Helping your clients avoid Medicare penalties is an important aspect of guiding and educating them. Below are some tips to help your clients enroll on time to avoid paying more.

Part A Penalties
​Most Medicare eligibles receive Part A for free however, if you have  a client who has to buy Part A, and they don't buy it when they're first eligible for Medicare (age 65), their monthly premium may go up by 10%. 

Your clients won't have to pay for Part A at age 65 if:

• They or their spouse has worked at least 40 quarters
• They already get retirement benefits from Social Security or the Railroad Retirement Board or they're eligible to get either of those benefits but just haven't filed for them yet.
• They or their spouse had Medicare-covered government employment.

​If your client has limited income and resources, their state may help pay for Part A.

Part B Penalties
​If your client doesn't sign up for Part B when they're first eligible, their monthly premium may go up 10% for each 12-month period that they could've had Part B. In most cases, they'll have to pay this penalty each time they pay their premiums, for as long as they have Part B. 

There is typically no late enrollment penalty if your client meets certain conditions that allows them to sign up for Part B during a Special Enrollment Period. As with Part A, if your client has limited income and resources, their state may help pay for Part B. 

If your client has other creditable coverage, they can delay Part B and postpone paying the premium. They can sign up later without a penalty, as long as they do it within eight months after their other coverage ends. There are directions on the back of their Medicare card if they want to refuse Part B.
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​Part D Penalties
In order to avoid any Part D penalties make sure your client enrolls in drug coverage when they're first eligible. Even if they don’t take drugs they should consider joining a Part D Plan or a Medicare Advantage Plan that includes drug coverage. If they don't they may pay a late enrollment penalty if (at any time after their Initial Enrollment Period is over) there's a period of 63 days or more when they don't have Medicare drug coverage - or other creditable prescription drug coverage. 

Additionally, make sure they enroll in drug coverage if they lose other creditable coverage (from an employer, union, TriCare, Dept. of Affairs, etc.) that's expected to pay at least as much as Medicare's standard prescription drug coverage. You'll want to advise your clients to keep records showing when they have other creditable drug coverage in order to avoid possible penalties in the future. If your client disagrees with a penalty, they can request a review by completing a 'reconsideration request form'.

Avoiding Medicare penalties doesn't have to be tricky as long as you advise your clients accordingly. Review their specific situation to determine when they should enroll in the different parts of Medicare to avoid any issues.

​If you'd like to review the different enrollment periods, request our Medicare Enrollment Periods guide which goes over the following: 

• Medicare Annual Enrollment Period (AEP) ​
• Initial Enrollment Period (IEP)
• Medicare Advantage Open Enrollment Period (MAOEP) 
• Special Enrollment Period (SEP)
• Medigap Open Enrollment Period (MOEP)

By Carolyn Portanova

The Medicare Advantage Enrollment Period runs from January 1st - March 31st. ​​

If your client is unhappy with their current Medicare Advantage plan, they can make a switch to another Medicare Advantage Plan (with or without drug coverage). They can also dis-enroll from their Medicare Advantage Plan and return to original Medicare. If they choose to do so, they'll be able to join a Medicare Prescription Drug Plan as well (Part D).

​If they enrolled in a Medicare Advantage Plan during their Initial Enrollment Period, they can change to another Medicare Advantage Plan (with or without drug coverage) or go back to Original Medicare (with or without drug coverage) within the first three months they have Medicare.

If your client switches to a different Medicare Advantage Plan or goes back to original Medicare with or without a drug plan, their new coverage will start the first day of the month after their new plan gets the request for coverage. An important detail to remember though, if your client decides to go back to original Medicare, they may not be able to buy a Medicare Supplement policy.

​The best time for your client to get a Medicare Supplement policy is during their six month Medigap Open Enrollment Period. During that time they can purchase any Medicare Supplement policy sold in their state, even if they have health problems. This period starts the first month they have enrolled in Medicare Part B and they're age 65 or older.

There are many details to consider, before jumping off their current coverage. However, there are options if their current plan is not a good fit.

By Carolyn Portanova

​Dual Eligible Special Needs Plans, also known as D-SNPSs, are special Medicare Advantage plans for those who are receiving both Medicare AND Medicaid assistance. These plans extend their Medicare coverage and help coordinate care and benefits between Medicare and Medicaid. They can ultimately provide the most comprehensive, affordable coverage for these individuals.

​These plans cover the same health care services that traditional Medicare Advantage plans cover, including Medicare Parts A and B and they also include prescription drug coverage. Many D-SNPs also offer Dental, Vision and Hearing coverage, Personal Emergency Response Systems (PERS), tele-health options, fitness and gym memberships, OTC (Over the Counter) cards (with prepaid credit to buy health products and groceries) and even transportation assistance. Many of these plans offer $0 premiums making them highly attractive to those with limited incomes. 

