Medicare, IRMAA and the like

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Artsdoctor
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Re: Medicaire, IRMAA and the like

Post by Artsdoctor »

josephny wrote: Sat Jul 06, 2024 6:00 am Here is the response from mybenefitadvisors.com:

"My wife just turned 65 and I wanted to find out what is required of us with respect to Medicare. HAVE HER GET ENROLLED IN PARTS A & B---POSSIBLY GET A SUPPLEMENT.

It is my understanding that if she does not sign up, there is a penalty. Can you confirm? MY RESEARCH SUGGESTS THAT THERE IS A PENALTY IF YOU WAIT 2 YEARS TO ENROLL.

And, she can sign up, at no cost, right? NO COST TO SIGN UP.

Will our current insurance carrier require a change in our coverage because of her enrollment in Medicare? THEY WONT REQUIRE ANYTHING, BUT YOU MAY WANT TO TERMINATE HER FROM THE GROUP PLAN. IF SHE CONTINUES TO USE THE OXFORD COVERAGE, HER CLAIMS CAN BE REDUCED BY THE AMOUNT MEDICARE WOULD PAY---OXFORD WILL NOT PAY AS PRIMARY

Can we be relieved of any obligation for supplemental Medicare coverage because of our current plan? I DO NOT KNOW THIS ANSWER PERHAPS KYLE DOES.

Lastly, and possibly most importantly, does it make sense to keep the current plan with her covered? Or does it make more sense for her to be on Medicare with all the best supplements plans? IT MIGHT BE COST EFFICIENT TO REMOVE HER FROM THE GROUP PLAN WHEN SHE IS FULLY ENROLLED. YOUR RATE WILL GO FROM A FAMILY RATE OF $3418.42 TO THE EMPLOYEE & CHILD RATE OF $2039.06---YOU WILL HAVE TO DETERMINE WHAT WILL WORK BEST FOR YOU."

I am following up with Kyle, someone there who knows more about Medicare.

My follow up with include what I believe are the most important things to me: (1) That my wife continue to have the same type of coverage (financial as well as which doctors and services are covered, etc.), (2) that we do not incur penalties (financial or otherwise) now or later, and (3) that the difference in cost isn't significant for us ($1,379/month minus whatever Medicare's additional policies would cost us -- I wouldn't dare use any more specific terms because I am 100% confused about supplementals, additional, advantages, parts A-Z, etc.).
First, you'll need to accept that your insurance broker really doesn't know anything about Medicare, which is pretty sad when you think about it. It means that virtually all of his clients could potentially be in the same spot as you are.

So essentially, your wife currently has no insurance right now. Oxford will only pay after Medicare's payments are made (it's the "secondary" while Medicare is the "primary"). However, she doesn't have Medicare so there's nothing to pay. Oxford would be correct in turning down any charges because they're not responsible for paying first.

She needs to sign up for Medicare right now. Part A is free and will be retroactive to her 65th birthday (or retroactive 6 months prior to application) so at least she'll have that. Part B cannot be retroactive but it can be started pretty quickly. She also needs Part D (pharmacy).

I'm not sure about the penalty. I was under the assumption that if she's outside of the window period that a penalty (pro-rated) would be assessed. However, she's just outside that period so any penalty would be small; nonetheless, all penalties are lifelong so it's worth getting started right away.

To be honest, your broker's lack of knowledge is so significant that I'd pull her from the Oxford plan and get her a Medicare supplement. The sooner you sever your relationship with him, the better.

All of the above assumes she'll want Traditional Medicare. If she wants Medicare Advantage, she'll be subject to the same potential penalties as above but instead of Parts A, B, and D, she'll have Part C.
tallguy3891
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Re: Medicaire, IRMAA and the like

Post by tallguy3891 »

Artsdoctor wrote: Sat Jul 06, 2024 9:23 am
josephny wrote: Sat Jul 06, 2024 6:00 am Here is the response from mybenefitadvisors.com:

"My wife just turned 65 and I wanted to find out what is required of us with respect to Medicare. HAVE HER GET ENROLLED IN PARTS A & B---POSSIBLY GET A SUPPLEMENT.

It is my understanding that if she does not sign up, there is a penalty. Can you confirm? MY RESEARCH SUGGESTS THAT THERE IS A PENALTY IF YOU WAIT 2 YEARS TO ENROLL.

And, she can sign up, at no cost, right? NO COST TO SIGN UP.

Will our current insurance carrier require a change in our coverage because of her enrollment in Medicare? THEY WONT REQUIRE ANYTHING, BUT YOU MAY WANT TO TERMINATE HER FROM THE GROUP PLAN. IF SHE CONTINUES TO USE THE OXFORD COVERAGE, HER CLAIMS CAN BE REDUCED BY THE AMOUNT MEDICARE WOULD PAY---OXFORD WILL NOT PAY AS PRIMARY

Can we be relieved of any obligation for supplemental Medicare coverage because of our current plan? I DO NOT KNOW THIS ANSWER PERHAPS KYLE DOES.

Lastly, and possibly most importantly, does it make sense to keep the current plan with her covered? Or does it make more sense for her to be on Medicare with all the best supplements plans? IT MIGHT BE COST EFFICIENT TO REMOVE HER FROM THE GROUP PLAN WHEN SHE IS FULLY ENROLLED. YOUR RATE WILL GO FROM A FAMILY RATE OF $3418.42 TO THE EMPLOYEE & CHILD RATE OF $2039.06---YOU WILL HAVE TO DETERMINE WHAT WILL WORK BEST FOR YOU."

I am following up with Kyle, someone there who knows more about Medicare.

My follow up with include what I believe are the most important things to me: (1) That my wife continue to have the same type of coverage (financial as well as which doctors and services are covered, etc.), (2) that we do not incur penalties (financial or otherwise) now or later, and (3) that the difference in cost isn't significant for us ($1,379/month minus whatever Medicare's additional policies would cost us -- I wouldn't dare use any more specific terms because I am 100% confused about supplementals, additional, advantages, parts A-Z, etc.).
First, you'll need to accept that your insurance broker really doesn't know anything about Medicare, which is pretty sad when you think about it. It means that virtually all of his clients could potentially be in the same spot as you are.

So essentially, your wife currently has no insurance right now. Oxford will only pay after Medicare's payments are made (it's the "secondary" while Medicare is the "primary"). However, she doesn't have Medicare so there's nothing to pay. Oxford would be correct in turning down any charges because they're not responsible for paying first.

She needs to sign up for Medicare right now. Part A is free and will be retroactive to her 65th birthday (or retroactive 6 months prior to application) so at least she'll have that. Part B cannot be retroactive but it can be started pretty quickly. She also needs Part D (pharmacy).

I'm not sure about the penalty. I was under the assumption that if she's outside of the window period that a penalty (pro-rated) would be assessed. However, she's just outside that period so any penalty would be small; nonetheless, all penalties are lifelong so it's worth getting started right away.

To be honest, your broker's lack of knowledge is so significant that I'd pull her from the Oxford plan and get her a Medicare supplement. The sooner you sever your relationship with him, the better.

All of the above assumes she'll want Traditional Medicare. If she wants Medicare Advantage, she'll be subject to the same potential penalties as above but instead of Parts A, B, and D, she'll have Part C.
The comment above about 2 years for the penalty [for Part B] is not accurate. It is 10% for each full 12 month period.

The penalty is not prorated for Part B. 10% for each full 12 months.

If anyone knows differently, please post. Verify at Medicare.gov
PeninsulaPerson
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Re: Medicaire, IRMAA and the like

Post by PeninsulaPerson »

OP - I did not see this mentioned in the various responses.

You need to search "SHIP counselling" and see a SHIP counselor. (SHINE in Massachusetts.)

You are getting excellent advice here but you seem to need one-to-one. That's what SHIP is.
delamer
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Re: Medicaire, IRMAA and the like

Post by delamer »

Since josephny has multiple children on his current plan, it is unlikely that he’ll qualify for the employee plus child coverage rate. I’ve never heard of that being for more than 2 people.

