If Your Income Has Gone Down
If your income has gone down due to any of the following situations, and the change makes a difference in the income level we consider, contact us to explain that you have new information and may need a new decision about your income-related monthly adjustment amount:
- You married, divorced, or became widowed.
- You or your spouse stopped working or reduced your work hours.
- You or your spouse lost income-producing property because of a disaster or other event beyond your control.
- You or your spouse experienced a scheduled cessation, termination, or reorganization of an employers pension plan.
- You or your spouse received a settlement from an employer or former employer because of the employers closure, bankruptcy, or reorganization.
If any of the above applies to you, we need to see documentation verifying the event and the reduction in your income. The documentation you provide should relate to the event and may include a death certificate, a letter from your employer about your retirement, or something similar. If you filed a federal income tax return for the year in question, you need to show us your signed copy of the return. Use Form Medicare Income-Related Monthly Adjustment Amount Life-Changing Event to report a major life-changing event. If your income has gone down, you may also use Form SSA-44 to request a reduction in your income-related monthly adjustment amount.
Reasons Not To Enroll In Medicare When You Turn 65
For many people, turning 65 is a big milestone, and understandably so. In fact, age 65 is when youre first allowed to get coverage under Medicare.
Youre allowed to enroll in Medicare starting three months before the month of your 65th birthday. And it pays to sign up on time, because if you dont, you could face costly surcharges on your Part B premiums whether you pay them directly or have them deducted from your Social Security benefits.
That said, there are a couple of scenarios where it pays to delay your Medicare enrollment. Heres when signing up at 65 doesnt make sense.
Can I Have Medicare And Employer Coverage
Instead of choosing between Medicare and employer coverage, you may decide to have both. This can be possible, but you need to understand how your two plans will coordinate.
If you work for an employer with 20 or more employees, your employer-sponsored group health plan is the primary payer and Medicare is the secondary payer. If the employer has fewer than 20 employees, Medicare is the primary payer, and the group health plan is the secondary payer. The primary payer always pays first, and the secondary payer pays costs that the primary payer doesnt cover, up to the coverage limits.
Coverage Gaps In Medicare
Be sure to think about how you’ll pay for the things Medicare doesn’t cover. For instance, it generally doesn’t cover dental work and routine vision or hearing care. Same goes for long-term care, cosmetic procedures and for the jet-setters medical care overseas.
Many people decide to pair original Medicare with a supplemental policy called Medigap to help cover out-of-pocket costs such as deductibles and coinsurance. You cannot, however, pair a Medigap policy with an Advantage Plan.
If you end up choosing an Advantage Plan, there’s a good chance limited coverage for dental and vision will be included.
For long-term care coverage, some people consider purchasing insurance specifically designed to cover those expenses.
Are Medicare Parts A And B Free
Since you have likely been paying taxes into a Medicare fund throughout your time in the workforce, you might assume that you’re in the clear regarding Medicare costs.
However, that money was going toward Medicare Part A, which is insurance for hospital visits and stays. This part of Medicare is generally covered since the funds are taken out of payroll tax during your working years.
If you havenât worked and contributed to the Medicare Part A fund through your taxes, you can also purchase Part A, with a premium of either $259 or $471 each month in 2021, depending on whether or not your spouse worked and paid Medicare taxes.
Alternatively, most people have to pay a monthly premium for Medicare Part B, which is insurance for medical services. Part B has a monthly premium that is automatically drawn from your benefits if you receive at least one of the following:
- Social Security
- Railroad Retirement Board
- Office of Personnel Management
If you arenât receiving any of these benefits, you will receive a bill every month â the cost of which will be determined on a sliding scale according to your income. The standard amount for 2021 is $148.50, but it will change depending on your and your spouseâs income.
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How Much Does Medicare Cost At Age 65
The bottom line is â it depends.
As much as we wish we had a hard and fast answer to this question, the cost of Medicare will likely vary from person to person, based on their income, needs, and plan choices.
Medicare Part A usually does not have a premium, but you do still have to pay an inpatient deductible at the hospital and coinsurance. The deductible for each benefit period is $1,484 with each period of coinsurance correlating with a rise in cost. For example:
- Days 1â60: $0 coinsurance
- Days 61â90: $371 coinsurance per day
- Days 91 and beyond: $742 coinsurance per each âlifetime reserve day,â which everyone has 60 of over their lifetime. After your lifetime reserve days run out, you will be responsible for all costs.
Medicare Part B has a premium that is income-dependent. The deductible is $203 in 2021. Once you reach your deductible,you will pay 20% of the Medicare-approved amount for most services.
