Tag Archives: healthcare

Medicare Medical (Part B) premium varies with income

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Medicare Medical (Part B) coverage helps pay for doctors’ services and outpatient care along with other services.  

Most people incorrectly think that the costs of providing Medicare Part B coverage are covered by the monthly Part B premium. 

Since its start, the Medicare Part B premium has been highly subsidized. The standard Part B premium paid by most people covers only about 25 percent of actual coverage cost, with the government paying the remaining 75 percent. In 2013, the standard Medicare Part B premium is $104.90 per month. 

Since 2007, a small percentage of higher income beneficiaries have paid a higher monthly Part B premium. This affects less than 5 percent of people with Medicare. Most people do not pay a higher premium. Higher Medicare Part B premiums start for individuals having a modified adjusted gross income (MAGI) above $85,000 or couples above $170,000. 

Using an income-based sliding scale based on the amount of modified adjusted gross income reported to the IRS, these premiums could equal 35, 50, 65 or 80 percent of the total premium cost. Increased monthly premiums can be appealed. In addition, if you pay an increased premium and your income has gone down because of the following reasons, an increased premium can be reviewed without an appeal. These reasons are:

  • You married, divorced, or became widowed;
  • You or your spouse stopped working or reduced your work hours;
  • You or your spouse lost income-producing property due to a disaster or other event beyond your control;
  • You or your spouse experienced a scheduled cessation, termination, or reorganization of an employer’s pension plan; or
  • You or your spouse received a settlement from an employer or former employer because of the employer’s closure, bankruptcy, or reorganization.

If any of the above applies, you will be asked for documentation verifying the event and the reduction in your income.

Higher-income beneficiaries with Medicare prescription drug coverage (Part D) also pay higher premiums.  

 More information is in the booklet “Medicare Premiums: Rules for Higher-Income Beneficiaries, online at www.socialsecurity.gov/pubs/10536.html.

General  Medicare information is at http://www.socialsecurity.gov/pgm/medicare.htm and at the official Medicare website, http://www.medicare.gov/.

 

What is Medicare Part D Extra Help?

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Q: What is Medicare Part D Extra Help?

A: Part of the Medicare prescription drug (Part D) program, the Extra Help low income subsidy can help pay for parts of Part D monthly premiums, annual deductibles and co-payments. If on Medicare, people receiving Supplemental Security Income (SSI) or medical assistance are automatically eligible for Extra Help. Estimated to be worth about $4,000 per year, you must be enrolled in a Medicare prescription drug plan to receive this Extra Help.

To apply, you must have Medicare Part A (Hospital Insurance) and/or Medicare Part B (Medical Insurance) and live in one of the 50 States or the District of Columbia. Applications can be completed at any time of the year. An easy way to apply for the Extra Help is through Social Security  online at www.socialsecurity.gov/prescriptionhelp/.

To qualify for the Extra Help, people must be receiving Medicare and have income limited to $17,235 for an individual or $23,265 for a married couple living together. Even if annual income is higher than these amounts, some help might still be possible if you support other family members who live with you, have earnings from work or live in Alaska or Hawaii. Resources are limited to $13,300 for an individual or $26,580 for a married couple living together. Resources include things such as bank accounts, stocks, and bonds but not your house or car.

Learn more or apply for Extra Help at www.socialsecurity.gov/prescriptionhelp/, by calling the SSA national number, 1-800-772-1213 (TTY 1-800-325-0778) or at your local office.

Applying for the Part D, prescription drug Extra Help low income subsidy does not enroll a person in a Medicare prescription drug plan. Social Security personnel cannot provide help you choose a prescription drug plan. More about Medicare prescription drug plans is at www.medicare.gov or call 1-800-MEDICARE (1-800-633-4227; TTY 1-877-486-2048).

Newest Annual Statistical Supplement now online

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The Annual Statistical Supplement, 2012 just became available online at http://www.ssa.gov/policy/docs/statcomps/supplement/2012/index.html.  

There is a massive amount of interesting information here, not just concerning Social Security retirement (old-age), survivors and disability insurance (OASDI), but also about other programs including Supplemental Security Income (SSI), Medicare, Medicaid, Unemployment Insurance, Workers’ Compensation, Black Lung Benefits, and Veterans’ Disability Benefits. Each Table of Contents topic has a link to that section in html or pdf formats.

Specific information provided depends on the topic. At approximately 528 pages in length, you will find something in the Annual Statistical Supplement, 2012 to interest you. The Supplement includes more than 240 statistical tables of comprehensive data on Social Security and Supplemental Security Income. Using Social Security as an example, topics include:

From the Highlights and Trends section, here are two interesting tidbits for you:  

“About 55.4 million persons received Social Security benefits for December 2011, an increase of 1,372,512 (2.5 percent) since December 2010. Sixty-nine percent were retired workers and their spouses and children, 11 percent were survivors of deceased workers, and 19 percent were disabled workers and their spouses and children.”

