What people don’t realize is that Medicare isn’t free.

Upon turning 65 Medicare A which covers hospital is mandatory, which means if you already have private medical insurance for your spouse / family Medicare becomes the first payer for your hospital costs, but not the dependents so you still need to maintain that policy to cover them.

Medicare B which covers doctor visits is deducted from Social Security payments and bills are paid by the Govt (as first payer if you also retain private ins.) The cost of Medicare B premiums is subject to an income test and surcharge for those with adj. gross family incomes over a certain amount which can double the cost. There is also a Catch-22. If you don’t enroll in Medicare B at age 65 the cost goes up every year you aren’t.

So if one doesn’t take B immediately at 65 because they are covered by the spouses work plan but five years later at age 70 that plan disappears Medicare B will cost much more.

In my case I maintain my Federal Blue-Cross to cover the wife, for which I pay $520mo. out of my pension, and $230/mo. for Medicare for myself because she is still working (as an MD) which puts our income into the sur-charge range.