In short
- Retirement has five connected pieces: health care, income, how long the money lasts, long-term care and legacy.
- Health care is a monthly cost, not a one-time signup. The standard Part B premium alone is $202.90 a month in 2026.
- Income changes your Medicare costs. For 2026, IRMAA can apply if your 2024 income was above $109,000 single or $218,000 joint.
- Medicare and Medicare Supplement plans don't pay for non-medical long-term care, so that piece needs its own plan.
- Bill starts with health care and is upfront that he is not an accountant or financial planner.
One of my logos has a puzzle in it. People ask about it, and the honest answer is that I couldn't think of a better picture of retirement. I think when it comes to retiring there's so many moving steps. Retirement's not just signing up for Medicare and hoping your money lasts.
Most people walk into my office holding one piece. Usually it's Medicare, because a birthday is coming or a job is ending. That's a fine place to start. It's just not the whole puzzle.
What are the pieces of the retirement puzzle?
There are five pieces I look at with almost everybody: health care, income, how long the money has to last, long-term care and legacy. Each one is a question people are already asking themselves, usually at about two in the morning.
| Piece | The question behind it | Where to read more |
|---|---|---|
| Health care | What will my medications, doctors and hospital bills cost? | Turning 65 in Nebraska |
| Income | Where's my money at, and what does my income do to my premiums? | IRMAA explained |
| How long it lasts | How long is my money going to last? | The wrong retirement question |
| Long-term care | What happens if I or my spouse needs long-term care? | Long-term care insurance |
| Legacy | How much am I going to leave for my family? | Life insurance for retirees |
None of these pieces sits by itself. Move one, and two others shift. That's the part people miss.
Why do I always start with health care?
Health care goes first because it's usually the reason somebody calls me. "Oh, hey, I'm turning 65, I'm losing my group health," or "I want to retire at 62, what are my options?" Those are the two I hear the most.
It's also the piece that costs you something every single month. The standard Part B premium alone is $202.90 a month in 2026, per person, before you add a drug plan, a Medicare Supplement or the copays in a Medicare Advantage plan. So we start where I always start, with your medications and your doctors. Then we look at what happens if you end up in the ambulance or the emergency room. Worst case scenario. Let's take an honest look at it now, so the health care piece doesn't quietly eat the other four.
How does income change the health care piece?
Income can raise your Medicare costs or lower them, depending on which side of a line you land on.
On the high side, Medicare adds an extra charge called IRMAA (the Income-Related Monthly Adjustment Amount). For 2026, if your modified adjusted gross income on your 2024 tax return was above $109,000 filing single or $218,000 filing jointly, you may pay more for Part B and Part D. Medicare looks back two years, so a big income year now shows up on your premiums later. The brackets are in IRMAA explained.
On the low side, there are programs that help pay premiums and drug costs, like the Medicare Savings Programs and Extra Help. The people I worry about are stuck in between. Instead of a sweet spot, I call it the sour spot: people making somewhere around $2,000 to $3,000 a month. They make a little too much to qualify for assistance, and after premiums and copays come out, there isn't much left for groceries and gas. That's where you make the difference at.
How long does the money have to last?
Longer than most people plan for. People are living longer and retiring younger. It's not unusual to see someone work for 40 years, retire at 60 or 62, and live till 90. The retirement phase is almost as long as the accumulation phase.
The CDC put life expectancy at age 65 at 19.5 more years in 2023 (18.2 for men, 20.7 for women). That's an average, so plenty of people go well past it. What's 5 years, 10 years, 15? Am I going to live to 90? Heck, I don't know. My kids might live to 120 for all I know. Maybe by then we'll just swap out a battery pack like on a DeWalt drill.
Here's where I say plainly what I'm not. I'm not an accountant, and I'm not a financial planner. When the question is how much tax comes out when you take money from an account, I lean on people who know that better than I do, and your own tax preparer belongs in that conversation. My job is to make sure the health care and insurance pieces aren't the thing that drains the account early.
Where does long-term care fit?
Long-term care is the piece that can knock the others off the table, because Medicare mostly doesn't pay for it. Medicare and most health insurance, including Medicare Supplement plans, don't pay for non-medical long-term care, like help with bathing and dressing, whether it's at home or in a nursing home. That comes straight from Medicare's own handbook.
