What To Do If Youre Wrongfully Billed For Medicare Costs
Know your rights as a Qualified Medicare Beneficiary.
If youre among the 7.5 million people in the Qualified Medicare Beneficiary Program, doctors, suppliers, and other providers should not bill you for services and items covered by Medicare, including deductibles, coinsurance, and copayments. If a provider asks you to pay, thats against the law.
The Centers for Medicare & Medicaid Services has heard from people with Medicare who report being billed for covered services, even though theyre in the QMB program. Older consumers have also submitted complaints to the CFPB, reporting that debt collectors tried to collect these types of bills, or sent this information to credit reporting companies.
Medicare Part A Costs
Most people are eligible for premium-free Part A. To be eligible, you or your spouse must have worked at least 40 calendar quarters and paid Medicare taxes during that time. If youre not eligible for premium-free Part A, you can choose to purchase it. The monthly premium cost for Part A ranges from $259 to $471 based on your work history.
What Is The Medicare Late Enrollment Penalty
You may owe the late enrollment penalty for Part A, Part B, or Part D or all three. How much you owe and how it’s calculated depends on the part and how long you went without Medicare coverage.
Very few people pay the Medicare Part A late enrollment penalty, because nearly everyone gets premium-free Part A. But, if you delayed enrollment for a full 12 months AND you don’t get premium-free Part A, you may owe the penalty.
The Part A late penalty is 10 percent of your premium for twice the number of years you could have had Part A but didn’t. So, if you delay for 12 full months, you pay the penalty for 2 years. A 24-month delay leaves you owing the late fee for 4 years, and so on.
The Medicare Part B late enrollment penalty is also calculated in 12-month increments. However, you owe the late fee for the entire time you have Medicare. In addition, every year you delay enrollment adds another 10 percent to your late fee. In this case, that means 12 months equals 10 percent, 24 months equals 20 percent, and so on.
Part D’s late fee is different, since you can only go 63 days without creditable prescription drug coverage before you begin accruing the penalty. “Creditable” means that your prescription drug plan is comparable to Medicare in terms of both costs and coverage. That means that prescription savings clubs do not qualify as .
Like Part B, you owe the Part D late enrollment penalty for the entire time you have Medicare.
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Manual For State Payment Of Medicare Premiums
On September 8, 2020, the Centers for Medicare & Medicaid Services released an updated version of the Manual for State Payment of Medicare Premiums . The manual updates information and instructions to states on federal policy, operations, and systems concerning the payment of Medicare Parts A and B premiums for individuals dually eligible for Medicare and Medicaid. The update to the manual is part of CMS Better Care for Dually Eligible Individuals Strategic Initiative aimed at improving quality, reducing costs, and improving customer experiences.
The prior version of this manual had not been fully updated since the 1990s. The updated manual clarifies various provisions of statute, regulation, and operations that have evolved over time. We redesigned the manual content to make it easier for states to discern federal requirements and find information, compliant with federal accessibility standards and fully available online for the first time.
The manual is part of the CMS Manual System, specifically Pub. 100-24. It is divided into the following sections:
How Do You Know If You Owe The Income
Using data from the Internal Revenue Service , the Social Security Administration determines who owes the Income-Related Monthly Adjustment Amount. SSA will notify you if you owe IRMAA. This notification will include information about appealing the IRMAA decision.
If you’re new to Medicare, you may be charged the standard Part B premium in the beginning, with the IRMAA determination coming once SSA receives your MAGI information from the IRS. Once you receive your Initial Determination Notice, you have 10 days to contact Social Security if you believe the determination was made in error.
You may appeal the IRMAA decision if you’ve experienced a permanent income reduction in the past 2 years. This is very common for Medicare beneficiaries who retired recently.
Visit SSA.gov for more information about IRMAA.
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Medicare Part B Premiums
For Part B coverage, youll pay a premium each year. Most people will pay the standard premium amount. In 2023, the standard premium is $164.90. However, if you make more than the preset income limits, youll pay more for your premium.
The added premium amount is known as an income-related monthly adjustment amount . The Social Security Administration determines your IRMAA based on the gross income on your tax return. Medicare uses your tax return from 2 years ago.
For example, when you apply for Medicare coverage for 2023, the IRS will provide Medicare with your income from your 2021 tax return. You may pay more depending on your income.
