Medicare guide
Retirement Planning: Health Care and Insurance
Retirement planning isn’t only about savings; health care and insurance decisions shape your budget for decades. Here’s what to plan for: Medicare enrollment and costs, gaps Medicare leaves, long-term care, and protecting a spouse.
Blake Insurance Group is an independent agency serving clients by phone, email, and online in states where we are licensed; coverage depends on the insurer, the policy, and underwriting.
Request a Medicare plan review
Tell us about your Medicare situation, and a licensed agent will follow up to review plans we offer in your area. Submitting the form does not enroll you in a plan.
Prefer a longer form? You can also request a quote with our Medicare quote form.
If the form does not load, call 888-387-3687, Monday through Friday, 9:00 to 5:00, or email info@blakeinsurancegroup.com.
A retirement insurance checklist
- Enroll in Medicare on time to avoid late penalties.
- Choose between Original Medicare with Medigap and Medicare Advantage.
- Plan for dental, vision, and hearing costs.
- Consider long-term care costs and how you’d pay them.
- Review life insurance and beneficiaries for a surviving spouse.
When you can enroll or switch
| Period | When | What you can do |
|---|---|---|
| Initial Enrollment Period | 7 months around your 65th birthday month | Sign up for Parts A and B, and join a plan |
| Annual Open Enrollment | October 15 – December 7 | Join, switch, or drop Medicare Advantage or drug plans; coverage starts January 1 |
| Medicare Advantage Open Enrollment | January 1 – March 31 | One change: switch MA plans or return to Original Medicare (and add a drug plan) |
| General Enrollment Period | January 1 – March 31 | Sign up for Parts A and B if you missed your IEP; penalties may apply |
| Special Enrollment Periods | After qualifying events | For example, moving or losing employer coverage |
| Medigap Open Enrollment | 6 months from the first month you have Part B and are 65+ | Buy any Medigap policy sold in your state without health questions |
Source: Medicare.gov, October 2026.
Original Medicare costs
| Item | 2026 amount |
|---|---|
| Part A hospital deductible | $1,736 per benefit period |
| Part A coinsurance, days 61–90 | $434 per day |
| Skilled nursing facility, days 21–100 | $217 per day |
| Part B standard premium | $202.90 per month |
| Part B deductible | $283 per year |
| Part D deductible (maximum) | $615 |
| Part D out-of-pocket cap | $2,100 |
| Insulin | No more than $35 for a month’s supply |
Sources: CMS (Nov. 2025, Apr. 2025) and Medicare.gov. 2027 Part A and B amounts had not been announced as of Oct. 22, 2026; CMS usually publishes them in mid-November. Higher-income beneficiaries pay more for Parts B and D.
Late enrollment penalties
Medicare charges late penalties if you delay without other qualifying coverage. Medicare.gov says the Part B penalty is 10% for each full 12-month period you could have had Part B but didn’t, usually for as long as you have Part B. The Part D penalty is 1% of the national base beneficiary premium for each month without creditable drug coverage after a 63-day gap; the base premium is $38.99 in 2026 and $41.33 in 2027. You can generally delay Part B without penalty if you have group coverage from current employment, and sign up within eight months after that coverage or employment ends.
Medigap basics
Medigap policies are standardized and sold by private insurers to help pay Original Medicare’s deductibles, coinsurance, and copays. The lettered plans are A, B, C, D, F, G, K, L, M, and N, and a plan with the same letter has the same basic benefits from any company. Plans C and F aren’t available to people new to Medicare on or after January 1, 2020; Plans D and G offer the same benefits except the Part B deductible. Medigap doesn’t work with Medicare Advantage and generally doesn’t include drug coverage, so most people pair it with a Part D plan.