So his family coverage rate won’t go down. If that is the case, then there is no downside to having her on both the current coverage plus Medicare (if they decide to enroll her in Medicare).
One thing that humbles me deeply is to see that human genius has its limits while human stupidity does not. - Alexandre Dumas, fils
SuzBanyan
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Re: Medicaire, IRMAA and the like

Post by SuzBanyan »

It sounds like it is possible your wife has no current insurance coverage, which could mean a very substantial financial cost exceeding any penalty for a late sign up for Medicare.

It sounds like you don’t want a Medicare Advantage plan as you said you want her to have the same type of coverage as she currently has and Medicare Advantage (aka Part C) is more restricted.

The good news is that traditional Medicare will allow her to use almost any doctor, hospital, clinic, or lab in the US.

Then the question is whether you want to keep your current policy paying $1379/month as a supplement to her Medicare or whether a Medicare Supplement policy (aka Medigap) is better. To keep this simple, the most comprehensive Medigap policy is Plan G, which has you paying only about $270 in 2024 in addition to the premiums.

From other Boglehead posts, assuming you are in NY, I believe that you can go to this site and see all the options and rates: https://www.dfs.ny.gov/consumers/health ... lans_rates
Scroll down to after it says: “ Insurers Offering Medigap Insurance in New York State
Medicare Supplement Insurance Carrier and Rate Look-Up” and hit the DFS Portal button. Enter your zip code and you will see all the options.

In general, go with the cheapest Plan G as they all provide the same product, although paying a few bucks more per month may make sense if you have a provider you are comfortable with and which you believe provides good service.

Someone correct me if I wrong, but from reading on Bogleheads, I believe NY makes it easy to change both Medigap providers but also the kind of Plans, like going from G to N. Which means that your choice is not for life and it is likely more important to make a good choice quickly then delaying while you look for the perfect choice.

Then you also need to sign her up for drug plan (aka Part D). This is done at Medicare.gov. As has already been stated, this is a somewhat mystical experience as your knowledge is both limited and unknowable. But you can change this every year, so you are not locked into a bad decision forever. Here the penalty for not signing up for Part D is based on months not years, so sooner is better than later.

If the other guy at your insurance broker is more knowledgeable, he may be able to sign her up for everything she needs after she has signed up for Medicare. Otherwise, as has been noted, a counselor at the non-profit SHIP in your state can help. The one I met with gave me Bogleheads level of info, complete with a decision flow chart.
tallguy3891
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Re: Medicaire, IRMAA and the like

Post by tallguy3891 »

As an aside, the 12 month period for the Part B penalty does not have to be consecutive months if a person terminates Part B and reenrolls at a later time. This reference also covers the initial enrollment rules for the penalty when first enrolling, or not, in Part B. Very useful reference.

See the following:

https://secure.ssa.gov/apps10/poms.nsf/lnx/0601001010
SR II
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Re: Medicaire, IRMAA and the like

Post by SR II »

Do yourself a favor and buy "Medicare for Dummies" (https://www.amazon.com/Medicare-Dummies ... 143&sr=8-1) rather than get yourself more confused by folks posting on here!
tallguy3891
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Re: Medicaire, IRMAA and the like

Post by tallguy3891 »

SR II wrote: Sat Jul 06, 2024 1:06 pm Do yourself a favor and buy "Medicare for Dummies" (https://www.amazon.com/Medicare-Dummies ... 143&sr=8-1) rather than get yourself more confused by folks posting on here!
Excellent advice, but people should also know that the 4th edition is from 2020, with the 5th edition to be released approx Sept 2024, so it is possible some info has changed if they have not updated the 4th edition.

For example, the effective date of Part B enrollment if signing up during the General Enrollment Period has changed in the last few years, and I noticed in the link I provided in my prior post it showed a change effective in 2023 for a particular situation. Most up to date info can probably be found at Medicare.gov
Duzz78
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Re: Medicaire, IRMAA and the like

Post by Duzz78 »

delamer wrote: Sat Jul 06, 2024 10:51 am Since josephny has multiple children on his current plan, it is unlikely that he’ll qualify for the employee plus child coverage rate. I’ve never heard of that being for more than 2 people.

So his family coverage rate won’t go down. If that is the case, then there is no downside to having her on both the current coverage plus Medicare (if they decide to enroll her in Medicare).
Employee and child level means no spouse is included. There is no limit to the number of children covered. Per insurance, child means biological children and stepchildren, adapted, foster and court ordered children or children under your care who financially depend on you. It can also mean an adult child who is disabled and for whom is under your care and financially dependent upon you.

If a child is a dependent on your income tax return, that dependent can usually be covered under your insurance plan.

Employee and family - employee, spouse and children
Duzz78
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Re: Medicaire, IRMAA and the like

Post by Duzz78 »

tallguy3891 wrote: Fri Jul 05, 2024 10:04 am
Duzz78 wrote: Fri Jul 05, 2024 1:45 am
josephny wrote: Thu Jul 04, 2024 9:37 pm I had no idea Medicare was so complicated.

Now I'm really anxious about us incurring penalties or fines for not signing up in time (it's almost 6 months since she turned 65).
You had up by 3 months after she turned 65 to sign up without any penalties incurring. You are now past the timeframe. Your goal is to minimize this amount now.

Our current plan is indeed through a business I own, with only myself and my partner (so, our families are the only participants). . . . . .

EDITED: See my original post earlier. Information truncated here for the purpose of shortening the length and adding my response comment to tallgue3891.
The Part B penalty does not apply until one has 12 months of having turned it down, so the first answer is not entirely accurate. Depending on what period someone refused Part B and when their birthday was factors in the calculation. The 12 months of not having Part B when first eligible for Part B begins the month after the end of the Initial Enrollment Period (IEP). So, if the person turned 65 in January 2024, their IEP ends April 2024. The 12 month window begins May 2024 and ends April 2025. The fact that the person missed their original enrollment (IEP) period does not necessarily mean they will have a penalty. It is the number of months truly without Part B which determines this. The OP needs to figure this timing asap if getting close to the number of months from the end of the IEP to the month enrollment will apply. A call to Social Security can help with this. Note: It used to be that if one signed up in the General Enrollment Period (GEP) of Jan-Mar each year, the Part B coverage was effective July 1st. This changed to where the person is now enrolled as of the month after signing up in the GEP, e.g., signs up in Jan 2025, is enrolled as of Feb 2025, etc. Remember, the IEP timeframe (3 months before the month of attaining age 65 to 3 months after the month attaining 65) can be different from the GEP (currently Jan-Mar of each year).

If I had so many questions about this and how it works with the health insurance type the OP currently has, I would personally go to Social Security and sit down with them and discuss all the details about the situation for the most accurate info.

PLEASE NOTE the corrections to my original post concerning the 12 month window for the Part B penalty. Verify with official source of Medicare.gov
Thank you tallguy3891 for chiming in and correction my information. I knew someone would catch the Part B information and expand on the rules. As many know, Medicare is complicated and your expanded explanation was long in it own right, but necessary. My main goal was to let OP know this is something he needs to work on now and not next year or in 7 years.
HIinvestor
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Re: Medicaire, IRMAA and the like

Post by HIinvestor »

I agree you should talk to the SHIP office at your Dept of Health, Office on Aging. I believe NONWORKING spouse who is still covered by working spouse’s family group plan MAY be able to delay enrollment in B without penalty. I would get this clarified with SHIP and Medicare ASAP.

https://www.cms.gov/training-education/ ... 0person%20(or,life%2Dlong%20late%20enrollment%20penalty.
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MJS
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Re: Medicaire, IRMAA and the like

Post by MJS »

DebiT wrote: Fri Jul 05, 2024 11:22 am I know this seems very complicated. I would like to propose a safe simple solution. Have your wife enroll in Medicare immediately. Do not pick a Medicare Advantage plan. In many states, once you do that, you may need underwriting tif you later want to enroll in “traditional Medicare”. Medicare Advantage plans are effectively “substitutes” for traditional Medicare, usually cheaper because you give away the almost infinite flexibility of traditional Medicare.