In 2023, higher premium amounts start when individuals make more than $97,000 per year, and it goes up from there. Youll receive an IRMAA letter in the mail from SSA if it is determined you need to pay a higher premium.
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Original Medicare And Part D Irmaa
If you receive a Medicare bill for Part B premium and Part D IRMAA costs, you may pay it in these ways:
- Medicares Easy Pay system lets you pay your Part A or Part B premium electronically. You can pay manually or set up automatic payments to be taken directly from a checking or savings account.
- You can pay with a debit card or credit card by writing your card number directly on your bill and mailing it in.
- You can pay with a check or money order.
Medicare Part B Premium In 2023
Each year the Medicare Part B premium amount changes to reflect inflation and the economic status of the U.S. The standard Medicare Part B premium in 2023 is $164.90 per month and can be as high as $560.50 monthly for high-earning beneficiaries. The standard Medicare Part B Premium in 2023 is $5.20 lower than the previous year.
If your income falls above a certain threshold, you will be subject to paying an Income-Related Monthly Adjustment Amount. This additional charge is on top of the standard monthly Medicare Part B premium to balance the cost between high and lower-earning beneficiaries.
You will pay the standard Medicare Part B premium in 2023 regardless of income if:
- You enroll in Medicare Part B for the first time in 2023
- You are billed directly for your Medicare Part B premium
- You do not receive Social Security benefits
- You have Medicare and Medicaid
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When To Pay For Part C Part D And Medigap
Medicare Part C, Part D, and Medigap are all purchased from private insurers. The way youre billed for monthly premiums may vary based on your insurer. In some cases, you may receive a monthly bill. Other insurers may give you the option of paying quarterly.
Medicare Advantage plans may or may not have a monthly premium. This is determined by the plan you choose. Medicare Part D and Medigap plans typically do have monthly premiums.
Once you start receiving Social Security benefits, the monthly premiums for your Part C, Part D, or Medigap plan can be deducted from your benefits. However, this process isnt automatic youll need to contact the plan provider to set up automatic payment.
It may take 3 months or longer until your premiums begin to be automatically deducted from your Social Security benefits. Talk with your plan provider to find out whether you should continue to pay your usual premium amount during this time or withhold payment.
Sometimes, not paying during this lag time may result in a large, single withdrawal of benefit funds the first time your premiums are deducted.
You can pay your Medicare bill in several ways. Well go over how to pay for each part of Medicare in the sections below.
What About Medicare Advantage
Medicare Part C, more commonly known as Medicare Advantage, is similar to Part D in that the plans are provided by private insurance companies. That means your monthly premiums vary depending on your plan and provider. However, Part C is optional. You will never owe late enrollment penalties for a Medicare Advantage plan.
However, signing up for an Advantage plan does not exempt you from the Medicare Part B premium. You’re also still responsible for any late enrollment penalties and the Income-Related Monthly Adjustment Amount, if either of those apply.
If you have a Medicare Advantage Prescription Drug plan and owe the Part D IRMAA, premium payments go to your plan provider you pay the surcharge to Medicare.
Compare your Medicare Advantage, Medigap, and Part D plan options with our Find a Plan tool. Just enter your zip code to begin reviewing Medicare plans in your area.
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Who Gets A Medicare Premium Bill
The Medicare Premium Bill goes to beneficiaries who pay Medicare directly for their Part A premium, Part B premium, or who owe the Part D Income-Related Monthly Adjustment Amount . Please note that, even if you collect Social Security, if you owe the Part D IRMAA, you must pay the surcharge directly to Medicare.
Billing for the Medicare Part B premium occurs every 3 months. You’ll be billed monthly if you owe the Medicare Part A premium or the Part D IRMAA.
What About Part C Part D And Medigap
You pay these bills directly to your plan provider. Each company may have a preferred method of payment.
Your insurer will let you know all your options for paying your bill. These may include:
- autopay, which automatically deducts the amount from your checking or savings account on a specific date each month
- paying by check
- paying by debit or credit card, either online or by mail
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Medicare Part A Premiums
Most people will pay nothing for Medicare Part A. Your Part A coverage is free as long as youre eligible for Social Security or Railroad Retirement Board benefits.
You can also get premium-free Part A coverage even if youre not ready to receive Social Security retirement benefits yet. So, if youre 65 years old and not ready to retire, you can still take advantage of Medicare coverage.
Part A does have a yearly deductible. In 2023, the deductible is $1,600. Youll need to spend this amount before your Part A coverage takes over.