Types of Medicare Advantage plans
| Type | How it works |
|---|---|
| HMO | Generally in-network care only, except emergencies, urgent care, and out-of-area dialysis; referrals usually required |
| HMO-POS | Like an HMO, but some out-of-network services allowed at higher cost |
| PPO | Out-of-network care allowed at higher cost; no referrals needed |
| PFFS | See any Medicare-approved provider that accepts the plan’s terms |
| SNP | Limited to people with Medicaid, certain chronic conditions, or institutional care; includes drug coverage |
| MSA | High-deductible plan with a medical savings account; no network; separate drug plan needed |
Source: Medicare.gov. Medicare Advantage plans often require prior authorization for some services.
Out-of-pocket limits
Medicare Advantage plans must cap in-network out-of-pocket costs for Part A and B services. For 2026, KFF reports the federal limit is $9,250 in network and $13,900 combined for in- and out-of-network services in PPOs, and that the average plan’s in-network limit is about $5,421. Original Medicare has no out-of-pocket cap, which is one reason people pair it with Medigap.
What Original Medicare doesn’t cover
- Eye exams for prescription eyeglasses
- Most dental care, such as cleanings, fillings, extractions, and dentures
- Hearing aids and exams for fitting them
- Non-medical long-term care (custodial care)
- Routine physical exams
- Cosmetic surgery
- Massage therapy
- Concierge care
- Care from providers who have opted out of Medicare, except emergencies
- Most care outside the United States
Long-term care
| Care | Annual median | Change |
|---|---|---|
| Nursing home, private room | $129,575 | +1% |
| Nursing home, semi-private room | $114,975 | +2% |
| Assisted living | $74,400 | +5% |
| Non-medical in-home care (44 hours a week) | $80,080 | +3% |
| Adult day health care | $24,700 | −5% |
Source: Genworth/CareScout 2025 Cost of Care Survey.
Medicare doesn’t pay for long-term custodial care, and Medigap generally doesn’t either. The NAIC’s shopper’s guide explains that long-term care policies usually pay once you need help with two of six activities of daily living or have a cognitive impairment, after an elimination period such as 30, 60, or 90 days. Hybrid life policies with long-term care riders reduce the death benefit when you use the care benefit.
Social Security survivor benefits
Social Security pays a one-time lump-sum death payment of $255 to a surviving spouse who lived with the deceased, or in some cases to an eligible child, and you must apply within two years of the death. Monthly survivor benefits may go to a widow or widower from age 60 (50 if disabled), to a widow or widower caring for the deceased’s child under 16 or disabled, to unmarried children under 18 (19 if still in high school), and to dependent parents 62 or older. The $255 payment won’t cover much of a funeral, which is one reason people buy final expense coverage.
Avoiding Medicare scams
Medicare.gov says Medicare will never call you to sell you anything or visit you at your home, and that it calls for personal information only in limited cases, such as returning your call. Don’t join a plan over the phone unless you called and asked for help, and don’t give your Medicare or Social Security number to anyone who contacts you unexpectedly. The FTC adds that Medicare sends new cards automatically and for free.
Report suspected fraud to 1-800-MEDICARE (1-800-633-4227) or the HHS Office of Inspector General at 1-800-HHS-TIPS (1-800-447-8477). Medicare Advantage and Part D members can also call the I-MEDIC at 1-877-772-3379.
Checking a plan and insurer
- Networks. Confirm your doctors and hospitals are in the plan’s network.
- Drugs. Check each prescription on the plan’s formulary and its tier.
- Costs. Compare premiums, deductibles, copays, and the out-of-pocket maximum.
- Agent license. Confirm the agent is licensed in your state through your state insurance department.
- Star Ratings. Review the plan’s rating on Medicare.gov’s Plan Finder.
What an independent agency does
An independent insurance agency is licensed to sell policies from several insurance companies. Instead of quoting one company's products, an independent agent can compare options from the insurers the agency represents, explain the differences in coverage, and help you re-shop at renewal. The insurance company, not the agent, makes underwriting and claim decisions.