Have her enroll in traditional Medicare,and pick a supplemental plan (aka MediGap) of the Plan G variety. This too is the top of the line. You could always step down later, but often stepping up requires underwriting. This is bad if she has or develops a pre-existing condition. Now you’re almost finished. She is now enrolled in Medicare Part A (which covers hospitals) and Part B ,which covers everything else.

Is your wife on any prescription drugs? If no, pick the cheapest Part D (prescriptions) plan you can find. You have the opportunity to change these every year anyway, which is complicated if someone takes lots of drugs, or expensive drugs. If she already does, there are calculators online for your state which will help with this. There are penalties for waiting, so get this figured out fast.
...
+1. This is what the plurality, possibly the majority, of Bogleheads do. It provides excellent Platinum level coverage.

Good luck!
Ipsa scientia potestas est. Bacon F.
HIinvestor
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Re: Medicaire, IRMAA and the like

Post by HIinvestor »

Here’s what Medicare says on its website:

https://www.medicare.gov/basics/get-sta ... %20penalty.
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swong
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Re: Medicaire, IRMAA and the like

Post by swong »

Keep in mind that if either one of you turn age 65 you "must" apply for Medicare otherwise you will incur a added permanent penalty for each year you delay. For us this was a bothersome caveat to work through. As for the infamous IRMAA penalty this too is bothersome especially if you are a high net worth family with multiple streams of income even during retirement. This is exacerbated by the fact you must eventually take RMDs, cash in matured savings bonds, and adding insult to injury IRMAA also counts interest from triple tax free municipal bonds. If anyone has been able to avoid any of these troublesome burdens I'd be interested in knowing and learning from their avoidance techniques!
delamer
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Re: Medicaire, IRMAA and the like

Post by delamer »

Duzz78 wrote: Sat Jul 06, 2024 10:06 pm
delamer wrote: Sat Jul 06, 2024 10:51 am Since josephny has multiple children on his current plan, it is unlikely that he’ll qualify for the employee plus child coverage rate. I’ve never heard of that being for more than 2 people.

So his family coverage rate won’t go down. If that is the case, then there is no downside to having her on both the current coverage plus Medicare (if they decide to enroll her in Medicare).
Employee and child level means no spouse is included. There is no limit to the number of children covered. Per insurance, child means biological children and stepchildren, adapted, foster and court ordered children or children under your care who financially depend on you. It can also mean an adult child who is disabled and for whom is under your care and financially dependent upon you.

If a child is a dependent on your income tax return, that dependent can usually be covered under your insurance plan.

Employee and family - employee, spouse and children
That’s interesting. I worked with health insurance plans as part of my career. I’d only encountered self-only (just policyholder), self-plus-one (policyholder plus either spouse or one child), and family (policyholder plus 2 or more others) coverage.

But I’ve been retired for almost 9 years and things change.
One thing that humbles me deeply is to see that human genius has its limits while human stupidity does not. - Alexandre Dumas, fils
Dottie57
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Re: Medicaire, IRMAA and the like

Post by Dottie57 »

josephny wrote: Thu Jul 04, 2024 9:14 am I have an email into the person who sold me the Oxford insurance plan at mybenefitadvisor.com asking about whether my wife can still be covered and if there is anything United Healthcare will require or have to do about her turning 65.

Given the complexity, I would (at least for now) prefer to leave the current coverage in place, if UHC will allow and there will be no penalties.

I don't know what else to do, because putting in the time now to become educated about Medicare (which is clearly very complicated) is not an option.
It is employer not insurance company that cares if wife is covered.
stlrick
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Re: Medicaire, IRMAA and the like

Post by stlrick »

The last time we heard from the OP, his priorities were: (1) he and his wife do not have the time to learn about the intricacies of Medicare, (2) he is anxious about incurring penalties or fines, (3) it is important that his wife continue to be covered and can see the same doctors, and (4) he does not want any insurance change to be a significant change in costs.

I think it is time to say plainly to the OP that all of these things will not work out that way. The change in costs are what they are, the penalties will be what they will be, and if he does nothing, it is not at all clear what his wife's coverage will be - and they may not find out until a major expense occurs. Moreover, his AGI for 2024 will be somewhere between 300k and 500k and it is "impossible to know more at this time." With that uncertainty in income, is it reasonable to be perseverating about a few thousand dollars in insurance costs?

Given the conditions of the business policy, there is only one rational course of action and it needs to be taken immediately. Enroll your wife in Medicare parts A and B. Select an insurance company for Plan D prescriptions and one for a Supplement Plan G. Drop her from the company policy. Get this done immediately. There is no avoiding the switch to Medicare and certainty about valid coverage for your wife overrides every other issue. More talk about this seems pointless.
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Artsdoctor
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Re: Medicaire, IRMAA and the like

Post by Artsdoctor »

tallguy3891 wrote: Sat Jul 06, 2024 12:27 pm As an aside, the 12 month period for the Part B penalty does not have to be consecutive months if a person terminates Part B and reenrolls at a later time. This reference also covers the initial enrollment rules for the penalty when first enrolling, or not, in Part B. Very useful reference.

See the following:

https://secure.ssa.gov/apps10/poms.nsf/lnx/0601001010
Thank you for providing this link.

From the way I'm reading it, it looks as if the penalty is assessed based on months, not years, after the initial enrollment period. For example, if your birthday is July 14, your initial enrollment period is April-June, July, then August-October (the classic 7-month period for most people). So provided you enroll by the end of the October, you're fine and there will be no penalty. If you apply in December, based on what your link suggests, you would have a penalty based on your one month of November. If I'm not interpreted this correctly, please let me know. This certainly makes intuitive sense but we all know that intuitive sense doesn't always flow through to social security and Medicare.
tallguy3891
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Re: Medicaire, IRMAA and the like

Post by tallguy3891 »

Artsdoctor wrote: Sun Jul 07, 2024 3:02 pm
tallguy3891 wrote: Sat Jul 06, 2024 12:27 pm As an aside, the 12 month period for the Part B penalty does not have to be consecutive months if a person terminates Part B and reenrolls at a later time. This reference also covers the initial enrollment rules for the penalty when first enrolling, or not, in Part B. Very useful reference.

See the following:

https://secure.ssa.gov/apps10/poms.nsf/lnx/0601001010
Thank you for providing this link.

From the way I'm reading it, it looks as if the penalty is assessed based on months, not years, after the initial enrollment period. For example, if your birthday is July 14, your initial enrollment period is April-June, July, then August-October (the classic 7-month period for most people). So provided you enroll by the end of the October, you're fine and there will be no penalty. If you apply in December, based on what your link suggests, you would have a penalty based on your one month of November. If I'm not interpreted this correctly, please let me know. This certainly makes intuitive sense but we all know that intuitive sense doesn't always flow through to social security and Medicare.
You are correct about the 7 month window begin and end dates in your scenario. However, since the Initial Enrollment Period (IEP) ends October 31st, the 12 month counting period for the penalty begins Nov 1st. There is no proration of the penalty. So, if the person enrolls in the very next General Enrollment Period of January thru March a few months later, there has been no 12 month period and thus no penalty. If they waited until the GEP following THAT one, there would have been over 12 months (Nov and Dec of the first year and Jan-Dec of the next year), so whether it was a full 12 months or 14 months, the penalty would be 10%.

However, if the person enrolled and terminated multiple times from Part B over several years, ALL of the months not enrolled would count, for example 4 in one period and 12 the next year and 6 the next time and 4 the next time, etc., and if they totaled 24 months there would be a 20% penalty, or 36 months, a 30% penalty, etc.

