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Medicare surcharges, prescription prices, and pension decisions for seniors.
Healthcare costs are the budget item that surprises retirees most, because the surprises are designed into the system. Medicare premiums that jump on income cliffs, drug prices that vary 10x between pharmacies, pension decisions you get one shot at. I put this page together for my own family's questions, and every tool on it answered one.
The IRMAA surcharge is the ambush. In 2026, crossing $106,000 in modified adjusted gross income as an individual adds over $70 a month per person to Part B premiums, and the thresholds are cliffs: one dollar over costs you the entire surcharge. What makes it sting is the two-year lookback, meaning the Roth conversion you did at 63 raises your premiums at 65. The IRMAA calculator maps your income against every cliff so there are no surprises, and if a life event like retirement lowered your income, the appeal calculator estimates what Form SSA-44 could save you. File the appeal. It is one form and routinely worth over $1,000 a year.
Prescriptions are the other battleground. The NADAC lookup shows what pharmacies actually pay for your drugs, which reframes every price you see. When the cash price at a discount pharmacy beats your copay, and it often does for generics, you are allowed to just pay cash. The drug shortage tracker is worth a bookmark too: if your medication has supply issues, knowing early means your doctor can plan alternatives instead of you discovering it at the pharmacy counter.
And for the pension question that comes once: lump sum or monthly checks. Divide the offer by the monthly payment for your break-even point, then run both scenarios in the pension calculator with realistic investment returns. It is a one-way door, so spend the ten minutes.
A practical annual rhythm: check your IRMAA standing each fall once the year's income is predictable, compare prescription cash prices against copays once a year, and keep the shortage tracker bookmarked if anyone in the household takes a critical medication. About an hour a year protects thousands of dollars and a great deal of peace of mind.
Estimate your 2026 Medicare IRMAA surcharge and plan around the cliffs.
Open the tool →Had a life-changing event? Estimate savings from an IRMAA appeal (SSA-44).
Open the tool →Look up NADAC drug prices to see what pharmacies actually pay.
Open the tool →Lump sum or monthly pension checks? Run the break-even math.
Open the tool →IRMAA surcharges begin above $106,000 MAGI for individuals and $212,000 for joint filers, based on tax returns from two years prior. Each tier adds to Part B and Part D costs. Because the thresholds are cliffs, managing income near a boundary can save over $800 a year per person.
File Form SSA-44 with Social Security after a life-changing event such as work stoppage, reduced hours, divorce, or death of a spouse. Include documentation showing your income dropped. Most valid appeals are approved and take a few months to process.
Pharmacy benefit managers and copay structures can price generics above their cash cost. Discount pharmacies and cash prices often undercut copays by 50 percent or more on common generics. Check the NADAC lookup for the pharmacy acquisition cost, then compare cash prices before assuming insurance is the deal.