The Resource Blog
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:
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.
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:
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.
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.
CMS has announced that Part B premiums will rise in 2017. 70% of Medicare beneficiaries will have their premiums increase from ~$105/month to $110/month. However, the remaining 30% will face a 10% increase in their base premiums. The 6% of beneficiaries who pay a high income surcharge will pay an additional 10% increase in that surcharge, on top of their Part B premiums.
All Social Security recipients will receive a 0.3% cost of living increase for 2017. A meager increase to say the least, but better than getting nothing at all, which was the case in 2016.
70% of recipients fall under a hold harmless provision implemented back in 1987 which is designed to keep their net checks from diminishing. So for those retirees who have their Part B premiums deducted from their Social Security checks, the premium cannot go up in any given year by more than the extra dollars that they're receiving as a cost of living adjustment.
The remaining 30%, who are well off and who don't have their premiums withheld from their SS checks, are the unlucky recipients of the rising costs that are deflected from those that fall under the hold harmless provision.
The numbers sound abysmal, but in light of what could have happened, they're not nearly as exorbitant as they could have been. Last year Congress voted to keep the increase to 16% for the 30% who pay the surcharge (rather than the proposed 52%). Next year's increase was proposed to be 22% which Congress has knocked back to 10%.
The costs are staggering, and the issue isn't going to resolve itself anytime soon as seniors continue to live longer, and the cost of care continues to climb.
By Carolyn Portanova
1480 Chapel Ridge Road
Apex, NC 27502
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