This is all assuming that the person did not have other creditable insurance such as through an employer, or be eligible for a Special Enrollment Period (SEP) or other exclusion reason (see previous link), such as is going on right now for the new Postal Health Program, where those who previously refused Part B have a SEP to sign up for Part B even after many years, without paying any penalty themselves (the gov't will pay it apparently). There are other exclusions too.

What may be of interest to some also is that if a person is on Social Security Disability or ESRD, for example on benefits and could have enrolled in Part B after 24 months but refused it, from say, age 58 on, once they reach age 65 they can enroll in Part B WITHOUT penalty because those months/years prior to age 65 do not count in the 12 month penalty calculation (see aforementioned link). Of course, if refused again in this situation at age 65, the 12 month penalty rules would apply going forward. This is per the current regulations. As always, verify with Social Security for the most current info for one's situation.
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Artsdoctor
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Re: Medicaire, IRMAA and the like

Post by Artsdoctor »

^ Got it. That's an excellent explanation. I think what makes this difficult to understand at first glance is separately Part B from Part D penalties. There's a lot written about creditable coverage and much of that pertains to Part D. There are several websites explaining how to calculate Part D penalties and, if I'm not mistaken, those ARE calculated on a monthly basis for late filers. That is well-defined in this Medicare post:

chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.cms.gov/Outreach-and-Educat ... llment.pdf

However, the Part D penalties are not the same as the Part B penalties. While it might be tempting to think that they interchangeable, there are definitely not. Your 12-month rule for Part B is perfectly defined and I appreciate the details.
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josephny
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Re: Medicaire, IRMAA and the like

Post by josephny »

We got the Medicare for Dummies book and explored the Medicare web site.

We tried to sign her up, but even that is terribly complicated.

Instructions say the IEP lasts for 7 months, from 3 months before turning 65 until 3 month after. And the GEP is from January 1 to March 31.

I see there is a "Special Enrollment Period" which extends the enrollment to 8 months past turning 65 if one is covered by a creditable group policy, but I don't see a way to enroll under the SEP. But, the application option states that it is only for "misrepresentation" by group health plan or employer.

So how do we sign up now?

https://www.cms.gov/files/document/cms- ... itions.pdf
SuzBanyan
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Re: Medicaire, IRMAA and the like

Post by SuzBanyan »

josephny wrote: Tue Jul 09, 2024 3:07 am We got the Medicare for Dummies book and explored the Medicare web site.

We tried to sign her up, but even that is terribly complicated.

Instructions say the IEP lasts for 7 months, from 3 months before turning 65 until 3 month after. And the GEP is from January 1 to March 31.

I see there is a "Special Enrollment Period" which extends the enrollment to 8 months past turning 65 if one is covered by a creditable group policy, but I don't see a way to enroll under the SEP. But, the application option states that it is only for "misrepresentation" by group health plan or employer.

So how do we sign up now?

https://www.cms.gov/files/document/cms- ... itions.pdf
She would be able to sign up now if she is in a special Enrollment Period or entitled to sign up due to “Exceptional Circumstances”.

It looks like Exceptional Circumstances can include misinformation from a health insurance broker for your (or your spouse’s) employer if that misinformation was received before the end of the initial enrollment period. Here is the form: https://www.cms.gov/files/document/appl ... itions.pdf

You may not need to use Exceptional Circumstances if she is in a Special Enrollment Period (SEP). It looks like there is a SEP that may apply if she was covered by your work based insurance and lost that coverage when she became eligible for Medicare. That SEP lasts for 8 months after she lost her work based coverage. You can read more here: https://www.medicareinteractive.org/get ... -insurance

The Application on page 3 states you should call Social Security if you believe you are eligible for a SEP due to Rheem end of work based insurance: https://www.cms.gov/files/document/cms- ... urance.pdf
tallguy3891
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Re: Medicaire, IRMAA and the like

Post by tallguy3891 »

josephny wrote: Tue Jul 09, 2024 3:07 am We got the Medicare for Dummies book and explored the Medicare web site.

We tried to sign her up, but even that is terribly complicated.

Instructions say the IEP lasts for 7 months, from 3 months before turning 65 until 3 month after. And the GEP is from January 1 to March 31.

I see there is a "Special Enrollment Period" which extends the enrollment to 8 months past turning 65 if one is covered by a creditable group policy, but I don't see a way to enroll under the SEP. But, the application option states that it is only for "misrepresentation" by group health plan or employer.

So how do we sign up now?

https://www.cms.gov/files/document/cms- ... itions.pdf
Sorry if I missed it somewhere along the thread, but what month and year did your spouse turn 65? The answer to that will determine your basic options.
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Artsdoctor
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Re: Medicaire, IRMAA and the like

Post by Artsdoctor »

It doesn't seem as if she'd be eligible for a Special Enrollment Period. There was no misrepresentation by your broker before the IEP; even the responses that were attached above didn't really constitute misrepresentation since he clearly stated that Oxford would not be the primary.

Everyone I know that turned 65 was bombarded with information regarding Medicare. However, since she wasn't already receiving social security, perhaps the amount of information was limited. AARP also sends out tons of information.

Fortunately, when she's able to sign up for Medicare, Part A will be retroactive 6 months or to the month she turned 65, whichever is shortest.
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josephny
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Re: Medicaire, IRMAA and the like

Post by josephny »

She turned 65 in February, 2024.

I own the business, and neither I nor the insurance broker advises her that she needed to enroll in Medicare and that her insurance might not cover her if she didn't. Is that midrepresentation?

We might have received US Mail spam solicitations, but nothing official.

It looks like the SEP for people who have coverage does not extend to small group policies (mine has my and my partner only).

I don't see a way to get her signed up.
tallguy3891
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Re: Medicaire, IRMAA and the like

Post by tallguy3891 »

josephny wrote: Tue Jul 09, 2024 9:38 am She turned 65 in February, 2024.

I own the business, and neither I nor the insurance broker advises her that she needed to enroll in Medicare and that her insurance might not cover her if she didn't. Is that midrepresentation?

We might have received US Mail spam solicitations, but nothing official.

It looks like the SEP for people who have coverage does not extend to small group policies (mine has my and my partner only).

I don't see a way to get her signed up.
1. Since she turned 65 in Feb, her Initial Enrollment Period (IEP) ended May 31st.

2. Therefore, I personally would try to file the form with Social Security (SSA) for the Special Enrollment Period situation previously mentioned and speak with SSA.

3. Even so, since the IEP ended in May, the 12 month toward penalty phase began June 1st. The General Enrollment Period (GEP) is Jan through March coming up in 2025. If she signs up in January, her Medicare coverage begins Feb 1st, and there has not been 12 months of non-enrollment so there would be no 10% penalty for Part B. I believe you stated she is still on your health coverage so she could stay on that until you choose otherwise.

4. I believe she has 6 months to enroll in a Medigap plan without underwriting after enrolling in Part B, those months starting the first of the month she enrolls in Part B. I personally would verify this with your chosen Medigap company.

5. I did not see if you mentioned whether she has a work history to qualify for premium free Part A. If she does not, depending on how much work history she has, she could still get Part A by paying a partial or full required premium.

6. Penalty months for Part D work differently so in my opinion it would be good to check into that too.

In my opinion one should always verify everything in posts with the official source such as Social Security.
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wwhan
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Re: Medicaire, IRMAA and the like

Post by wwhan »

josephny wrote: Tue Jul 09, 2024 9:38 am She turned 65 in February, 2024.

I own the business, and neither I nor the insurance broker advises her that she needed to enroll in Medicare and that her insurance might not cover her if she didn't. Is that midrepresentation?

We might have received US Mail spam solicitations, but nothing official.

It looks like the SEP for people who have coverage does not extend to small group policies (mine has my and my partner only).