If you have a Medicare Supplement plan, you likely won’t pay any of the costs associated with having Part A, and you will most likely only be responsible for the $203 Part B deductible . The exact benefits will depend on which Medicare Supplement plan you choose.
What To Do With Aca Insurance When Turning 65
President/CEO at Healthcare Solutions Direct, LLC, a nationwide insurance agency focused primarily on the retiree health market.
If you have an individual health plan through the Affordable Care Act marketplace, youll want to cancel that plan when you are eligible for Medicare at age 65. Thats because ACA plans are no longer terminated automatically when a person turns 65. From my experience, many insurance agents will not tell you to cancel the marketplace plan the month before you turn 65. This could be a costly mistake that could easily be avoided.
What makes this confusing to the insurance industry as a whole is there are so many names for this insurance, such as marketplace insurance, Obamacare and ACA plans. Before 2010, when the ACA went into effect, all plans outside group insurance were referred to by one name: individual health insurance.
As an owner of a healthcare insurance agency with over 10 years of experience, I have provided expert support to thousands of Medicare-eligible individuals. I would often explain that Obamacare was designed for Americans under 65, and Medicare was designed for those 65 and older.
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Turning 65 What You Need To Know About Signing Up For Medicare
The first of the 78 million baby boomers turned 65 on January 1, 2011, and some 10,000 boomers a day will reportedly reach that milestone between now and 2030. If you are about to turn 65, then it is time to think about Medicare. You become eligible for Medicare at age 65, and delaying your enrollment can result in penalties, so it is important to act right away.
There are a number of different options to consider when signing up for Medicare. Medicare consists of four major programs: Part A covers hospital stays, Part B covers physician fees, Part C permits Medicare beneficiaries to receive their medical care from among a number of delivery options, and Part D covers prescription medications. In addition, Medigap policies offer additional coverage to individuals enrolled in Parts A and B.
Local Elder Law Attorneys in Your City
Medicare enrollment begins three months before your 65th birthday and continues for 7 months. If you are currently receiving Social Security benefits, you don’t need to do anything. You will be automatically enrolled in Medicare Parts A and B effective the month you turn 65. If you do not receive Social Security benefits, then you will need to sign up for Medicare by calling the Social Security Administration at 800-772-1213 or online at . It is best to do it as early as possible so your coverage begins as soon as you turn 65.
How Social Security Determines You Have A Higher Premium
Social Security uses the most recent federal tax return the IRS provides to us. If you must pay higher premiums, we use a sliding scale to calculate the adjustments, based on your modified adjusted gross income . Your MAGI is your total adjusted gross income and tax-exempt interest income.
If you file your taxes as married, filing jointly and your MAGI is greater than $176,000, youll pay higher premiums for your Part B and Medicare prescription drug coverage. If you file your taxes using a different status, and your MAGI is greater than $88,000, youll pay higher premiums , for an idea of what you can expect to pay).
If you must pay higher premiums, well send you a letter with your premium amount and the reason for our determination. If you have both Medicare Part B and Medicare prescription drug coverage, youll pay higher premiums for each. If you have only one Medicare Part B or Medicare prescription drug coverage youll pay an income-related monthly adjustment amount only on the benefit you have. If you decide to enroll in the other program later in the same year, and you already are paying an income-related monthly adjustment amount, well apply an adjustment automatically to the other program when you enroll. In this case, we wont send you another letter explaining how we made this determination.
Remember, if your income isnt greater than the limits described above, this law does not apply to you.
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Medicare Prescription Drug Coverage
Medicare Prescription Drug Plans are sold by private insurance companies approved by Medicare. All people new to Medicare have a seven-month window to enroll in a PDP three months before, the month of and three months after their Medicare becomes effective. The month you enroll affects the PDPs effective date. All people with Medicare are eligible to enroll in a PDP however, unless you are new to Medicare or are entitled to a Special Enrollment Period, you must enroll or change plans during the Open Enrollment Period for Medicare Advantage and Medicare Part D, Oct. 15 through Dec. 7. There is a monthly premium for these plans. If you have limited income and assets/resources, assistance is available to help pay premiums, deductibles and co-payments. You may be entitled to Extra Help through the Social Security Administration. To apply for this benefit contact SHIIP at 1-855-408-1212 or the Social Security Administration at 800-772-1213 or www.socialsecurity.gov.
What Does Medicare Cover
Medicare helps pay for certain health care services and durable medical equipment. To have full Medicare coverage, Medicare beneficiaries must have Part A and Part B .
The following is a partial list of Medicare-covered services. The covered services listed below may require payment of deductibles and Co-Payments.
