Medicare open enrollment begins October 15th & ends December 7th
1 – If you’re ready for Medicare, you should first learn about the different parts of it:
Medicare Part A covers inpatient hospital stays, skilled nursing facility care, hospice care, and some aspects of home health care.
Medicare Part B covers doctor visits, outpatient care, preventive services, and medical supplies.
2 – Find out when you are eligible to enroll:
Just like regular individual health insurance, there are only specific times when people can enroll in Medicare. Your Initial Enrollment Period takes place within a 7-month time period – it starts 3 months BEFORE the month you turn 65, occurs DURING the month you turn 65, and ends 3 months AFTER the month you turn 65. For example, if you turn 65 on June 8th, your enrollment period begins in March and ends in September.
If you decide not to enroll when you first become eligible, you could potentially pay an enrollment penalty and have a gap in coverage.
3 – Decide: Part A & B or just Part A
Most people paid Medicare taxes while they worked so there is no monthly premium charge for Part A. Even if you have health insurance from an employer, most people should still enroll in Part A when they turn 65. In some cases, people may decide to wait on getting Part B – it depends on the type of health insurance they currently have. If you do decide to enroll in Part B, the monthly premium can vary depending on your income, but most people will pay $135.50, which is the standard premium amount as of 2019.
4 – Part A & B:
If you decide to enroll in both Part A and Part B, you have the option of getting Original Medicare (like an HMO) OR a Medicare Advantage Plan (like a PPO). There is also the option to enroll in additional coverage like a Medicare prescription drug plan or Supplemental Insurance, also known as “Medigap.” Those that are still working and have employer-sponsored health insurance don’t need to add these on.
5 – Get enrolled!
If you are automatically enrolled in Part A, you will get your new Medicare Card 3 months before your 65th birthday or if you are on disability, you will receive it the 25th month you have been on disability. If you are not enrolled in Medicare automatically, you will need to apply for it. Ask us how here!
6 – Keep in mind…
Medicare prescription drug coverage can vary by cost, the type of coverage, quality, and convenience. Keep the following in mind when considering your Medicare drug coverage options:
- Do you take specific drugs?
- Are your prescriptions high in cost?
- Do you take a lot of generic prescriptions?
- Are you not currently taking any prescribed drugs but want extra coverage in case you need it?
- Do you already have prescription coverage on one plan and understand the restrictions regarding that coverage?
7 – What to take care of during your first year on Medicare:
- Complete an Authorization Form if you would like to give your friends or family permission to call Medicare and discuss your information/coverage on your behalf.
- Use your initial preventive visit appointment that you are granted once you enroll in Medicare. It is a free, one-time appointment that provides a comprehensive look at your current health and initiates any necessary health related discussions.
- To access your personal Medicare information at any time, sign up for an account at www.MyMedicare.gov – throught this site, you can track claims, view summary notices, order a new Medicare ID card if you lost yours, check the status of your Medicare Part B Deductible, view information about your eligibility, track preventive services, and search for and find information about your plan and prescription drug coverage.
- Become familiar with what Medicare actually covers. You will receive a list of all the services, tests, and items that are already covered on your plan. If what you are looking for isn’t listed, you should discuss your needs with a provider and ask if Medicare will cover it.
- Choose whether you’d like to receive paperless communications so you can receive PDF versions of your annual “Medicare & You” booklet.
Most individuals qualify for Part A, also referred to as “premium-free Part A.”
If you do not qualify for premium-free Part A, you may need to pay a monthly premium of $437. Anyone who paid for Medicare taxes less than 30 quarters would need to pay this standard premium. For those that paid Medicare taxes between 30 – 39 quarters, the monthly premium for Part A is $240.
For the most part, if you decide to buy Part A you must also purchase Medicare Part B (Medical insurance) and pay premiums for both parts.
- Skilled nursing facility care
- Inpatient hospital care & in a skilled nursing facility
- Home health care
- Hospice care
If you need other types of supplies and services you should discuss your needs with your doctor and ask if Medicare will cover them.