I don't see a way to get her signed up.
Just sign her up for Medicare A & B, then get supplement G and part D.

https://www.medicare.gov/basics/get-sta ... -start#SEP
tallguy3891
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Re: Medicaire, IRMAA and the like

Post by tallguy3891 »

tallguy3891 wrote: Tue Jul 09, 2024 11:04 am
josephny wrote: Tue Jul 09, 2024 9:38 am She turned 65 in February, 2024.

I own the business, and neither I nor the insurance broker advises her that she needed to enroll in Medicare and that her insurance might not cover her if she didn't. Is that midrepresentation?

We might have received US Mail spam solicitations, but nothing official.

It looks like the SEP for people who have coverage does not extend to small group policies (mine has my and my partner only).

I don't see a way to get her signed up.
1. Since she turned 65 in Feb, her Initial Enrollment Period (IEP) ended May 31st.

2. Therefore, I personally would try to file the form with Social Security (SSA) for the Special Enrollment Period situation previously mentioned and speak with SSA.

3. Even so, since the IEP ended in May, the 12 month toward penalty phase began June 1st. The General Enrollment Period (GEP) is Jan through March coming up in 2025. If she signs up in January, her Medicare coverage begins Feb 1st, and there has not been 12 months of non-enrollment so there would be no 10% penalty for Part B. I believe you stated she is still on your health coverage so she could stay on that until you choose otherwise.

4. I believe she has 6 months to enroll in a Medigap plan without underwriting after enrolling in Part B, those months starting the first of the month she enrolls in Part B. I personally would verify this with your chosen Medigap company.

5. I did not see if you mentioned whether she has a work history to qualify for premium free Part A. If she does not, depending on how much work history she has, she could still get Part A by paying a partial or full required premium.

6. Penalty months for Part D work differently so in my opinion it would be good to check into that too.

In my opinion one should always verify everything in posts with the official source such as Social Security.
As an additional bit of info, if a person DOES have to pay a premium for Part A Medicare, there can be a late penalty also which is handled a little differently than Part B IF the person does not sign up during the Initial Enrollment Period. If the Part A will be premium free, currently there is NO penalty.

Some people did not have enough work to have premium free Part A, but they can enroll and pay a premium. Then later, when their spouse is eligible for Social Security (even if not signing up apparently), the person can switch to sign up off the spouse which could be premium free if the spouse had enough work history.
Duzz78
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Re: Medicaire, IRMAA and the like

Post by Duzz78 »

delamer wrote: Sun Jul 07, 2024 8:56 am
Duzz78 wrote: Sat Jul 06, 2024 10:06 pm
delamer wrote: Sat Jul 06, 2024 10:51 am Since josephny has multiple children on his current plan, it is unlikely that he’ll qualify for the employee plus child coverage rate. I’ve never heard of that being for more than 2 people.

So his family coverage rate won’t go down. If that is the case, then there is no downside to having her on both the current coverage plus Medicare (if they decide to enroll her in Medicare).
Employee and child level means no spouse is included. There is no limit to the number of children covered. Per insurance, child means biological children and stepchildren, adapted, foster and court ordered children or children under your care who financially depend on you. It can also mean an adult child who is disabled and for whom is under your care and financially dependent upon you.

If a child is a dependent on your income tax return, that dependent can usually be covered under your insurance plan.

Employee and family - employee, spouse and children
That’s interesting. I worked with health insurance plans as part of my career. I’d only encountered self-only (just policyholder), self-plus-one (policyholder plus either spouse or one child), and family (policyholder plus 2 or more others) coverage.

But I’ve been retired for almost 9 years and things change.
Only known them as such. But them only been covered on one company plan. Watching one retirement guy on Youtube, he had the same 4 groups that I mentioned. He also confirmed that the premium for Employee+Spouse costs more than the Employee+Child(ren). We adults apparently costs more medically than kids. I have yet to figure out why an adult costs more at a movie theater than a kid.
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Artsdoctor
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Re: Medicaire, IRMAA and the like

Post by Artsdoctor »

josephny wrote: Tue Jul 09, 2024 9:38 am She turned 65 in February, 2024.

I own the business, and neither I nor the insurance broker advises her that she needed to enroll in Medicare and that her insurance might not cover her if she didn't. Is that midrepresentation?

We might have received US Mail spam solicitations, but nothing official.

It looks like the SEP for people who have coverage does not extend to small group policies (mine has my and my partner only).

I don't see a way to get her signed up.
I think that TallGuy spelled out a great plan. You can certainly try applying for a Special Enrollment Period. You can state that there's been misrepresentation but I think what Medicare has in mind is that your insurance broker told you that her insurance covered her (it's really not his responsibility to call every client who is turning 65 that they need to sign up for Medicare; although a good broker might tell a small business owner that that's the case, it's been my experience that they do not).

Medicare enrolled is handled through Social Security and, provided your wife has a social security number, she should have received a Medicare packet in the mail prior to turning 65. Everything's automated so if she didn't get something, then I'd log onto her social security account and make sure that everything is correct (such as address).

Technically, Oxford is not obligated to be her primary insurance so they may not pay any charges that come their way. I would try to have your broker intervene to see if there's something you can work out. Usually, insurance companies don't want to pay if they don't have to; you can imagine them saying that she should be on Medicare which would be her primary insurance and their obligation is only to be her secondary insurance.
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josephny
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Re: Medicaire, IRMAA and the like

Post by josephny »

Progress/update:

I spoke with a rep at a local private medicare advising group.

He advised to submit the application for A & B (which she qualifies for based on decades on earnings), without the need for completing the SEP forms.

His position is that the fact that she has good current coverage is the only significant factor for her to submit the regular enrollment app. (not the IEP timetable, not the 20-employee and over, not whether her current coverage meets the requirements of Medicare, etc.). He said he has never heard of Medicare rejecting an application such as her, or retroactively rejecting/cancelling such an app.

I went ahead an enrolled her online at:

https://www.ssa.gov/medicare/sign-up

Got the confirmation of the submission and now we are waiting for confirmation of her enrollment.

Once enrollment is confirmed, it sounds like a part G and D is the highest level of coverage, and the way we would go, and it looks like we'd save quite a bit of money by removing her from my family policy (not the goal, but a good thing nonetheless).

BTW, we got Medicare for Dummies and I think a better title would be "Medicare so that you feel like a Dummy when you try to read and understand this."

Thank you all very much -- I know it it not easy to try to take someone with zero understanding through this process, and your help and patience is true generousity and kindness.
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Re: Medicaire, IRMAA and the like

Post by jebmke »

josephny wrote: Wed Jul 10, 2024 3:01 am Progress/update:

I spoke with a rep at a local private medicare advising group.

He advised to submit the application for A & B (which she qualifies for based on decades on earnings), without the need for completing the SEP forms.

His position is that the fact that she has good current coverage is the only significant factor for her to submit the regular enrollment app. (not the IEP timetable, not the 20-employee and over, not whether her current coverage meets the requirements of Medicare, etc.). He said he has never heard of Medicare rejecting an application such as her, or retroactively rejecting/cancelling such an app.

I went ahead an enrolled her online at:

https://www.ssa.gov/medicare/sign-up

Got the confirmation of the submission and now we are waiting for confirmation of her enrollment.

Once enrollment is confirmed, it sounds like a part G and D is the highest level of coverage, and the way we would go, and it looks like we'd save quite a bit of money by removing her from my family policy (not the goal, but a good thing nonetheless).

BTW, we got Medicare for Dummies and I think a better title would be "Medicare so that you feel like a Dummy when you try to read and understand this."

