What You Need To Know About Medicare: Part 2

Danielle Roberts of BoomerBenefits.com is back again this week, talking with Devin about more Medicare issues. Danielle is an expert on Medicare supplements and Medicare Advantage plans, and runs the Boomer Benefits company to help seniors with their Medicare needs. In last week’s episode, Danielle and Devin talked about the parts of Medicare, the difference between a Medicare supplement and a Medicare Advantage plan, and how to find the right agent and product for you.

The Various Timeframes

Each year, there is an Annual Election Period that runs from October 15th to December 7th. This is when you can make enrollments, changes, and disenrollment for Part D and Medicare Advantage plans. The reason that there is an open enrollment period is because people need to be encouraged to purchase the plan BEFORE they need the coverage, and also because the Part D and Medicare Advantage plans will have changes each year.

With an Advantage plan, is your health considered during the enrollment period? The only condition that will disqualify you from enrolling in an Advantage plan during a valid election period is end-stage renal disease.

The initial enrollment period for Medicare is from three months before your 65th birthday through three months after your 65th birthday. If you fail to enroll in Medicare during the initial enrollment period, there is a general enrollment period from January 1st to March 31st each year, then your coverage will start in July and you will owe in a penalty for enrolling late, unless you are still covered by an employer plan.

What if you’re still working when you are 65? If you work for an employer that has more than 20 employees, and you have group health insurance through that employer, you can delay enrolling in Part B and Part D because your employer health care is primary. Then later, when you retire, you would then enroll in Part B in what Medicare calls a special election period or special enrollment period. You have 8 months to add Part B with no penalty, and you have 63 days to add part D with no penalty. Devin points out that this doesn’t apply to a COBRA plan – COBRA is not creditable coverage, so you want to add that Medicare Part B before the 8 month period is up.

These rules also apply to spouses who are covered under their husband or wife’s employer’s group plan.

If you work for a smaller employer, that has less than 20 employees, then your Medicare coverage is primary. In this case, you want to enroll in Part B and Part D when you turn 65.

There is  rule that some folks may not know about because it went away and now it has come back: it is called an open enrollment period, from January 1st to March 31st, during which you can drop your Medicare advantage plan and return to original Medicare, or you can make a one-time switch to a different Medicare advantage plan. Now, if you switch back to original Medicare, and you want to add a supplement, you may need to answer those health questions. Danielle recommends that you apply for, and get approved for, the Medicare supplement before disenrolling from the Medicare advantage plan.

The Income Related Monthly Adjustment Amount

The Income Related Monthly Adjustment Amount (IRMAA) is a surcharge on Medicare Part B premiums for higher income beneficiaries. The first tier starts at $85,000 in income for an individual, and $170,000 for a married couple. If your income exceeds that threshold, you’ll pay more for Medicare Parts B and D. As your income increases, the surcharge increases.

If you have one year of extra income, then the premiums will go back down in the following year. This happens automatically; there’s nothing that you have to do.

Danielle points out that you can file a reconsideration request with Social Security if you have

Danielle Roberts is from BoomerBenefits.com, they also have a Facebook page and a Facebook group, and a YouTube channel. They also have a Medicare 101 webinar, where you can learn more about Medicare basics.

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