If you have questions about covered services, call Medicare at 1-800-633-4227.
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Do I Have To Sign Up For Medicare If I Have Private Insurance
It depends on the type of insurance you have and your place of employment. If you are self-employed or work at a small business with less than 20 employees, double check that you will still be covered past 65. If you have COBRA coverage, make sure to sign up for Medicare. If these do not apply to you, and you’re still covered by your health insurance, you can put off signing up for Medicare.
Applying For Medicare Supplement Insurance At Age 65
When you turn 65, you will be granted a Medigap Open Enrollment Period during which you can apply for a Medigap plan. This six-month period will begin once you turn 65 and are enrolled in Medicare Part B .
During this period, insurance companies cant use your medical history like your hearing loss as a reason to raise your premiums or deny your coverage completely. They must issue you a plan at the same rate as someone with no significant medical history.
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Im Turning 65 Soon But I Like My Current Insurance Do I Have To Enroll In Medicare Will There Be Penalties If I Dont
It depends on how you are receiving your current insurance. If you are receiving employer-sponsored health insurance through either your or your spouses job when you turn 65, you may be able to keep your insurance until you retire. You will need to contact your employers benefits representative to find out whether they will continue your coverage when you turn 65. Since Medicare Part A is premium-free for most beneficiaries, you may want to enroll in Part A as soon as you are eligible , even if you will continue to receive employer-sponsored insurance at that time. If you are covered under an employer plan, you may want to delay signing up for Part B until you retire. However, it is a good idea to check with Social Security or Medicare to confirm you will not face a penalty for late enrollment. Similarly, unless you have drug coverage that is as good as what Medicare drug plans offer, you will need to sign up for a Medicare prescription drug plan when you enroll in Medicare or you may face a late enrollment penalty.
If you decide to drop your Marketplace coverage when you become eligible for Medicare, make sure your Medicare coverage has started before you cancel your Marketplace plan so that you avoid any gaps in coverage. You can start signing up for Medicare three months before your 65th birthday.
Original Medicare = 20% Coinsurance
If you stay with original Medicare, you’ll be subject to 20% coinsurance for most covered services. Prescription drugs will not be covered unless you sign up for a Part C or Part D plan. You can avoid the 20% coinsurance with a Medicare Advantage Plan , or a Medicare supplement. For supplement plans, see our Medicare Supplement Comparison Chart. We can help you enroll in Advantage Plans or Supplements, or help you explore what course of action to take. Call our helpline at 888-997-5204.
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When Do I Sign Up For Medicare
As discussed above, you will be automatically enrolled into Medicare if you are already receiving Social Security. If this is your situation, there is nothing else you need to do. Medicare will send you a card in the mail about 3 months in advance of the month in which you turn 65. Your Medicare will start on the 1st day of the month you turn 65 UNLESS your birthday is on the 1st day of the month, in which case it will start on the 1st day of the previous month.
If you are not receiving Social Security and need to sign up for Medicare, you should do it 2-3 months before the month that you turn 65. You can do it online or at a local Social Security office. It can take Social Security up to a month or more to process a new enrollment into Medicare.
Is Medicare Part A Free
If you made payroll taxes in your life, you probably know they set aside a trust fund to help fund Part A. If you or a spouse contribute to Medicare taxes while working a minimum of 40 quarters in the U.S., then Part A is free.
Beneficiaries that only contributed 30-39 quarters your premium would be $274. Those with fewer than 30 quarters of contributions would pay the full premium, which is $499.
What Are My Rights As A Medicare Beneficiary
As a Medicare beneficiary, you have certain guaranteed rights. These rights protect you when you get health care, they assure you access to needed health care services, and protect you against unethical practices.
You have these rights whether you are in Original Medicare or another Medicare health plan.
Your rights include, but are not limited to:
The Right to Receive Emergency Care
If you have severe pain, an injury, or a sudden illness that you believe may cause your health serious danger without immediate care, you have the right to receive emergency care. You never need prior approval for emergency care, and you may receive emergency care anywhere in the United States.
The Right to Appeal Decisions About Payments or Services for Medical Care
If you are enrolled in Original Medicare, you have the right to appeal denial of a payment for a service you have been provided. If you are enrolled in another Medicare health plan, you have the right to appeal the plan’s denial for a service to be provided.
The Right to Information About All Treatment Options
You have the right to know about all your health care treatment options from your health care provider. Medicare forbids its health plans from making any rules that would stop a doctor from telling you everything you need to know about your health care. If you think your Medicare health plan may have kept a provider from telling you everything you need to know about your health care options, then you have the right to appeal.