Thank you all very much -- I know it it not easy to try to take someone with zero understanding through this process, and your help and patience is true generousity and kindness.
Good to hear. Remember that Part D is quite complicated and you can’t really know the right answer except retrospectively. The good thing is that you can change it every year without any penalties so your exposure for a “wrong” decision is somewhat limited. For many, it is the most frustrating part of the entire Medicare experience.
When you discover that you are riding a dead horse, the best strategy is to dismount.
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Artsdoctor
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Re: Medicaire, IRMAA and the like

Post by Artsdoctor »

OP: Great news! Please report back to us when the whole process has been completed. It's a complicated system and your input can help us all.
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Re: Medicaire, IRMAA and the like

Post by Church Lady »

Remember that Part D is quite complicated and you can’t really know the right answer except retrospectively.
Signing up for Part D via the medicare.gov website is not complicated. The only tricky thing is gathering a list of all your prescriptions and entering them into the web site. One of my prescriptions is not on the government list; It's impossible to enter it. Tricky!

You enter your preferred pharmacies also.

For all the prescriptions you enter, Medicare.gov will give you a list of all part D programs in your zip code, and estimate your annual cost under each plan at each of your pharmacies. It took me a couple iterations with different pharmacies before I settled on a plan. It was not hard to go back and add or delete pharmacies to optimize my selection. You click on the plan you want, and follow the prompts. Easy peasy!

You can alternatively call a Medicare broker who will do what I just described for you.

Of course, who is to say your doctor won't change your prescriptions after you enroll. In that case, you won't know if you selected the optimal plan until next year's enrollment period.

Fun story: I boasted to a relative that I would save over $400 a year by switching plans and pharmacies. She asked how I did it, tried Medicare.gov herself, and is saving over $4000 (yes, thousand!) by switching plans and pharmacies. (I have no idea what meds she is on). It pays to shop on medicare.gov!
He that loveth silver shall not be satisfied with silver; nor he that loveth abundance with increase: this is also vanity.
tallguy3891
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Re: Medicaire, IRMAA and the like

Post by tallguy3891 »

josephny wrote: Wed Jul 10, 2024 3:01 am Progress/update:

I spoke with a rep at a local private medicare advising group.

He advised to submit the application for A & B (which she qualifies for based on decades on earnings), without the need for completing the SEP forms.

His position is that the fact that she has good current coverage is the only significant factor for her to submit the regular enrollment app. (not the IEP timetable, not the 20-employee and over, not whether her current coverage meets the requirements of Medicare, etc.). He said he has never heard of Medicare rejecting an application such as her, or retroactively rejecting/cancelling such an app.

I went ahead an enrolled her online at:

https://www.ssa.gov/medicare/sign-up

Got the confirmation of the submission and now we are waiting for confirmation of her enrollment.

Once enrollment is confirmed, it sounds like a part G and D is the highest level of coverage, and the way we would go, and it looks like we'd save quite a bit of money by removing her from my family policy (not the goal, but a good thing nonetheless).

BTW, we got Medicare for Dummies and I think a better title would be "Medicare so that you feel like a Dummy when you try to read and understand this."

Thank you all very much -- I know it it not easy to try to take someone with zero understanding through this process, and your help and patience is true generousity and kindness.
Did your spouse retire recently? That can make a difference also with the timeframes. Attaching a link which might be helpful.

https://www.cms.gov/Outreach-and-Educat ... irment.pdf
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Re: Medicaire, IRMAA and the like

Post by jebmke »

Church Lady wrote: Wed Jul 10, 2024 9:50 am
Remember that Part D is quite complicated and you can’t really know the right answer except retrospectively.
Signing up for Part D via the medicare.gov website is not complicated. The only tricky thing is gathering a list of all your prescriptions and entering them into the web site. One of my prescriptions is not on the government list; It's impossible to enter it. Tricky!

You enter your preferred pharmacies also.

For all the prescriptions you enter, Medicare.gov will give you a list of all part D programs in your zip code, and estimate your annual cost under each plan at each of your pharmacies. It took me a couple iterations with different pharmacies before I settled on a plan. It was not hard to go back and add or delete pharmacies to optimize my selection. You click on the plan you want, and follow the prompts. Easy peasy!

You can alternatively call a Medicare broker who will do what I just described for you.

Of course, who is to say your doctor won't change your prescriptions after you enroll. In that case, you won't know if you selected the optimal plan until next year's enrollment period.

Fun story: I boasted to a relative that I would save over $400 a year by switching plans and pharmacies. She asked how I did it, tried Medicare.gov herself, and is saving over $4000 (yes, thousand!) by switching plans and pharmacies. (I have no idea what meds she is on). It pays to shop on medicare.gov!
signing up is simple. Registering for the draft in 1971 was simple too. Understanding offerings and making an intelligent decision is nearly impossible -- perhaps technically impossible.
When you discover that you are riding a dead horse, the best strategy is to dismount.
nonnie
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Re: Medicaire, IRMAA and the like

Post by nonnie »

Church Lady wrote: Wed Jul 10, 2024 9:50 am
Remember that Part D is quite complicated and you can’t really know the right answer except retrospectively.
Signing up for Part D via the medicare.gov website is not complicated. The only tricky thing is gathering a list of all your prescriptions and entering them into the web site. One of my prescriptions is not on the government list; It's impossible to enter it. Tricky!

You enter your preferred pharmacies also.

For all the prescriptions you enter, Medicare.gov will give you a list of all part D programs in your zip code, and estimate your annual cost under each plan at each of your pharmacies. It took me a couple iterations with different pharmacies before I settled on a plan. It was not hard to go back and add or delete pharmacies to optimize my selection. You click on the plan you want, and follow the prompts. Easy peasy!

You can alternatively call a Medicare broker who will do what I just described for you.

Of course, who is to say your doctor won't change your prescriptions after you enroll. In that case, you won't know if you selected the optimal plan until next year's enrollment period.

Fun story: I boasted to a relative that I would save over $400 a year by switching plans and pharmacies. She asked how I did it, tried Medicare.gov herself, and is saving over $4000 (yes, thousand!) by switching plans and pharmacies. (I have no idea what meds she is on). It pays to shop on medicare.gov!
A further recommendation is once a decision is made on Part D meds via the Medicare website is to enter the medications into the website of the chosen insurer. I used to have a broker that had proprietary software that was better than Medicare's--which is not always correct--
but they stopped representing Part D because commissions didn't justify the amount of work necessary.
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Re: Medicaire, IRMAA and the like

Post by jebmke »

nonnie wrote: Wed Jul 10, 2024 6:32 pm
Church Lady wrote: Wed Jul 10, 2024 9:50 am
Remember that Part D is quite complicated and you can’t really know the right answer except retrospectively.
Signing up for Part D via the medicare.gov website is not complicated. The only tricky thing is gathering a list of all your prescriptions and entering them into the web site. One of my prescriptions is not on the government list; It's impossible to enter it. Tricky!

You enter your preferred pharmacies also.

For all the prescriptions you enter, Medicare.gov will give you a list of all part D programs in your zip code, and estimate your annual cost under each plan at each of your pharmacies. It took me a couple iterations with different pharmacies before I settled on a plan. It was not hard to go back and add or delete pharmacies to optimize my selection. You click on the plan you want, and follow the prompts. Easy peasy!

You can alternatively call a Medicare broker who will do what I just described for you.

Of course, who is to say your doctor won't change your prescriptions after you enroll. In that case, you won't know if you selected the optimal plan until next year's enrollment period.

Fun story: I boasted to a relative that I would save over $400 a year by switching plans and pharmacies. She asked how I did it, tried Medicare.gov herself, and is saving over $4000 (yes, thousand!) by switching plans and pharmacies. (I have no idea what meds she is on). It pays to shop on medicare.gov!
A further recommendation is once a decision is made on Part D meds via the Medicare website is to enter the medications into the website of the chosen insurer. I used to have a broker that had proprietary software that was better than Medicare's--which is not always correct--
but they stopped representing Part D because commissions didn't justify the amount of work necessary.
The major problem with Part D isn't the signing up part. The major problem is that you may well not know in advance what kind of coverage will be correct. All it takes is one new medication at the high end after you have signed up and you blow out the whole model.
When you discover that you are riding a dead horse, the best strategy is to dismount.
Topic Author
josephny
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Re: Medicare, IRMAA and the like

Post by josephny »

Ummm....the complexity has no end.

