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When to Enroll
It depends on the number of employees at your company.
It depends on the number of employees at your Spouse's company. The same Medicare Secondary Payer rules apply as mentioned in the question above, based on the number of employees at the company that is providing the Group Health Insurance (e.g. Spouse's company, in this case).
When you become Medicare-eligible, you are no longer able to be enrolled in the Individual pre-65 Health Plan. So, you will need to enroll in Medicare Parts A & B when you become eligible for Medicare.
How To Enroll
In this example, if you enroll in Social Security benefits (and not Medicare), you will be automatically enrolled in Medicare Part A, and the Part A effective date will be back-dated up to 6-months. This is important if you are still working and are contributing to a Health Savings Account (HSA), because you are no longer able to contribute to an HSA after you are enrolled in Medicare Part A. Any HSA contributions would be considered excess contributions which could be taxed and penalized.
The simplest way to enroll in this situation is directly online at the Social Security website. You can use the following link and it should only take about 5-10 minutes. https://ssa.gov/benefits/medicare/. Another option would be to call Social Security to enroll in Medicare, 1-800-772-1213 but you could have wait times as long as 1 hour or more depending on the time of year.
There are a couple of different ways to enroll in this scenario. With either option, you need to show proof that you were covered on the Group Health Plan since you were age 65 to avoid any penalties or delays in your Part B coverage.
Medicare Costs
It depends on a number of factors (age, income, sex, zip code, and more), but most people end up paying about $300/month. There are three main premiums for most people: Part B, Medigap aka Medicare Supplement, and Part D.
There is no fee to work with Senior Advisors. We are compensated by the Insurance Company if we help you enroll in a Plan. We work with all the A-Rated insurance companies including Aetna, Mutual of Omaha, Cigna, BCBS, and more. You will pay the same premium if you enroll directly with the Carrier or if you work with a broker like Senior Advisors. Also, we provide a FREE annual review of the Part D Drug Plans for all of our clients as well.
IRMAAS
If your income will still be in a higher income bracket, yes you will have to pay IRMAAs for Part B and Part D to the federal government. If your income will no longer be in the same income bracket due to a life event (e.g. Work Stoppage, Work Reduction), you can appeal the IRMAAs using the SSA-44 form.
The government is using your MAGI (Modified Adjusted Gross Income) from the last tax return the government has processed. For most people, MAGI is the same as your AGI (Adjusted Gross Income), but MAGI can be higher because tax-exempt interest gets added back in.
The income brackets for the IRMAAs are determined based on how you file your tax returns. So, if you file a joint tax return, you and your spouse will pay the same IRMAA regardless of which one of you is generating the income.
The IRMAA letter generally arrives about 3-4 weeks after you enroll in Medicare Part B. You should start the appeal process after receiving the IRMAA letter.
You will both still need to appeal the IRMAA.
Most people won't have any proof/documentation to provide so the SSA-44 form basically indicates that the government will accept your signature as your proof. Per SSA-44, "In the absence of such proof, we will accept your signed statement, under penalty of perjury, on this form, that you partially or fully stopped working or accepted a job with reduced compensation."
Generally, it only takes a few weeks to process and your first bill should NOT include the IRMAAs if you appeal in a timely fashion.
If you appealed your IRMAAs based on a projected lower income tier, and your income actually comes in at a higher income tier (than you appealed down to), the government will come back at you for the incremental IRMAAs after they process your tax return.
If you are in a higher income bracket, you will receive a letter each December (based on your income return from the prior year's income) that explains the IRMAAs you will need to pay for the following year. For example, in December of 2023, the government is using the 2022 Tax return (latest one they have) to determine your 2024 IRMAAs. So, it is possible, you may have to appeal the IRMAAs twice because the IRMAA determination (e.g. 2024) will be based on a tax return from two year behind (e.g. 2022 income).
Medicare Supplements vs. Medicare Advantage
These commercials are for Medicare Advantage Plans, which is the fully privatized Medicare option that replaces your Original Medicare coverage. If you sign-up for Medicare Advantage, you are no longer on Medicare. Here is a link to a video that explains the differences, and below you will find the high-level differences between Medicare Advantage and Original
Medicare with a Medicare Supplement:
Your friend has a Medicare Advantage Plan (not a Supplement) if he/she is paying $0/month. We can help with Medicare Advantage Plans or Medicare Supplements, but you should be aware of the key differences between the two paths mentioned above.
Part D of Medicare
There are two reasons we recommend Part D Coverage even if you aren't taking any drugs:
Every Part D Plan has to cover at least two drugs in each therapeutic category so there is a high probability that any Part D Plan you select will cover the medication you are prescribed in the middle of the year. Additionally, there is a possibility that the copay for the specific drug could actually be lower on the "cheap Part D Plan" versus a higher premium Part D Plan. Finally, you get an opportunity every year (between October 15 - December 7 during the Annual Enrollment Period) to review and update your Part D Coverage for the following year. We send out a reminder every September to get your latest drug information so we can review your Part D Plans for the following year during the Oct 15 - Dec 7 AEP.
There is a tool available on Medicare.gov called the Medicare Plan Finder. This tool allows you to search for the most cost-effective Part D Plan based on a specific list of medications which can be entered in the tool. Here is a link to a short video that explains how to find the most cost-effective Part D Plan.
What's Covered
Yes, Chiropractic care is covered under Part B of Original Medicare if the Provider participates in Medicare. If you do not have a Medicare Supplement, you would be responsible for 20% of the costs after the Part B deductible.
Yes, these outpatient services are covered under Part B of Medicare. If you do not have a Medicare Supplement, you would be responsible for 20% of the costs after the Part B deductible. (Or, if you have a Medicare Advantage Plan, you will be responsible for 20% of the costs up to the Maximum out of Pocket of $8,300.)
Medically necessary services like Cataracts, Glaucoma, Wet Macular Degeneration, and Diabetes related vision issues would be covered by Medicare Part B. If you do not have a Medicare Supplement, you would be responsible for 20% of the costs after the Part B deductible. Non-Medically necessary, Dental, Vision & Hearing services are NOT covered by Original Medicare. There are some individual plans available for these services.
Provider Networks
The answer will vary based on what coverage you enroll in.
Dental, Vision & Hearing
Medically necessary services like Cataracts, Glaucoma, Wet Macular Degeneration, and Diabetes related vision issues would be covered by Medicare Part B. If you do not have a Medicare Supplement, you would be responsible for 20% of the costs after the Part B deductible. Non-Medically necessary, Dental, Vision & Hearing services are NOT covered by Original Medicare. There are some individual plans available for these services.
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We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options. Not connected with or endorsed by the United States government or the federal Medicare program.
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