TRUE OR FALSE: “I don’t need to think about Medicare until I’m 65 or retired since that’s when I become eligible.”
FALSE. Please tell us you answered FALSE.
Medicare is a federal health care program that is regulated by CMS (Centers for Medicare & Medicaid Services) and with that, comes a lot of important guidelines to follow. And breaking these rules can result in much more than a slap on the wrist. We’re talking financial penalties that can stick with you indefinitely. Forever. Or worse, make you ineligible for coverage.
Medicare is typically available to people at age 65 or retired, but is also offered to those under 65 if disabled or suffering from End-Stage Renal Disease/permanent kidney failure.
Here are a few scenarios that could get you a not-so-nice penalty:
- Your group employer does not provide sufficiently credible coverage OR you enroll in Medicare but don’t think you need Part D because you aren’t currently taking any medications.
- Result: Part D penalty that gets tacked on to your premium when you do obtain the correct coverage & will stay on forever. As of now, this is 1% of the base beneficiary premium for every month after age 65 that you didn’t have it.
- How to avoid: Enroll in even a low premium Part D plan, regardless if you need it at the moment or not.
- Your employer has fewer than 20 employees & you didn’t sign up for Part B since you’re still working.
- Result: You could have major coverage gaps you aren’t even aware of.
- How to avoid: Enroll in Parts A&B at age 65 if still working with 20 or fewer colleagues.
- You’re still working & contributing to your HSA account.
- Result: You are at risk for being assessed a tax penalty.
- How to avoid: Stop contributing to your HSA 6 months prior to Medicare eligibility. You can still use the funds in that account for deductibles, copays or coinsurance but you cannot add any more money to it.
- You elected COBRA coverage at the time of retirement but didn’t enroll in Part B.
- Result: COBRA is now secondary to Part B so you must enroll in Part B in order to not have a coverage gap.
- How to avoid: If you already have Medicare, you can get COBRA…. But if you become Medicare eligible while on COBRA, you cannot keep it. Most importantly, losing COBRA does NOT qualify as a Special Enrollment to get Part B.
So much of this is situational and really depends on your personal circumstance. We are happy to discuss this individually and help determine exactly what you need to do and when.
How does Medicare work if I’m eligible but still working? What if I’m also drawing social security? How does my spouse fit into all of this?
Medicare can seem like an overwhelming and intimidating time but it doesn’t have to be. A big part of the confusion and nervousness is regarding when you’re eligible but still working and how social security and your spouse can be affected. Here are a few of the most common questions surrounding this:
- What if I’m turning 65 but still working? If you’re still working full time for a company with twenty or more employees, you are not required to enroll in Medicare Part B upon turning 65. You can wait until you retire. However, if the company you work for has less than twenty employees, you may be required to go ahead and enroll in Part B. Keep in mind, Part A is automatic and has no premium, but Part B almost always does have a premium associated with the coverage, depending on your income. You can still remain on the employer-provided group plan if you prefer.
- What do I need to do if I’m still working and also drawing social security? If you turn 65, are working, and already drawing from your social security, you will be automatically enrolled in both Parts A and B, and the premium for Part B will be deducted from your social security. If you decide to come off of your employer’s group plan to go on a Medicare supplement, you can elect whether or not you’d like the Part D prescription coverage to be deducted from your social security as well.
- What if I’m retiring but my spouse isn’t 65 yet? Your employer may offer a group retirement plan that your spouse can remain on but most times, they will need to get an individual health plan in place for themselves when you go on Medicare.
A lot of this is very situational and handled case by case. We are always happy to discuss those specific circumstances with you or you’re welcome to join one of our quarterly Medicare seminars as well. Please contact us at firstname.lastname@example.org or (352)371-7977 if we can be of assistance.
Approaching 65 or retirement can be a time of celebration, but also a time of confusion and overwhelm when it comes the transition from health insurance to Medicare. There are Parts A and B original Medicare, then what’s referred to as Part C for Advantage Plans, but also Supplements and Part D Prescription Drug Plans. It’s a lot, right? Although it sounds like an alphabet soup puzzle, it doesn’t have to be over complicated. Let’s focus on the Part D Prescription Drug coverage for now. This is sold by private companies, in addition to the medical coverage on a Supplement, that goes with original Parts A and B.
How do I choose a Part D Plan?
- You can visit medicare.gov and select the tab titled “Drug Coverage (Part D)”. If you are going the route of an Advantage Plan, there will be Part D coverage built into that plan. But if you’re opting for a Supplement, such as the ever-so-popular Plan F with Florida Blue, you’ll need a separate Part D Plan.
- This Part D section of medicare.gov is a great tool to compare plans that are specifically offered in your zip code. You can also look up actual medications in their formulary to see what your cost would be, based on what plan and pharmacy you prefer.
- As you compare coverage, you may see things like copays and coinsurance that apply to certain drugs. There is also a coverage gap referred to as the “donut hole”. In 2019, the guideline is that once you and your drug plan have spent $3,820 on covered medications, you enter the “donut hole”. Once in that coverage gap, you’ll pay no more than 25% of the plan’s cost for covered brand-name drugs. In 2019, Medicare will pay 63% of generic drugs during this time as well.
