If you’re approaching 65 and earning over $100,000 a year, your Medicare decision will look different from someone with a lower income—and that’s okay. The key is understanding the unique considerations that come with a higher income so you can protect both your healthcare and your retirement savings.
In this post, we’ll walk through three important tips for high-income earners as they transition into Medicare. Whether you’re still working or preparing to retire soon, these insights will help you make the best Medicare decision for your future.
Tip #1: Know When You Should Enroll in Medicare
Many high-income individuals continue working past age 65, and that’s where things get a bit confusing. Contrary to what you may have heard, you don’t always have to join Medicare at 65—especially if you’re still covered under an employer plan that meets Medicare’s rules.
Unfortunately, some people receive misleading letters or get pressured into enrolling early. If you enroll in Medicare too soon, you may end up paying for coverage you don’t need—or lose out on valuable benefits like HSA contributions.
Instead, take the time to confirm:
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Does your employer plan meet Medicare rules?
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Is it more cost-effective than Medicare?
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Should you delay Medicare to keep other financial benefits?
Understanding your personal timeline is essential to avoiding costly missteps.
Tip #2: Choose the Program That Best Aligns With Your Financial Goals
When it comes to Medicare plan comparison, not all coverage is created equal—especially when you have the means to prioritize both quality and flexibility.
For higher-income retirees, Original Medicare with a Supplement and a Part D plan is often the better fit. Yes, the premiums are higher—but this route typically offers:
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Lower overall out-of-pocket costs
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Access to more doctors and specialists
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Fewer denials for care or procedures
While Medicare Advantage plans may offer lower upfront costs, they often come with network restrictions and more frequent prior authorizations. That means if you want to see a specific doctor or go out of network for specialty care, you could face steep out-of-pocket costs—or be denied coverage altogether.
For those with financial flexibility, the peace of mind and provider access that comes with Original Medicare is often worth the slightly higher monthly premium.
Tip #3: Be Aware of Medicare’s Income-Related Penalties
Here’s a surprise most people don’t expect: Medicare premiums are higher for higher-income individuals.
As of 2025, if your 2023 Modified Adjusted Gross Income (MAGI) is above:
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$106,000 (individual filer)
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$212,000 (married couple filing jointly)
…you’ll pay an Income-Related Monthly Adjustment Amount (IRMAA) on top of your standard Medicare Part B and Part D premiums. These surcharges can add thousands of dollars per year to your Medicare costs.
The good news? In certain cases, you can request a reduction in your IRMAA if your income has dropped due to life events like retirement, divorce, or a significant change in income. But you need to know the rules to avoid overpaying unnecessarily.
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