You have a few paths and they cost very different amounts. COBRA continues your current employer plan for up to eighteen months, at the full premium plus a fee. An ACA marketplace plan usually costs less and may come with a narrower network. If your spouse is still working, joining their plan is often the cheapest option and the one people overlook. Which one wins depends on your doctors, your prescriptions, how many years you need to cover, and how much control you have over your taxable income.

COBRA makes sense when you are mid-treatment, when you have met your deductible for the year, or when your doctors are the deciding factor. Marketplace plans tend to win on cost, especially for households who can manage their income to qualify for premium tax credits. The comparison changes year by year, so retiring in March produces a different answer than retiring in October.

Marketplace premium tax credits are calculated from your modified adjusted gross income. Because you decide which accounts to draw from in early retirement, you have more control over that number than you did while working. Drawing from a taxable brokerage account, a Roth, and a traditional IRA produces different income totals for the same amount of spending money, and that difference can change your premium substantially.

IRMAA is a surcharge on Medicare Part B and Part D premiums for higher income households. Medicare looks at your income from two years prior, which means your income at 63 sets your Medicare premium at 65. This catches people who do large Roth conversions in their early sixties without accounting for what it does to their Medicare costs later.

Often yes, and the timing matters more than the amount. The window between retiring and starting Social Security is usually when your taxable income is lowest, which makes conversions cheapest. The complication is that conversion income can reduce your marketplace subsidy in the same year and raise your Medicare premium two years later. The right answer balances all three.

Medicare eligibility before 65 is limited to specific circumstances involving disability or certain diagnoses. For most people retiring early, the answer is no, and the years between your retirement date and your 65th birthday need to be planned for.

More than most people expect, and the range is wide. Two households retiring the same year with the same portfolio can pay very different amounts depending on their income planning, their state, their ages, and whether they qualify for premium tax credits. We price it against your actual situation rather than a national average, because averages are not useful when the spread is this large.