Happily, she's only on 1 med. I identified it to the company that advised us on signing up and he proposed: Wellcare Value Plus (PDP) S4802-206-D at $91.80/month. This will mean her med will cost around $11/month (far less than what we pay now for her med).

He also recommends Plan G through AARP (his recommendation) at $308/month.

But I'm reading as much as I can stand to read about Medicare and it seems there are additional insurance policies one can purchase (in additon to Medicare with A, B, D, and G that supplement (lower case s). Why costs these additional, optional, policies pay, and therefore the reason for buying them, for is a total mystery to me.
nonnie
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Re: Medicare, IRMAA and the like

Post by nonnie »

josephny wrote: Wed Jul 10, 2024 7:46 pm Ummm....the complexity has no end.

Happily, she's only on 1 med. I identified it to the company that advised us on signing up and he proposed: Wellcare Value Plus (PDP) S4802-206-D at $91.80/month. This will mean her med will cost around $11/month (far less than what we pay now for her med).

He also recommends Plan G through AARP (his recommendation) at $308/month.

But I'm reading as much as I can stand to read about Medicare and it seems there are additional insurance policies one can purchase (in additon to Medicare with A, B, D, and G that supplement (lower case s). Why costs these additional, optional, policies pay, and therefore the reason for buying them, for is a total mystery to me.

With only one medication, it is highly unlikely she would need a Part D plan as expensive as this one. My WellCare plan, Value Script, is only 40 cents per month, yes $.40. did he give you a comparison of all the plans and prices and a reason for such a high cost plan? First thing to check out is which Tier (one, two, three, four) this med is on the plan.

You may not want to go this route, this early but it may be cheaper to buy the medication without using insurance. Very easy to price on Amazon Pharmacy or Cost Plus drugs website,
https://costplusdrugs.com/

Please post back for advice.
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wwhan
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Re: Medicare, IRMAA and the like

Post by wwhan »

nonnie wrote: Wed Jul 10, 2024 7:53 pm..With only one medication, it is highly unlikely she would need a Part D plan as expensive as this one. My WellCare plan, Value Script, is only 40 cents per month, yes $.40. did he give you a comparison of all the plans and prices and a reason for such a high cost plan? First thing to check out is which Tier (one, two, three, four) this med is on the plan.

You may not want to go this route, this early but it may be cheaper to buy the medication without using insurance. Very easy to price on Amazon Pharmacy or Cost Plus drugs website,
https://costplusdrugs.com/

Please post back for advice.
+1,

I also have Part D WellCare plan, Value Script, is only 40 cents per month. One generic prescription, no cost.

Also you can look up the specific prescription costs on the medicare website under the find plans: https://www.medicare.gov/plan-compare/# ... 24&lang=en
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wwhan
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Re: Medicare, IRMAA and the like

Post by wwhan »

josephny wrote: Wed Jul 10, 2024 7:46 pm....

He also recommends Plan G through AARP (his recommendation) at $308/month.

But I'm reading as much as I can stand to read about Medicare and it seems there are additional insurance policies one can purchase (in additon to Medicare with A, B, D, and G that supplement (lower case s). Why costs these additional, optional, policies pay, and therefore the reason for buying them, for is a total mystery to me.
The Plan G through AARP (United Healthcare is fine). The price depends on your zip code.

Best Medicare Supplement (Medigap) Companies: https://www.investopedia.com/best-medic ... es-5074131

Nerdwallet: https://www.nerdwallet.com/p/best/insur ... -companies

Forbes: https://www.forbes.com/health/medicare/ ... providers/

When I look up AARP G medigap supplemental plan- United Healthcare Insurance Company (Standard) for my zip code and age 70, it says $187/month, on the Medicare website: https://www.medicare.gov/plan-compare/# ... 24&lang=en

Here is the AARP medigap supplemental United Healthcare website: https://www.aarpmedicaresupplement.com/

To signup, for the AARP plan, she will likely need to join AARP (5 year $63).

The medigap supplemental Plan G is the most comprehensive plan available to new enrollment.

The AARP medigap supplemental United Healthcare uses Community Pricing - Premiums are the same no matter how old you are. Premiums may go up because of inflation and other factors.

Note the fine print on age affected rates for AARP, which has discount that declines every year by 3%, until age 77.

"The Enrollment Discount is applied to the current Standard Rate. The Standard Rate usually changes each year. The discount you receive in your first year of coverage depends on your age on your plan effective date. The discount percentage decreases 3% each year on the anniversary date of your plan until the discount runs out."

Age on Plan Effective Date
Starting & Discount
65 36%
66 33%
67 30%
68 27%
69 24%
70 21%
71 18%
72 15%
73 12%
74 9%
75 6%
76 3%
77 0%

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josephny
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Re: Medicare, IRMAA and the like

Post by josephny »

I feel like I'm stuck in a Groundhog Day meets Abbott and Costello routine. As soon as I think I'm making progress towards understanding, it get more complicated.

Is this correct:

Part A: Free
Part B: $174.70/month plus $419.30 IRMMA (yes, highest bracket)
Part D: <some-base between $30 and $91/month> plus $81 IRMMA
Part G: $308/month

All in, her Medicare will cost ~$1,050/month

So much for saving money....
PeninsulaPerson
Posts: 1658
Joined: Sat Jan 08, 2022 9:35 am
Location: Metro Boston

Re: Medicare, IRMAA and the like

Post by PeninsulaPerson »

josephny wrote: Thu Jul 11, 2024 5:11 am
I feel like I'm stuck in a Groundhog Day meets Abbott and Costello routine. As soon as I think I'm making progress towards understanding, it get more complicated.

Have you consulted with with a SHIP counselor in your state?
tallguy3891
Posts: 835
Joined: Sat Jul 03, 2021 10:47 am

Re: Medicare, IRMAA and the like

Post by tallguy3891 »

josephny wrote: Thu Jul 11, 2024 5:11 am I feel like I'm stuck in a Groundhog Day meets Abbott and Costello routine. As soon as I think I'm making progress towards understanding, it get more complicated.

Is this correct:

Part A: Free
Part B: $174.70/month plus $419.30 IRMMA (yes, highest bracket)
Part D: <some-base between $30 and $91/month> plus $81 IRMMA
Part G: $308/month

All in, her Medicare will cost ~$1,050/month

So much for saving money....
Others here know more about this and can comment, but:

1. Did you find out if the insurance she is currently covered under through you counts as creditable insurance---does she HAVE to sign up for Part B to avoid a future penalty since she is covered under the current insurance?

2. You stated you live in NY. Is this a State which allows one to change any Medigap plan to any other later on without any underwriting? If so, could she get a much cheaper Plan G High Deductible (H-D) to start with and change later?
Topic Author
josephny
Posts: 208
Joined: Wed Apr 03, 2024 9:24 am

Re: Medicare, IRMAA and the like

Post by josephny »

tallguy3891 wrote: Thu Jul 11, 2024 9:50 am
josephny wrote: Thu Jul 11, 2024 5:11 am I feel like I'm stuck in a Groundhog Day meets Abbott and Costello routine. As soon as I think I'm making progress towards understanding, it get more complicated.

Is this correct:

Part A: Free
Part B: $174.70/month plus $419.30 IRMMA (yes, highest bracket)
Part D: <some-base between $30 and $91/month> plus $81 IRMMA
Part G: $308/month

All in, her Medicare will cost ~$1,050/month

So much for saving money....
Others here know more about this and can comment, but:

1. Did you find out if the insurance she is currently covered under through you counts as creditable insurance---does she HAVE to sign up for Part B to avoid a future penalty since she is covered under the current insurance?

2. You stated you live in NY. Is this a State which allows one to change any Medigap plan to any other later on without any underwriting? If so, could she get a much cheaper Plan G High Deductible (H-D) to start with and change later?
1) No one knows.