And it isn't cheap. The 2025 CareScout Cost of Care Survey put the Nebraska median for a semi-private nursing home room at $275 a day, or about $100,521 a year.
The question people ask me is simple: what happens if myself or my significant other ends up in long-term care? How does that affect insurances? My wife is a nurse who worked in long-term care for about 15 years, so it's not an abstract question in our house either.
People generally pay for it with savings, with Medicaid if they qualify, or with private long-term care insurance. The details are in long-term care insurance in Nebraska and does Medicare pay for nursing homes.
Where does legacy fit?
Legacy is the last piece, and it's the one I wish more people thought about first. The number one worry I hear is "Am I going to run out of money before I die?" I'd rather we work toward a different question: how much legacy am I going to leave for my family? I wrote a whole post on why that switch matters.
Where the money sits matters here, too. Some things, when they get inherited, get taxed. Some things don't. Life insurance is one tool for the legacy piece, and it's one I'm licensed to help with.
How do the pieces push on each other?
Here are a few ways I see one piece move another:
- Retire at 62, and the health care piece gets bigger. Medicare usually starts at 65, so those three years need their own coverage, and your medications can decide whether you can afford it. See health insurance if you retire before 65.
- Take a big withdrawal, and the income piece can raise your premiums two years later through IRMAA.
- Pick a plan only for its low premium, and one bad year in the hospital can spend money that was meant for the legacy piece.
- Have a long-term care need with no plan for it, and savings can disappear fast, along with whatever you meant to leave behind.
None of this means you have to solve the whole puzzle in one afternoon. It means we shouldn't snap one piece in place and act like we're done.
Where should you start?
Start with the piece that's keeping you up at night, and tell me about the others while we're at it. If you're turning 65 or retiring early, that's probably health care. If you're already on Medicare, it's probably your yearly plan review.
My help costs you nothing, because the insurance companies pay agents, not you. If you'd rather start somewhere neutral, Medicare.gov, 1-800-MEDICARE (1-800-633-4227, 24 hours a day, 7 days a week; TTY 1-877-486-2048) and Nebraska SHIP (formerly SHIIP), the state's counseling program at 1-800-234-7119, are all good places. When you're ready to look at the whole puzzle, talk to me.
Frequently asked questions
Because the pieces share one pot of money. The savings that pay your health care costs are the same savings that would pay for long-term care and whatever you leave your family. A plan with a low premium but a high out-of-pocket maximum, or a long-term care need nobody planned for, can drain money meant for something else. Bill Jurey starts with Medicare and then looks at how the other pieces fit, and he's clear that he isn't an accountant or a financial planner.
The standard Part B premium is $202.90 a month in 2026, and most people pay that amount. That's before a drug plan premium, a Medicare Supplement premium, or the copays and deductibles in a Medicare Advantage plan, and people with higher incomes pay IRMAA on top. Your real total depends on the coverage you choose, your medications and your income, so add up the whole year instead of looking at one monthly premium.
For 2026, you may pay IRMAA, an extra charge added to Part B and Part D premiums, if your modified adjusted gross income on your 2024 tax return was above $109,000 filing individually or $218,000 married filing jointly. Medicare uses the tax return from two years earlier. If your income has dropped because of a life-changing event such as retirement, you can ask Social Security to use your newer income instead.
Mostly no. Medicare and most health insurance, including Medicare Supplement plans, don't pay for non-medical long-term care, meaning help with everyday activities like bathing, dressing and using the bathroom, whether you get it at home or in a nursing home. Medicare covers skilled nursing facility care only in limited situations. People usually pay for long-term care with savings, Medicaid if they qualify, or private long-term care insurance.
No. Bill's help costs you nothing. Insurance companies pay licensed agents when a client enrolls in a plan, the same way a car insurance agent is paid by the company instead of by you. If any agent asks you to pay for help picking a Medicare plan, report them. You can also get unbiased help from Medicare.gov, 1-800-MEDICARE and Nebraska SHIP.
Sources
- Medicare.gov: Medicare & You 2027 handbook (Part B premium, IRMAA, long-term care) (opens in a new tab)
- Medicare.gov: Long-term care coverage (opens in a new tab)
- CDC National Center for Health Statistics: Mortality in the United States, 2023 (opens in a new tab)
- CareScout Cost of Care Survey 2025: median cost data tables (opens in a new tab)
