment timing matters because Part A can sometimes be retroactive.
No one told you an HSA gets more flexible after 65.
You may still use HSA money tax-free for qualified medical expenses.
After 65, nonmedical withdrawals no longer get the extra 20% penalty, although ordinary income tax still applies.