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Post by Admin/YBB on Sept 19, 2021 14:26:02 GMT -6
Medicare 1.0
Normal Medicare ELIGIBILITY age is 65 but it may be delayed if still working & covered by work group insurance. Part A is free with at least 40 WORK-CREDITS from covered employment; a maximum of 4 work-credits per year are possible based on income specified by Social Security Administration (SSA). There are significant PENALTIES forever for delayed signup for Medicare. COBRA & RETIREE insurance don’t count for delaying Medicare. Medicare signup is through SSA within a +/- 3 month window around age 65. The ORIGINAL Medicare includes hospital/ surgical Part A, physician Part B, prescriptions Part D.
As the original Medicare covers only about 80%, one must also buy MEDIGAP/ supplemental insurance. There is an alphabet soup of these plans: Plan G has the best coverage but the highest price; Plan N may also be acceptable (it doesn’t cover excess over Medicare approved amounts); old Plan F also covered Medicare deductibles but is now closed to new people. It is difficult to SWITCH Medigap plans after the initial signup, and medical underwriting may be required, so initially choose the plan with the best coverage that you can afford. While these plans are standardized for coverage, their pricing is not, so in some low-cost areas, they may be offered at very low/ no cost; this may seem unfair to people living in high-cost areas but not much can be done about this. When Medicare kicks in at 65, the employer group insurance may become Medigap/ supplemental insurance & reduced payroll deductions may continue.
MEDICARE ADVANTAGE (MA) is an integrated plan (also called Part C) that includes Part A, B, D, plus possibly eye &/or dental coverages. MA is basically a semi-private plan in that Medicare pays private insurers under contracts to provide basic/ standard Medicare services, plus any additional services; to avoid mischief, private insurers are paid on services provided rather than as per patient covered in the pool (so, many MA providers suffered during the pandemic when people stopped going to doctors for a while; on the other hand, auto insurers had to refund some money as there were fewer claims with people driving less). HMO and PPO options are available. One must have both Part A and B to signup for MA; this applies to couples individually. Large employers may have special MA plans & payroll deductions for premiums may continue for those. Only one ID card is needed with MA – leave Medicare card at home as using it will produce wrong billing. (If use original Medicare with Medigap & Part D, need to carry 3 ID cards) #PersonalFinance 9/19/21.
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Post by Admin/YBB on Sept 20, 2021 8:37:50 GMT -6
Medicare 1.1 Some complex aspects & odds & ends are included here. ELIGIBILITY. Work requirement for free Part A is at least 40 WORK-CREDITS from covered employment; a maximum of 4 work-credits per year are possible based on income specified by SSA. If one is not eligible on own work record, then one can gain eligibility when the eligible younger spouse (with enough work record) turns 62. However, late penalties may then apply if one is older than 65 but Part B was not signed up at 65; this may be a case when there is retiree coverage but Medicare eligibility kicks in when eligible younger spouse turns 62. If not eligible for free or reduced-cost Part A, then it can be bought by paying premium. There is AUTO SIGNUP for Medicare at 65 if one is already getting Social Security. The Medicare card is received in mail about 3 months before the 65th birthday. One may decline if one has group health insurance through work, but the default is acceptance (if no action taken). Social Security may be started early at 62 or at FRA (65-67) or late at 70; but be aware of this auto-signup feature of Medicare if getting Social Security between 62-65; all others need to apply for Medicare. Employer may also request copy of Medicare card or a denial letter from SSA (if covered through work or retirement). Medicare HOLD-HARMLESS provision will limit Medicare premium increases to Social Security COLA; it is applicable to anyone having Medicare premiums deducted from Social Security payments. It may seem unfair to those paying for Medicare through billing & new enrollees. IRMAA. For high income earners, extra IRMAA premiums apply for Parts B & D; reason is that basic Medicare is subsidized, so premiums are higher for those with higher incomes. These occur in quantum jumps (not as graduated changes) & may be painful when they kick in. Income (MAGI) from 2 years prior is considered & many watch those income trigger points to avoid IRMAA hits. ENROLLMENT beyond normal signup at 65 is tricky. Special enrollment period (SEP) signups are allowed when switching form work group health insurance to Medicare (retiree health coverage is not coverage from current work even though it is through previous employer). All others must use the annual general enrollment period (GEP) signup window (January 1-March 31, with coverage effective on July 1). One must rely on COBRA or private insurance until the Medicare becomes effective. SWITCH between original Medicare & Medicare Advantage is possible; open annual enrollment period (AEP) is October 15-December 7. Beware of tricky rules such as simultaneous coverage from Medigap & Medicare Advantage is not allowed. Medigap has an initial 30-day free-look period & switches are easier; later Medigap switches are possible but may be tricky & may require medical underwriting. PREMIUMS must be paid to the SSA for Parts B & D (along with any IRMAA payments & late-penalties); when using the Medicare Advantage (Part C), Part B premium and all IRMAA (for Part B & D) must be paid to Medicare. Once