- Services that are considered “medically necessary” such as supplies or services needed for diagnosing or treating a medical issue
- Preventive services
- Ambulance services
- Durable medical equipment
- Second opinions before a surgery
- Some outpatient prescription drugs
- Mental health – inpatient, outpatient, partial hospitalization
Part B premiums
You pay a premium each month for Part B. Your Part B premium will be automatically deducted from your benefit payment if you get benefits from one of these:
- Social Security
- Railroad Retirement Board
- Office of Personnel Management
If you don’t get these benefit payments, you’ll get a bill.
Most people will pay the standard premium amount. If your modified adjusted gross income is above a certain amount, you may pay an Income Related Monthly Adjustment Amount (IRMAA). Medicare uses the modified adjusted gross income reported on your IRS tax return from 2 years ago. This is the most recent tax return information provided to Social Security by the IRS.
The standard Part B premium amount in 2021 is $148.50. Most people pay the standard Part B premium amount. If your modified adjusted gross income as reported on your IRS tax return from 2 years ago is above a certain amount, you’ll pay the standard premium amount and an Income Related Monthly Adjustment Amount (IRMAA). IRMAA is an extra charge added to your premium.
|If your yearly income in 2019 (for what you pay in 2021) was||You pay each month (in 2021)|
|File individual tax return||File joint tax return||File married & separate tax return|
|$88,000 or less||$176,000 or less||$88,000 or less||$148.50|
|above $88,000 up to $111,000||above $176,000 up to $222,000||Not applicable||$207.90|
|above $111,000 up to $138,000||above $222,000 up to $276,000||Not applicable||$297.00|
|above $138,000 up to $165,000||above $276,000 up to $330,000||Not applicable||$386.10|
|above $165,000 and less than $500,000||above $330,000 and less than $750,000||above $88,000 and less than $412,000||$475.20|
|$500,000 or above||$750,000 or above||$412,000 or above||$504.90|
The standard Part B premium amount in 2022 is $170.10. Most people pay the standard Part B premium amount. If your modified adjusted gross income as reported on your IRS tax return from 2 years ago is above a certain amount, you’ll pay the standard premium amount and an Income Related Monthly Adjustment Amount (IRMAA). IRMAA is an extra charge added to your premium.
|If your yearly income in 2020 (for what you pay in 2022) was||You pay each month (in 2022)|
|File individual tax return||File joint tax return||File married & separate tax return|
|$91,000 or less||$182,000 or less||$91,000 or less||$170.10|
|above $91,000 up to $114,000||above $182,000 up to $228,000||Not applicable||$238.10|
|above $114,000 up to $142,000||above $228,000 up to $284,000||Not applicable||$340.20|
|above $142,000 up to $170,000||above $284,000 up to $340,000||Not applicable||$442.30|
|above $170,000 and less than $500,000||above $340,000 and less than $750,000||above $91,000 and less than $409,000||$544.30|
|$500,000 or above||$750,000 or above||$409,000 or above||$578.30|
- Routine foot care
- Cosmetic surgery
- Hearing aids and exams fitting them
- Most dental services
- Eye exams to prescribe glasses
- Long-term care/Custodial care
If you enrolled in Medicare through Social Security, you will need to contact Social Security to discuss dropping Part B.
If your Medicare coverage is already in effect and you would like to cancel Part B, you will need to contact Social Security and have them advise you on how to send them a signed request that states your request to terminate coverage. Once this signed notice has been submitted, your coverage will terminate the first day of the month after Social Security receives it.
*Make sure you understand how choosing not to enroll in Part B may affect you as it varies depending on individual situations.
If you are a federal retiree and have an annuity from Office of Personnel Management (OPM) and you are not eligible for Social Security or RRB benefits, you can request for your Part B premiums to be deducted from your annuity by calling 1-800-MEDICARE.
If you are experiencing financial hardship and need help paying your Medicare premiums, your state could potentially help with payments.
If you do not receive Social Security benefits , RRB, or Civil Service benefits and you only enroll in Part B, you will receive a bill every 3 months.
If you purchase Medicare Part A OR you owe for Part D IRMAA, you will receive a bill every month.
You can pay for your bills in the following ways:
- Contact your bank to learn what information you need to pay directly from your bank account through your bank’s online bill payment option.
- Enroll in automatic payments with “Medicare Easy Pay” to have your premiums taken out of your savings or checking account automatically every month. Payments are usually deducted on the 20th of the month.