Blake Insurance Group is an independent agency. We work with clients by phone, email, and online in states where we are licensed, and we will tell you which insurers we can quote for your situation.
How we work
Blake Insurance Group serves clients by phone, email, and online in states where we are licensed. The insurers and plans we can offer depend on our appointments and your location; a company named on this page may not be available through us.
How to verify an insurer or agency
Before buying through any website or app, confirm who is selling you the policy and who will issue it:
- Find the licensed agency or insurer named in the site's footer, terms, or license page.
- Look up the agency or producer on your state insurance department's license search, or through the National Insurance Producer Registry (NIPR).
- Look up the insurer on your state insurance department's company search to confirm it is authorized in your state.
- Save the insurer's name and policy number once issued, since that is who handles claims.
A legitimate service will make this information easy to find. Be cautious if you cannot identify the licensed entity.
Sources
We checked the facts on this page against the sources below in October 2026. Plans, prices, and rules change, so confirm current terms before you buy.
- Medicare.gov: Compare Medicare Advantage plan types
- KFF: Medicare Advantage out-of-pocket limits
- KFF: Medicare Advantage plan availability for 2027 (Oct. 2026)
- KFF: Medicare Advantage enrollment update (2026)
- Medicare.gov: Joining a health or drug plan
- Medicare.gov: Compare Medigap plan benefits
- CMS: 2026 Medicare Parts A & B premiums and deductibles (Nov. 2025)
- 42 CFR 422.2267: Required materials and content (TPMO disclaimer)
- 42 CFR 423.2264: Beneficiary contact and Scope of Appointment
- ACL: State Health Insurance Assistance Program (Mar. 2026)
- Medicare.gov: Medicare fraud
- CMS: Contract Year 2027 Medicare Advantage and Part D final rule (Apr. 2026)
- Genworth/CareScout: 2025 Cost of Care Survey (Mar. 2026)
- NAIC: A Shopper's Guide to Long-Term Care Insurance
- Medicare.gov: Long-term care
- SSA: 20 CFR 404.390, lump-sum death payment
- SSA Blog: Understanding survivors benefits
What to have ready for a Medicare review
These details help an agent quote accurately.
- Medicare card. Your Medicare number and Part A and B start dates.
- Doctors. Names of doctors and hospitals you want to keep.
- Prescriptions. Drug names, doses, and pharmacies.
- Current coverage. Any plan, employer, or Medicaid coverage you have.
- ZIP code. Plans differ by county.
Retirement planning FAQs
When should I sign up for Medicare?
Usually during your Initial Enrollment Period around your 65th birthday.
Does Medicare pay for long-term care?
No, not long-term custodial care.
What does Social Security pay survivors?
Monthly benefits for eligible survivors and a one-time $255 payment.
Should I keep life insurance in retirement?
It depends on whether anyone relies on your income or you want to cover final expenses.
Related guides
Important information
Independent agency. Blake Insurance Group LLC is an independent insurance agency. Licensed insurance producer NPN 16117464. Licensed states: AZ, AL, TX, CA, NY, OH, FL, NC, VA, GA, OK, NM, IA, KS, MI, NE, SC, SD, WV, IL, NJ, PA, TN, and WA. Which insurance companies we can quote depends on our current appointments, the product, and your state. Mentioning a company on this page does not mean we represent it.
Medicare disclaimer. We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov, 1-800-MEDICARE (TTY users 1-877-486-2048), or your local State Health Insurance Assistance Program (SHIP) to get information on all of your options.
Medicare figures. Costs, limits, and rules on this page were checked against CMS, Medicare.gov, and the other listed sources in October 2026. 2027 Part A and B amounts had not been announced. Confirm current figures at Medicare.gov.
Coverage terms. Descriptions are general. The policy contract controls what is covered.
Availability. Coverage, prices, and eligibility vary by company, state, and applicant, and are subject to underwriting. The issued policy controls.
Your next step
Request a quote, and a licensed agent will compare options available to us for your situation.
