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Medicare assumptions and estimates
Medicare assumptions and estimates

This article explains the assumptions that are included in the Medicare estimation in your Plan.

Nancy Gates avatar
Written by Nancy Gates
Updated over a week ago

Medicare Expenses

In PlannerPlus you have the option to itemize your Medicare Expenses or use our Estimator.

Medicare Estimate Assumptions

Our Medicare modeling is based upon data that we access via API from

The estimates for Medicare expenses modeled in Planner represent average costs. As future health care costs are difficult to estimate, we rely upon the averages by state data for our projections. For this reason, it's important to bear in mind that plans are state specific.

The estimates for average Medicare expenses modeled in Planner are inclusive of premiums, deductibles, prescriptions, and and out-of-pocket expenses such as dental costs and vision assuming “Excellent” health. If you think your needs are beyond "national average" I would recommend adding additional recurring expenses in your plan.

The values are adjusted from today using the medical inflation rate in your plan assumptions.

Employer Sponsored

When you select employer sponsored Medicare coverage, you are indicating that you are working beyond age 65 or you have coverage which allows you to avoid paying for Medicare. Many individuals have employer sponsored Medicare for a period of time and not through their longevity age.

When you select "NO" for employer sponsored you are indicating that, yes, you will rely upon Medicare for health insurance after age 65. This is the most common case.

Medicare Estimator

PlannerPlus users can model different policy, health, and premium level options to more accurately estimate Medicare expenses. Income Related Monthly Adjustment Amounts (IRMAA) are factored into Part B and Part D premium as per IRS protocols.

Estimates used in Planner are based upon of assumptions for:

  • Your Medical Coverage Type, e.g. Original Medicare A and B Only, Medicare Advantage, etc.

  • Your Premium Level If you select a Medigap policy

    • Having or planning to get Medicare supplemental insurance assumes the low premium Medigap policy with drug coverage plan

  • Your Health Status indications. e.g. number of medical conditions, smoker or non smoker. These map to excellent, good, or poor.

  • Your Income after 65 (for IRMAA calculation)

When you select your premium level, this will affect the out of pocket costs, as with most insurance coverage. Higher premiums typically incur lower out of pocket costs, and lower premiums typically incur higher out of pocket costs.

The estimator will estimate Medicare costs based on the selections you make, it will include estimates for premiums, copays, out of pocket costs and IRMAA.

This is a good area to explore different scenarios. We encourage you to select different choices in the menu and assess the lifetime cost estimates and impact on your plan health.

The choices available in the Planner are as seen here:

Itemized Medicare Expenses

You have the option to enter your actual Medicare costs by selecting "Itemized." When you itemize, you need to account for all of your Medicare premiums and out of pocket costs on your own. If you are currently on Medicare or plan to be on Medicare in the near future and you know your Medicare costs, you can enter your actual costs.


RMAA will be modeled under both of the above assumptions. We don't currently have a feature to turn off IRMAA. A workaround would be to select Employer sponsored coverage. Add an amount for Medicare Expenses until your longevity age. This will turn off the IRMAA until the final year of the simulation but add in Medicare for the final month.

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