2) No idea.

I'm close to giving up on this.
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Artsdoctor
Posts: 6180
Joined: Thu Jun 28, 2012 3:09 pm
Location: Los Angeles, CA

Re: Medicare, IRMAA and the like

Post by Artsdoctor »

tallguy3891 wrote: Thu Jul 11, 2024 9:50 am
josephny wrote: Thu Jul 11, 2024 5:11 am I feel like I'm stuck in a Groundhog Day meets Abbott and Costello routine. As soon as I think I'm making progress towards understanding, it get more complicated.

Is this correct:

Part A: Free
Part B: $174.70/month plus $419.30 IRMMA (yes, highest bracket)
Part D: <some-base between $30 and $91/month> plus $81 IRMMA
Part G: $308/month

All in, her Medicare will cost ~$1,050/month

So much for saving money....
Others here know more about this and can comment, but:

1. Did you find out if the insurance she is currently covered under through you counts as creditable insurance---does she HAVE to sign up for Part B to avoid a future penalty since she is covered under the current insurance?

2. You stated you live in NY. Is this a State which allows one to change any Medigap plan to any other later on without any underwriting? If so, could she get a much cheaper Plan G High Deductible (H-D) to start with and change later?
This system is extremely complex. I thought that it was complex when I dealing with it as a physician, and I came to appreciate the added complexity when I turned 65.

There are penalties, as outlined above. Presuming that someone qualifies for Part A anyway, most of the penalties that people talk about pertain to Parts B and D. As I've learned, those penalties are calculated differently. Whether or not the OP's wife would be subject to penalties isn't entirely clear; it sounds like "no" to Part B penalties and "yes" to Part D penalties although perhaps his application will go through without any difficulties and everything w will work out just fine. In the larger scheme of things, people would do well (in my opinion) to assume they should sign up for Medicare at 65 UNLESS they are confident that the exceptions apply to them. The stakes are just too high.

Then, there's the opportunity cost of not being on Medicare. In my opinion, this is more important although less appreciated than the penalties. After many years in practice, I have come to appreciate how difficult insurance companies can be to work with. Although there are always exceptions to the rule, I've found that insurance companies will try to pass the buck to another insurer if there is one. They can even pay and then take back the payment if they've discovered another insurer they didn't know about. This plays out all the time when anyone asks, "Who's the primary?" Meaning, I've seen patients with three separate insurers but they don't know who pays first, second, and third. With Medicare, there are rules that address this: those people using employer-based policies along with Medicare will have Medicare as the primary if the employer is a large plan, and Medicare as secondary if the employer is a small plan.

In this post, my primary concern is that OP's wife has a plan through a small employer. Normally, people on small plans would want to sign up for Medicare because a small group plan may not act as the primary payer when the patient needs them most. A bill would be submitted (here, to Oxford), and the private insurer will take a look at the birthdate and essentially ask, "where's Medicare?" They're going to know that it's a small employer and they'd be within their rights to essentially say, "we'd be happy to be the secondary payer, but we're certainly not on the hook for expenses as a primary payer would be."

The system is not designed to be easy. Presumably, the complexities have evolved (worsened) over time as Medicare has added on new rules without revamping older rules altogether. They truly make attempts to make it understandable but they are aware that there are many criticisms that are valid.
jebmke
Posts: 27396
Joined: Thu Apr 05, 2007 2:44 pm
Location: Delmarva Peninsula

Re: Medicare, IRMAA and the like

Post by jebmke »

Artsdoctor wrote: Thu Jul 11, 2024 1:29 pm This system is extremely complex. I thought that it was complex when I dealing with it as a physician, and I came to appreciate the added complexity when I turned 65.
If you were starting from scratch and commissioned consultants to design a health care system from scratch and one of the firms came to you with the US health care system, your reaction would be "does insanity run in your family or are you a one-off?"
When you discover that you are riding a dead horse, the best strategy is to dismount.
nonnie
Posts: 3170
Joined: Thu Mar 13, 2008 8:05 pm

Re: Medicare, IRMAA and the like

Post by nonnie »

josephny wrote: Thu Jul 11, 2024 5:11 am I feel like I'm stuck in a Groundhog Day meets Abbott and Costello routine. As soon as I think I'm making progress towards understanding, it get more complicated.

Is this correct:

Part A: Free
Part B: $174.70/month plus $419.30 IRMMA (yes, highest bracket)
Part D: <some-base between $30 and $91/month> plus $81 IRMMA
Part G: $308/month

All in, her Medicare will cost ~$1,050/month

So much for saving money....
Part D premium can range from zero to $150 or more. With only one prescription there is no reason for you to pay $80 or $90 a month (whatever you choose you will have to pay IRMMA on top of it)

Part G premium sounds pretty high for someone only 65. I'm 81 and my premium only recently went up to $325.

Sounds to me like the agent who is recommending these plans to you is going with the ones that give them the highest commission especially for Part D.
tallguy3891
Posts: 835
Joined: Sat Jul 03, 2021 10:47 am

Re: Medicare, IRMAA and the like

Post by tallguy3891 »

josephny wrote: Thu Jul 11, 2024 12:41 pm
tallguy3891 wrote: Thu Jul 11, 2024 9:50 am
josephny wrote: Thu Jul 11, 2024 5:11 am I feel like I'm stuck in a Groundhog Day meets Abbott and Costello routine. As soon as I think I'm making progress towards understanding, it get more complicated.

Is this correct:

Part A: Free
Part B: $174.70/month plus $419.30 IRMMA (yes, highest bracket)
Part D: <some-base between $30 and $91/month> plus $81 IRMMA
Part G: $308/month

All in, her Medicare will cost ~$1,050/month

So much for saving money....
Others here know more about this and can comment, but:

1. Did you find out if the insurance she is currently covered under through you counts as creditable insurance---does she HAVE to sign up for Part B to avoid a future penalty since she is covered under the current insurance?

2. You stated you live in NY. Is this a State which allows one to change any Medigap plan to any other later on without any underwriting? If so, could she get a much cheaper Plan G High Deductible (H-D) to start with and change later?
1) No one knows.

2) No idea.

I'm close to giving up on this.
I believe this is a solvable issue. Sorry to keep numbering my answers, but it helps me keep my comments in hopefully understandable small chunks.

1. I did some reading and apparently insurance carriers are supposed to notify you every year whether their coverage is "creditable" coverage pertaining to Parts B and D, apparently meaning that it is as good as or better than Medicare. I personally would not be surprised if it turns out that since it is private coverage for a small business that it is not creditable, but I would make sure. Should be an easy phone call.

2. Therefore, I personally would contact the health insurance carrier and ask them whether this is so, and whether yes or no, get something in writing from them as proof.

3. You already know from previous comments that your spouse should be able to sign up at least in January of 2025 for Parts A and B to be effective Feb 1st. I think one can sign up for Part D in the months of early Oct thru early Dec of 2024 to be effective Jan 2025.

4. What reading I've done indicated to me that since you live in NY, one can indeed change Medigap providers without underwriting as of this time. You mentioned the cost previously of Part G, but if you go to Medicare.gov you can plug in your zip code and see the rates for Part G High Deductible too, which should be much cheaper to be on than G. One could, apparently, from what I've read switch to a different Medigap Plan later.

5. So, at least this way, as of the new year, she could have Parts A, B, D, and Plan G High Deductible (H-D) as a supplement if she chooses to do so.

6. Others could maybe help regarding options for the IRMAA situation.

7. This is how I would look at it if it were me, if I could not get signed up right now, which would be my first choice for myself. You stated you did apply for her now, please let us know what their decision is if you don't mind sharing that.

Medicare is confusing for lots of people. My opinion is to take it one step at a time.
Last edited by tallguy3891 on Thu Jul 11, 2024 7:45 pm, edited 1 time in total.
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