Medicare Advisor in Del Mar: Original Medicare + Supplement for the 92014 HNW Pre-Retiree

For most Del Mar pre-retirees, the Medicare conversation starts with one fact: the Scripps and UCSD physicians you already see don’t reliably participate in Medicare Advantage networks. That single point usually settles the direction — Original Medicare paired with a Medigap Supplement (Plan G or Plan N), not Medicare Advantage. Then we get to the harder problem: IRMAA, and how to plan for it through the deferred comp, RSU vests, and equity events that drove your last decade of income.

Del Mar is a tech, biotech, and finance corridor as much as it is a beach town. The 92014 client profile we see most often is a 62-65-year-old executive or founder with lumpy, back-loaded income — which makes IRMAA more of a moving target than for clients with W-2-only careers. The plan structure stays the same. The income modeling is what does the real work.

The local network reality: where Del Mar gets its tier-1 care

Most Del Mar residents pull from a tight cluster of facilities, all within 15-20 minutes of 92014:

  • Scripps Memorial Hospital La Jolla — the closest tier-1 hospital, immediately south on the 5
  • Scripps Clinic Carmel Valley — outpatient and specialty care for the everyday workhorse appointments
  • Scripps Encinitas — a few exits north, often used for emergencies and outpatient care
  • UC San Diego Health (La Jolla / Hillcrest campuses) — academic medicine, complex specialty work, oncology
  • Scripps Green Hospital — tertiary care, transplant, specialty surgery

All accept Original Medicare without network parsing. Most Medicare Advantage plans serving San Diego County either don’t include all of these systems or include only specific medical groups within them, with rosters that can shift between plan years. Walk into any of these facilities with Original Medicare and a Supplement and you don’t think about networks, prior authorizations, or referral routing.

This is the same logic that drives HNW patients to Mayo Clinic nationally. Mayo only accepts Original Medicare. If you want guaranteed access to a tier-1 system, that’s the door.

Original Medicare + Supplement: what it actually feels like

Picture your current PPO. Strip out the deductible, the copays, the network restrictions, the referrals, the prior authorizations. Add roughly 96% of doctors and hospitals nationwide. That’s Original Medicare with a Plan G Supplement. It’s going to look and feel like the sexiest PPO plan you’ve ever had.

The structure:

  • Part A — hospital coverage, premium-free for most people
  • Part B — doctors and outpatient, $202.90/month standard in 2026 (more if IRMAA applies)
  • Medigap Plan G — covers everything Part A and B don’t pay except the $283 annual Part B deductible
  • Part D — standalone drug plan, average premium ~$46/month in 2026

After the $283 deductible, your covered medical costs run to zero. Surgery? Zero. Imaging? Zero. Specialist visit? Zero. Hospital stay? Zero.

The IRMAA problem for tech and finance HNW

Here’s where Del Mar pre-retirees diverge from the standard HNW playbook. If your last few years included RSU vests, ISO/NSO exercises, deferred comp distributions, a tender offer, or a real estate sale, your AGI in those years was higher than your steady-state retirement income will be. Medicare uses your tax return from two years ago to set your premium, and the brackets are cliffs — one dollar over a threshold can cost you thousands a year.

The 2026 Part B brackets, single filer (married filing jointly is double the income, same per-person premium):

  • Up to $109,000: $202.90/month
  • $109,001 – $137,000: $284.10/month
  • $137,001 – $171,000: $405.80/month
  • $171,001 – $205,000: $527.50/month
  • $205,001 – $500,000: $649.20/month
  • Above $500,000: $689.90/month

Two planning levers matter:

  1. The two-year lookback. Your 2024 return drives your 2026 premium. If 2024 included a one-time spike (acquisition, RSU cliff, deferred comp election), that spike is paying IRMAA today even though your retirement income is lower.
  2. Form SSA-44. When a qualifying life-changing event occurs — retirement, work reduction, loss of an income-producing asset — you can request that Social Security adjust your IRMAA bracket prospectively, without waiting two years for the tax return cycle to catch up. This is the single most-used IRMAA planning tool for Del Mar tech and finance clients.

We model this for every new client during the planning call. The goal isn’t to dodge IRMAA — HNW clients rarely escape it entirely — but to know the number, time the equity events around it where possible, and avoid avoidable cliff crossings.