- Pay by debit or credit card – When you receive bills, you may provide your credit card information in the credit card area. Account information will need to be written legibly and accurately in order for the payment to be processed. Mail the payment information to the address below.
- Mailing a check or money order to the following address:
- Medicare Premium Collection Center – PO Box 790355 – St. Louis, MO 63179-0355
Keep in mind this amount can change every year. If it is determined you have to pay a higher amount and you do not agree with this determination (e.g. if your income decreases), you can use the following for to contact Social Security – Medicare Income-Related Monthly Adjustment Amount – Life-Changing Event
Make sure you aware that if you enroll in Part D when you’re first eligible for it, you will only pay your Part D premium. If you enroll late, you may have to pay a penalty in addition to that premium as mentioned in the next FAQ below.
Looking at the chart below, you can see estimated prescription drug plan monthly premium costs based on different income brackets:
|If your filing status and yearly income in 2017 was|
|File individual tax return||File joint tax return||File married & separate tax return||You pay each month (in 2019)|
|$85,000 or less||$170,000 or less||$85,000 or less||your plan premium|
|above $85,000 up to $107,000||above $170,000 up to $214,000||not applicable||$12.40 + your plan premium|
|above $107,000 up to $133,500||above $214,000 up to $267,000||not applicable||$31.90 + your plan premium|
|above $133,500 up to $160,000||above $267,000 up to $320,000||not applicable||$51.40 + your plan premium|
|above $160,000 and less than $500,000||above $320,000 and less than $750,000||above $85,000 and less than $415,000||$70.90 + your plan premium|
|$500,000 or above||$750,000 and above||$415,000 and above||$77.40 + your plan premium|
|If your filing status and yearly income in 2018 was|
|File individual tax return||File joint tax return||File married & separate tax return||You pay each month (in 2020)|
|$87,000 or less||$174,000 or less||$87,000 or less||your plan premium|
|above $87,000 up to $109,000||above $174,000 up to $218,000||not applicable||$12.20 + your plan premium|
|above $109,000 up to $136,000||above $218,000 up to $272,000||not applicable||$31.50 + your plan premium|
|above $136,000 up to $163,000||above $272,000 up to $326,000||not applicable||$50.70 + your plan premium|
|above $163,000 and less than $500,000||above $326,000 and less than $750,000||above $87,000 and less than $413,000||$70.00 + your plan premium|
|$500,000 or above||$750,000 and above||$413,000 and above||$76.40 + your plan premium|
Note: The above charts were taken from the following site – Medicare.gove Monthly premium for drug plans
*The penalty is calculated by multiplying 1% of the “national base beneficiary premium” ($32.74 in 2020 and $33.06 in 2021) by the number of months you were fully without Part D or creditable coverage. This amount is rounded to the nearest $.10 and added on to your monthly premium for Part D.
*Information taken from the following site – Medicare.gov
- PREVIOUS California Birthday Rule:
- A member could have submitted an enrollment prior to the month of his or her birthday, during the month of his or her birthday, or the month after his or her birthday
- For members with a March 30th birthday –
- Member could have submitted his or her enrollment during February with possible effective dates of March 1st, April 1st, or May 1st
- Member could have submitted his or her enrollment during March with possible effective dates of April 1st, May 1st, or June 1st
- Member could have submitted his or her enrollment during April with possible effective dates of May 1st, June 1st, or July 1st
- Member could have upgraded to a more comprehensive plan during this time (i.e. N to G)
- NEW California Birthday Rule:
- A member can now submit his or her enrollment 30 days prior to their actual birthday
- A member can now submit an enrollment 60 days after his or her actual birthday
- March 30th birthdays –
- Members can submit enrollments starting Feb. 28th or 29th for an effective date of March 1st, April 1st, or May 1st
- Members can submit enrollments in March for an effective date of April 1st, May 1st, or June 1st
- Members can submit enrollments in April for an effective date of May 1st, June 1st, or July 1st
- Members can submit enrollments in May as long as it is within 60 days of the actual birthday for an effective date of June 1st, July 1st, or August 1st
- Members can change to a plan of equal or lesser value at this time