When can I enroll?
- Time frames to consider: You can choose and enroll in a Part D plan within the same 7 month window as regular Medicare…. 3 months before your 65th birthday month until 3 months after. Outside of that period, the late enrollment penalty will apply. And if your health status or prescribed medications happen to change throughout the year, you can switch Part D Plans during open enrollment, which begins October 15th, 2019.
What if I don’t enroll on time or choose not to have a Part D Plan?
- It is advised that even if you don’t currently take any regular medications, still enroll in some sort of Part D coverage to avoid the late enrollment penalty. The current penalty fee in 2019 is 1% of the “national base beneficiary premium” of $33.19 times the number of full, uncovered months you didn’t have Part D or creditable coverage once becoming eligible. The monthly penalty is then rounded to the nearest $.10 and added to your monthly Part D premium…. Forever.
- Keep in mind that your health can change or decline quickly and the cost of prescription medications are at an all-time high. It’s more important than ever to have Part D coverage and it’s worth every penny to avoid astronomical out of pocket expenses and the forever-haunting penalty that comes from going without.
This can all seem very complicated so it’s really best and most accurate if you look up your specific medications and compare plans based on your actual needs. We are always happy to help guide you through this process and make recommendations or answer questions anytime.
Yes, it’s April 1st but don’t be fooled!
If you’ve ever heard “Be your own advocate!” when it comes to health care, or ever been in a situation where that would apply… you know how true it is. Things are happening in health care. Big things. And while some of them are huge innovations, strides with technology and more knowledge than medical professionals ever dreamed of… there’s still a bit of a dark side that the average consumer needs to be aware of. Billing. Womp womp.
Now before this gets misconstrued as a negative connotation of doctors, nurses, hospitals or anything else specific to the medical world, we are not by any means speaking generally or negatively about all things health-related. This is simply a warning to patients to pay attention.
Here are some quick stats from a healthline study to ensure that we are providing facts rather than opinions on this:
- Up to 80% of medical bills have errors
- Nearly 1/3 of Americans learn that their health insurance doesn’t pay what they expected
- 59% of the time Americans are contacted by debt collectors is for an outstanding medical bill
- 16% of Americans’ credit report includes medical debt totaling over $80 billion
Instead of pointing the finger at medical professionals or facilities for over charging, let’s discuss a few ways you can prevent being on the receiving end of those not so fun surprise charges:
- Speak up. If you don’t understand a procedure, diagnosis, treatment plan or medication, find your voice and use it. Ask questions. Make notes. Do some research. You know your phone is close by, look it up online and educate yourself. Yes, you should trust the licensed and very well educated professional that spent a lot of time in school to do this for a living but understand what they’re telling you and be sure you’re on board.
- Price shop. Find out if certain facilities perform procedures for less and why. This is common with teaching hospitals. This also applies heavily to prescription drugs. Don’t just use the pharmacy closest to your house because it’s convenient and they have a drive-thru. Look at goodrx.com or call around to others to see what their cost is. Now obviously, keep in mind that if you have health insurance, there may be certain pharmacies they work with or providers that are in or out of their network. But don’t just default to the most popular or most convenient. Your wallet will thank you.
- Request details. Ask for an itemized bill/Explanation of Benefits. Keep documentation for your records. Don’t just pay whatever you’re told without knowing what exactly it’s for.
- Channel that feisty preteen 7th grader in debate class that we know is still in you and fight for yourself. It might amaze you at how much health care providers are willing to negotiate if you can come to an agreement of either a payment plan, pay in full discount or overall reduction if it can be justified.
Your health is not a game and you can’t put a price on a medical necessity… so you should by all means get the best care possible. However, a little awareness and self-advocacy can go a long way and may even help facilitate a more proactive approach to good health… now that you’ll be able to afford it.
Another year’s gone by and it’s time to file your taxes again. But what do these 1095 forms mean? What we said in our tax form blog last year still stands true. To refresh your memory, visit our site here for some good information on the various 1095 forms: https://mcgriffwilliams.com/blog/1095-tax-forms/ or even another one we did prior to that: https://mcgriffwilliams.com/blog/health-insurance-tax-forms/.
Good stuff, right? That was all pertaining to individual under 65 health plans. When it comes to Medicare, there are so many glorious things that happen when you’re finally eligible to switch over. Yes, you’re another year older but these days, many people look forward to that birthday in particular. Your health insurance rates typically go down when you transition from an individual plan and the coverage may even get better. It’s a great system that seems to run very smoothly.
There is one thing that you may not know though… you’ll still get those aforementioned tax forms in the mail. If you’re on Medicare, whether it be an Advantage plan or a supplement, you may still receive a 1095 form. The only difference now is that you aren’t required to submit it when you file your taxes. Hold on to this form for future reference if needed, it’s really just for your records.
Things are ever-changing in the health insurance and income tax world so if you ever have questions or concerns, we are happy to help. Give us a ring at (352)371-7977 or email email@example.com.