Individuals who are eligible for D-SNPs are a diverse group of people that can include those with multiple chronic conditions, physical disabilities, mental illnesses, cognitive impairments and developmental disabilities. It can also include individuals who are relatively healthy. These individuals typically require assistance managing their care, which is where the care coordination of these plans is hugely beneficial for them.
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Who pays for what and how does it all work? With most Medicare Advantage plans, your client pays a portion of the plan cost out of pocket. With a D-SNP, Medicare and Medicaid pay most or all of the costs. Medicare is the primary payer for care services. State-run Medicaid then steps in by providing assistance with Medicare premiums and cost sharing and also covers some services that Medicare does not cover, such as Long-term care services.

This is a very under-served market and there is no shortage of potential clients who could benefit from a Dual Special Needs Plan.

If you have clients that are currently enrolled in both Medicare and Medicaid programs, discuss the benefits of enrolling them in a D-SNP. There are a variety of D-SNPs available. Some are Health Maintenance Organizations programs and some are Preferred Provider Organizations programs. These plans vary by state and by insurance carrier, so it's important to research plans in your client's area thoroughly before enrolling them. Premiums, copayments, coinsurances, and deductibles also vary depending on the plan.

You can enroll clients during their Initial Enrollment Period, during the Medicare Annual Enrollment Period (October 15th - December 7th), during the Medicare Advantage Enrollment Period (January 1 - March 31) or during a Special Enrollment period: January–March, April - June or July - September, if they have a qualifying event which allows them to do so. To learn more about the different enrollment periods, visit CMS.gov or Medicare.gov.

If you're looking to find potential D-SNP prospects, you're likely to find them in low income housing communities, senior centers, churches, and certain retirement communities. Volunteering at food banks, charity events and community centers is a good way to reach out and help those who may be eligible.

If you have questions about Dual Special Needs Plans or need help offering them, please reach out to us.

By Carolyn Portanova

Over 4 million Medicare beneficiaries pay income-related adjustment amounts (IRMAA) for their monthly Part B and Part D premiums due to their higher income levels. Most beneficiaries don't pay Part A premiums because they (or their spouse) worked for at least 10 years and paid Medicare taxes. However, people who do buy Part A will pay a premium of either $274 or $499 each month in 2022 depending on how long they or their spouse worked and paid Medicare taxes.

The standard monthly Part B premium for 2022 will be $170.10, which is what most Medicare beneficiaries will pay. For higher earners, that amount will range from $238.10 - $578.30, depending on their income level.

​Part D surcharges next year will range from $12.40 to $77.90 (that’s in addition to any Prescription Drug Plan premium they may pay as well).

These surcharges are based on your clients' tax returns from two years prior - which may not accurately reflect their current financial situation.

If your clients' income has changed significantly, they can appeal those income-related adjustment amounts by completing the Social Security Administration's Life Changing Event form AND by providing proof that their income has changed, which can include:

• A more recent tax return
• A letter from their former employer stating they've retired
• Current pay stubs

​Talk to your clients if they've recently retired or had a change in income. They may qualify for lower Part B and Part D premiums.

Learn more about Medicare costs by visiting Medicare.gov/your-medicare-costs

By Carolyn Portanova

You may have heard the terms: Part B giveback, reduction or rebate. Do you know what that means or how it works for your clients?
 
The give-back benefit is another term for Part B premium reduction. This is when a Medicare Advantage plan reduces the amount your client pays towards their Part B monthly premium. These givebacks are offered by some Medicare Advantage plans and are designed to make plans even MORE affordable. The amount of the givebacks can range depending upon the plan and location. They can be as low as $20 and some plans offer more than $100 in giveback rebates. ​

How it Works:
If a beneficiary is on Social Security, the Part B premium comes out of their monthly benefit before it hits their bank account OR it's reflected in their monthly check. The giveback reduces their Part B premium, which means more money ends up in the individual’s bank account. 

If your client pays their Part B premium directly (not by automatic Social Security check deduction), their Part B premium statement will be updated with the giveback amount credited to what they owe. The standard Part B premium for 2021 is $148.50. This amount changes yearly and is based on income. Learn more.

Example:
​If a beneficiary's monthly Social Security check is normally $1600 and their giveback is $100, their Social Security benefit will now be $1700. If they pay the standard Part B premium ($148.50) the amount they will owe after receiving the giveback will be $48.50.

Part B givebacks can offer Medicare beneficiaries yet another way to save money by choosing a Medicare Advantage plan. ​​

To be eligible for this program your client must be responsible for paying their own Part B premium, which means they are NOT eligible to receive Medicaid or participate in a Medicare Savings Plan. 

​As always, it's important to make sure the Medicare Advantage plan fits your client's needs and budget. It's also crucial to make sure it includes access to the doctors and hospitals they need, as well as making sure their prescription drugs are on the plan’s formulary.​

By Carolyn Portanova and Crystal Kominski