the Social Security payments start, the Medicare premiums for Parts B, D & IRMAA will be deducted from those payments; otherwise, there may be monthly or quarterly billings. Annual changes in Parts B & D premiums typically occur at different times (first for Part B, then for Part D), so one has to be careful around the year-end/ start if using bank auto-pay. The Medigap premium or the remaining premium for Medicare Advantage goes to the insurer. Make sure that another family member is aware of Medicare premium payments – schedule, paid to whom, & how; there may be serious consequences for missed premium payments. Medicare became MANDATORY for all public state & local employees after 3/31/1986. So, there are people without Medicare coverage just as there are people without Social Security coverage (several states with their own health insurance programs were exempted when these programs began). Employers these days are PUSHING OUT people from their group health plans when Medicare eligibility is gained somehow (through own or spouse’s work). Old Medicare NUMBER was just the Social Security number (with a letter suffix), but it is now a special number. ONLINE access to SSA & Medicare websites is possible only after respective approvals. The site contents vary depending on the level of benefits. Don’t LAMINATE the Medicare card. But one can use open plastic pockets or customize a snack Ziplock (cut to size & use Scotch tape). Reason may be that laminated cards don’t produce good photocopies. #PersonalFinance 9/20/21, edit 9/25/21. Edit/Add, 10/12/23. MFO LINK MFO 11/28/23Medicare isn't based on any inflation index. Medicare looks at its estimated expenses and then devises several IRMAA tiers annually with varying levels of subsidies. Participants pay 25% (basic, no IRMAA), 35%, 50%, 65%, 80%, 85% of the total costs. www.ssa.gov/benefits/medicare/medicare-premiums.htmlLinks Medicare website www.medicare.gov/Part B Premium (Basic & IRMAA) www.medicare.gov/your-medicare-costs/part-b-costsSSA MAGI for IRMAA secure.ssa.gov/poms.nsf/lnx/0601101035secure.ssa.gov/poms.nsf/lnx/0601101010#bwww.ssa.gov/forms/ssa-44-ext.pdfPart B Late Penalty www.medicare.gov/your-medicare-costs/part-b-costs/part-b-late-enrollment-penaltyMedigap Plans Compared www.medicare.gov/supplements-other-insurance/how-to-compare-medigap-policieswww.aarpmedicareplans.com/shop/compare/compare-ms.htmlwww.ehealthinsurance.com/medicare/supplement-all/compare-medicare-supplement-plansSSA Website (Medicare) www.ssa.gov/benefits/medicare/
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Post by Admin/YBB on Nov 11, 2021 10:41:44 GMT -6
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Post by Admin/YBB on Nov 12, 2021 20:02:20 GMT -6
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Post by Admin/YBB on Apr 20, 2022 5:42:21 GMT -6
A poster at MFO asked whether the MAGI for IRMAA included only the taxable portion of Social Security payments, or all of it. Here are my posts on it that it is the former, not the latter. www.mutualfundobserver.com/discuss/discussion/59492/social-security-irmaayogibearbull April 19 edited April 19 Flag There is confusion on this. One definition from reading the SSA brochures is, MAGI = AGI + tax-exempt interest www.ssa.gov/benefits/medicare/medicare-premiums.htmlBut another is, MAGI = AGI + untaxed Social Security payment + tax-exempt interest Different MAGI are used for different purposes and that adds to the confusion. yogibearbull 6:36AM Flag Now I have a non-linkable "proof" based on checking numbers on our OWN tax returns and what was mentioned in our SSA "DETERMINATION letters" (received typically in November/December) that it is like the 1st FORMULA. So, the SSA takes the AGI from the 1040 of 1-2 years ago (that includes only the TAXABLE Social Security payments) and adds TAX-EXEMPT interest to get MAGI for IRMAA. The Determination letter mentioned those 2 numbers separately and the total and said that the IRS provided them to the SSA. Specifically, the untaxed portion of the Social Security payment was NOT added to MAGI for IRMAA. The 2nd formula can also be found quickly on web search but it is used for other things, NOT Medicare IRMAA. But misleading statements can be found on the web.
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Post by Admin/YBB on Apr 25, 2022 11:57:45 GMT -6
New changes will make traditional Medicare more similar to Medicare Advantage plans, www.morningstar.com/articles/1088562/big-changes-may-be-coming-to-traditional-medicare"Traditional Medicare (also often called Original Medicare) is the old-fashioned fee-for-service program: You visit a healthcare provider and the provider submits the bill to Medicare. Medicare Advantage, on the other hand, is the commercially offered managed-care alternative, which offers an all-in-one solution in exchange for certain trade-offs. Medicare Advantage plans give you incentive to use healthcare providers in their networks, and they can make decisions that affect how and where you'll receive care.....The Centers for Medicare & Medicaid Services, or CMS, recently announced the next phase of its plan to transform traditional fee-for-service Medicare. Critics argue that the planned changes amount to a dramatic expansion of privatization. Supporters counter that the new approach will improve traditional Medicare by creating financial incentives for providers to coordinate patient care and focus on overall improvements in patient health.....Either way, if you are enrolled in traditional Medicare, or expect that you will be in the future, there's one especially eye-opening aspect of this plan: CMS plans to enroll everyone in this new model by the end of this decade--and as early as next year, in some cases--without prior consent....."
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