Medicare is one of the most expensive and most misunderstood variables in any retirement plan — and most clients don't see it coming.

In this episode of The What If Show, Brooke Thomas and Steve Goldstein of Thomas Gold Solutions break down exactly why Medicare deserves its own dedicated chapter in every retirement plan you build. They cover the IRMAA surcharge tiers (and how a single dollar over the income threshold can spike a client's premiums), which types of income — including Roth conversions and capital gains — feed into that calculation, why the two-year look-back period creates planning blind spots, and how Medicare cost growth is quietly outpacing Social Security COLA increases in a way most advisors and clients haven't connected yet.

They also tackle this episode's Retirement BS myth: that Medicare is a fixed, predictable cost you simply check off at age 65. It isn't — and the math Steve walks through at the end of the episode shows just how much is at stake.

If you'd like the free IRMAA one-pager Thomas Gold has put together for advisors to share with their clients, email info@thomasgold.com.

Chapters:

00:00 – Intro: The What If Show

00:07 – Welcome to Episode 5

00:53 – Why Medicare Is One of the Biggest Retirement Variables

01:33 – Healthcare Inflation: 5–7% vs. the 3.2% Average

03:29 – IRMAA Explained: What It Is and Why It Matters

05:44 – The IRMAA Tiers: From $202.90 to $689.90 Per Month

09:24 – The Cliff Tier Trap: $1 Over the Limit Changes Everything

10:55 – Medicare Parts A, B, C, and D: A Clear Breakdown

14:21 – Enrollment Timing and Late Penalty Warning

16:23 – How Retirement Analyzer Automates IRMAA Calculations

18:40 – What Counts Toward Your MAGI (Roth Conversions, Capital Gains & More)

19:20 – Why Spreadsheets Fail and Purpose-Built Software Wins

23:08 – The Quiet Retirement Killer: Medicare Costs vs. Social Security COLAs

26:12 – Scenario Planning: Why Where You Retire Affects Medicare Costs

30:14 – 🚨 Retirement BS: "Medicare Is Just a Fixed Cost"

31:31 – The SSA-44 Form: How to Appeal an IRMAA Determination

34:17 – The Shocking Math: Nearly $1 Million in Lifetime Medicare Costs

35:10 – Audience Question + Call to Action

36:27 – Merch, Sneakers, and Hat Tips for Bald Men