Plan G or Plan N: the choice for Del Mar

Two Supplements matter for new enrollees: Plan G and Plan N.

Plan G — covers everything Original Medicare doesn’t pay except the $283 annual Part B deductible. After that, covered medical costs are zero. Higher monthly premium, near-zero variability afterward. The default for most HNW clients who value predictability.

Plan N — same architecture, slightly lower premium, small copays (up to $20 per office visit, up to $50 per ER visit, waived if admitted). Plan N typically runs $25-40/month less than Plan G.

For Del Mar pre-retirees with light medical usage and good cash flow control, Plan N is a legitimate choice. For clients with active specialist care, more frequent imaging, or any complex condition under management, Plan G’s zero-after-deductible structure usually wins on total cost.

How the Medicare Execution Process® works for Del Mar clients

The first call is 30 minutes, no slide deck, no obligation. We cover:

  1. Your medical relationships at Scripps, UCSD, or any concierge physician
  2. Your IRMAA picture — what your 2024 return shows, what your retirement income picture will look like, where the cliffs are
  3. Supplement vs. Advantage analysis with real numbers, both paths
  4. Plan G or Plan N recommendation, with the specific carriers available in San Diego County
  5. Part D drug plan that aligns with your prescription list
  6. Coordination with your financial advisor or CPA on IRMAA-aware retirement income sequencing

1,300+ HNW Medicare enrollments placed across 40+ states using this sequence. There’s no cost to the planning conversation.

Frequently asked questions

I just had a big RSU vest year. Will my IRMAA stay high forever?

No — IRMAA is calculated annually based on your tax return from two calendar years prior. A one-time RSU vest pushes your IRMAA up for one or two years and then drops back to your steady-state income level. If the vest year coincides with retirement, Form SSA-44 can accelerate the relief. The key is knowing which years the cliff applies and planning around it.

Can my financial advisor coordinate with Brian on IRMAA timing?

Yes — this is one of the most common reasons Del Mar advisors refer clients in. Brian models IRMAA brackets against the advisor’s retirement income plan so Roth conversions, RMD timing, and capital gains realization can be sequenced around the brackets. There’s no fee-sharing — the coordination is built into the planning relationship.

Are Scripps Memorial La Jolla and UC San Diego Health in any Medicare Advantage plans serving Del Mar?

Some, but with limitations. Specific MA plans include some Scripps and UCSD locations but exclude others, restrict you to certain medical groups, and can change rosters between plan years. If you already have an established physician relationship, Original Medicare + Supplement is the cleaner path for keeping that relationship intact.

I’m delaying Part B because I’m still on employer coverage. Is that risky?

It depends on your employer size. If your employer has 20 or more employees and offers creditable coverage, you can usually delay Part B without late enrollment penalty, with a Special Enrollment Period when employment ends. Smaller employers, COBRA, retiree-only plans, and marketplace plans are different scenarios with different math — bring the Summary of Benefits to your planning call and we’ll quantify the right move.

Does Medicare cover me if I travel for work or own a second home out of state?

Original Medicare works anywhere in the US that accepts Medicare assignment, with no network restrictions and no referrals required. A Plan G or Plan N Supplement extends that coverage seamlessly. This is a meaningful difference from Medicare Advantage, which covers emergencies out-of-area but routes routine and specialty care back to your home network.

Schedule a 30-minute Medicare planning call

Brian McArthur places HNW Medicare enrollments for Del Mar pre-retirees and works closely with their financial advisors and CPAs. The first call is structured: 30 minutes, no obligation, no slide deck. We cover your medical relationships, your income picture, and the right product fit.

Book your call at go.designmymedicare.com/brian

Phone: 619-885-0556
Office: 20366 Elfin Forest Rd, Escondido, CA 92029 (20 minutes east of Del Mar)

For the full breakdown of how Original Medicare + Supplement compares to Medicare Advantage, see the Medicare Advantage vs. Medicare Supplement comparison.

Brian McArthur is a licensed insurance agent. Design My Medicare® and the Medicare Execution Process® are registered trademarks. Premium figures cited are 2026 standard amounts published by CMS; individual premiums vary based on income (IRMAA), plan choice, and carrier. Not connected with or endorsed by the U.S. government or the federal Medicare program.