When Do I Pay For My Medicare Premiums
If you enroll in Medicare before you begin collecting Social Security benefits, your first premium bill may surprise you. It will be due, paid in full, 1 month before your Medicare coverage begins.
This bill will typically be for 3 months worth of Part B premiums. So, its known as a quarterly bill.
If you have original Medicare , youll continue to receive bills directly from Medicare until you start collecting either Social Security or RRB benefits. Once your benefits begin, your premiums will be taken directly out of your monthly payments.
Youll also receive bills directly from your plans provider if you have any of the following types of plans:
- Medicare Part D, which is prescription drug coverage
- Medigap, also called Medicare supplement insurance
The structure of these bills and their payment period may vary from insurer to insurer.
Social Security and RRB benefits are paid in arrears. This means that the benefit check you receive is for the previous month. For example, the Social Security benefit check you receive in August is for July benefits. The Medicare premium deducted from that check will also be for July.
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What If I Miss A Payment Or Send It Late
If you have original Medicare and are late paying your monthly premium, youll get a second bill requesting payment. If your premium remains unpaid, youll receive a delinquency notice, followed by a termination notice.
To maintain coverage, you must pay the full past-due amount within 30 days of the termination notice.
If you have a Medicare Advantage or Part D plan and miss a payment, youll receive a notice from your plan provider. Your missed payment will appear on your next bill, and youll be given a grace period of at least 2 months to pay it. The length of this grace period varies by provider.
Youll continue to receive notices of nonpayment that will include information about disenrollment from your plan if your past-due amount isnt paid in full within the grace period. You may also incur late fees or penalties during this time.
Its important to know your plans policy about disenrollment these vary from provider to provider.
If you fail to pay your plans premiums during the grace period, your plan may disenroll you from benefits. At that time, youll receive a final notice, letting you know that youre no longer covered under your plan.
How Do I Pay The Medicare Premium
There are several ways to pay Medicare premiums.
- Pay online: A person can pay online through their secure Medicare account. Payment can be done through a credit card, debit card, or a checking or savings account.
- Paying through a bank: A person can pay their bill directly from a savings or checking account via the bank online bill payment service.
- Sign up for Medicare Easy Pay: Medicare Easy Pay is a free service that automatically deducts payments directly from a personâs checking or savings account. The amounts are usually taken from the account on the 20th day of the month.
- Pay by mail: A person can mail their payment directly to Medicare. A payment coupon is sent with the bill for the premiums, and it needs to be filled in with the correct payment details, and then signed. If a person sends the payment without completing and enclosing the coupon, the payments may be delayed.
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Can I Get Help In Paying The Medicare Premium
There are several ways a person may get financial assistance to pay Medicare premiums.
For example, a person may qualify for extra help from Medicare to pay the costs of prescription drug coverage . They will need to meet set income and resource limits.
In addition, Supplemental Security Income is a monthly benefit for people with limited income or resources, who have disabilities, including blindness, or are aged 65 or older. SSI benefits are separate from Social Security retirement or disability benefits.
Other available help includes the following:
- Medicaid is a partnered federal/state program. It may help with health costs for some individuals with limited income.
- Medicare savings programs may help a person pay the premiums. These programs may also help with coinsurance, copays, deductibles, and prescription drug costs.
- TheProgram of All-inclusive Care for the Elderly helps local communities meet social and medical needs. Many people who get PACE may also be eligible for Medicaid and Medicare.
- Extra Help is a program that helps a person with limited income and resources to pay Medicare prescription drug costs, such as deductibles, coinsurance, and premiums. If a person gets Extra Help but is not sure if they are paying the correct amount, their drug plan can help verify the correct level.
- The Childrenâs Health Insurance Program provides free or low-cost health coverage for children under the age of 20. CHIP covers United States citizens and eligible immigrants.
Medicare Part B Costs
Most people pay the standard Part B premium. In 2021, that amount is $148.50.
If the modified adjusted gross income you reported on your taxes from 2 years ago is higher than a certain limit, though, you may need to pay a monthly IRMAA in addition to your premium. The maximum you can expect to pay for your Part B premium is $504.90 per month.
Medicare Part B also has out-of-pocket costs associated with it. These include an annual deductible of $203. After youve met your deductible, youll pay coinsurance on most services that Medicare Part B covers. This amount is 20 percent of the Medicare-approved costs of services and supplies.
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