insurance-medicare-planning

insurance-medicare-planning

Trigger phrases:

• "medicare planning"
• "turning 65 medicare"
• "Medicare Part A B C D"
• "medigap or advantage"

Cadence: First run 6-12 months before age 65 (Initial Enrollment Period starts 3 months before the 65th birthday month). Annual reruns during the Annual Election Period (Oct 15 - Dec 7).

Scope Gate

Reads age (or dob) from vault/insurance/config.md. If age < 55 and medicare_planning_enabled is not set to true, this op exits with a single line: "Medicare planning is enabled at age 55+ or by setting medicare_planning_enabled: true in vault/insurance/config.md."

What It Does

Medicare has six interlocking decisions in a tight enrollment window. Mistakes are expensive and sometimes permanent (late-enrollment penalties on Part B and Part D last for life).

Decision support areas:

• Part A (hospital): premium-free for most; check work-credit eligibility.
• Part B (medical): premium based on prior-year MAGI (IRMAA brackets). Late-enrollment penalty is 10%/year-delayed, permanent. The op surfaces the penalty cost if the user delays.
• Original Medicare + Medigap vs Medicare Advantage (Part C): different network and cost structures. The op compares projected total annual cost across both paths using prior-year utilization (pulled from vault/health/ if installed).
• Part D (drug): plan choice depends on the user's specific RX list. The op outputs the data needed to use the official Medicare Plan Finder.
• IRMAA awareness: Surfaces current IRMAA brackets and flags whether the user's prior-year MAGI lands above a threshold; suggests SSA-44 form for life-changing-event appeals (retirement, work cessation).
• HSA-stop reminder: Once enrolled in any part of Medicare, HSA contributions must stop. Surfaced in the op output and synced to vault/career/ if the user is still working.

Steps

1. Confirm scope gate.
2. Read dob, medicare_status, state, and prior-year MAGI from vault/insurance/config.md (and vault/wealth/ for MAGI if installed).
3. Compute IEP / GEP / SEP / AEP windows based on dob and current date.
4. Run side-by-side projection of Original Medicare + Medigap + Part D vs Medicare Advantage using utilization from vault/health/.
5. Surface IRMAA bracket and SSA-44 applicability if recently retired.
6. Output decision packet to vault/insurance/02_briefs/medicare-{YYYY-MM}.md.
7. Surface HSA-stop reminder to open-loops.
8. Call task-sync-to-cross-agents to flag pending Medicare decisions in health and career vaults.

Configuration

vault/insurance/config.md:

• dob, state, medicare_planning_enabled (override flag)
• prior_year_magi (or pulled from wealth)
• current_rx_list (for Part D plan finder prep)

Error Handling

• Prior-year MAGI unavailable: Note that IRMAA bracket cannot be computed; recommend pulling from prior-year tax return.
• Out of state: Medigap pricing varies; surface that quotes are state-specific.

Vault Paths

• Reads: ~/Documents/aireadylife/vault/insurance/config.md, optional ~/Documents/aireadylife/vault/{health,wealth,career}/
• Writes: ~/Documents/aireadylife/vault/insurance/02_briefs/medicare-{YYYY-MM}.md, ~/Documents/aireadylife/vault/insurance/open-loops.md