“OASDI benefit awards in calendar year 2011 totaled 5,567,020, including 2,577,647 to retired workers, 498,248 to their spouses and children, and 885,713 to survivors of insured workers. Benefits were awarded to 998,979 disabled workers and to 606,433 of their spouses and children.”

Again, more than just Social Security information is in the Annual Statistical Supplement, 2012. Enjoy.

What does Medicare cover?

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What does Medicare cover?

It surprises many people to learn that Social Security employees are not good sources of information about what Medicare covers.

Other than providing general information, the primary Social Security role concerning Medicare is to help people enroll in the program. The Centers for Medicare & Medicaid Services (CMS), a component of the Department of Health & Human Services  is the agency in charge of the Medicare program.

General information about Medicare is at available through the Social Security Administration website, www.socialsecurity.gov. The booklet, Medicare, (SSA publication 05-10043) provides an overview of the program and is a good place to start when learning about Medicare. Read it at http://www.socialsecurity.gov/pubs/10043.html  or get a copy from any Social Security office.

Here is some information from that booklet:

Medicare has four parts

  • Hospital insurance (Part A) helps pay for inpatient care in a hospital or skilled nursing facility (following a hospital stay), some home health care and hospice care.
  • Medical insurance (Part B) helps pay for doctors’ services and many other medical services and supplies that are not covered by hospital insurance.
  • Medicare Advantage (Part C) plans are available in many areas. People with Medicare Parts A and B can choose to receive all of their health care services through one of these provider organizations under Part C.
  • Prescription drug coverage (Part D) helps pay for medications doctors prescribe for treatment.

Detailed Medicare coverage information is in the annual publication Medicare and You. This official government booklet has a summary of Medicare benefits, coverage decisions, rights and protections, and answers to the most frequently asked questions about Medicare. The current version, Medicare and You 2013, is online at http://www.medicare.gov/Pubs/pdf/10050.pdf.

You can order a paper copy of Medicare and You 2013 from the publication section of the Medicare website, www.medicare.gov/publications. A paper copy can also be requested by calling the Medicare toll-free number, 1-800-Medicare (1-800-633-4227) (TTY 1-877-486-2048). 

2013 Medicare Part B premium information

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The Centers for Medicare and Medicaid Services (CMS) has announced that the standard 2013 Medicare Part B (Medical) premium will be $104.90 per month. Some people pay a higher premium.

The Centers for Medicare & Medicaid Services is the agency in charge of the Medicare program, even though you apply for Medicare at Social Security. 

More information about Medicare changes for 2013 is posted at http://blog.medicare.gov/2012/11/16/2013-medicare-update/.  You can reach this same information through www.medicare.gov.

Medicare age is still 65

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Even though Social Security full retirement ages (FRA) vary based on year of birth, it is important to remember that the age to begin receiving Medicare has not changed. It is still 65.  

Medicare is our country’s health insurance program for people age 65 or older. Certain people younger than age 65 can qualify for Medicare, too, including those who have disabilities and those who have permanent kidney failure.The program helps with the cost of health care, but it does not cover all medical expenses or the cost of most long-term care  

Even if waiting until after age 65 to apply for Social Security retirement benefits, most people start getting Medicare coverage at age 65.  

To begin your Medicare coverage when you first become eligible, apply within three months of reaching age 65, but definitely before the month you turn age 65, to avoid any delays in coverage.   

You can file your Medicare application online in as little as 10 minutes at www.socialsecurity.gov/medicareonly. Again, you can apply for Medicare even if not ready to retire.

More than just the online Medicare application is at the above website link. You will also find information about Medicare, and have the opportunity to watch some short videos about applying for Medicare online. One is a family reunion for the cast of The Patty Duke Show. In another, Patty Duke and George Takei go boldly where you should be going — online.

Using the online Medicare application is fast, easy, and secure. You do not need an appointment and you can avoid waiting in traffic or in line. If you have about ten minutes, you have time to complete and submit your online Medicare application.

People who started receiving Social Security retirement or disability benefits before age 65 do not need to apply for Medicare. They will be automatically enrolled in Medicare.

There is no additional charge for Medicare hospital insurance (Part A) since you already paid for it by working and paying Medicare tax. However, there is a monthly premium for medical insurance (Part B). Since there is a monthly premium for Part B coverage, there is an option of turning it down. 

If you already have other health insurance when you become eligible for Medicare, consider whether you want the Medicare medical insurance (Part B). In particular, this is important if you are covered under a group health plan, either from your own or your spouse’s current employment.  If this applies, you can delay Part B enrollment without penalty. Read more about this in the Signing Up for Medicare section of the booklet, Medicare.

To learn more about Medicare and some options for choosing coverage, read the publication, Medicare, at www.socialsecurity.gov/pubs/10043.html or available from any Social Security office. Coverage information is at www.medicare.gov.  

To learn more about applying for Medicare Only using the online application, visit www.socialsecurity.gov/medicareonly. If filing online is not for you, call the Social Security national toll-free number, 1-800-772-1213 (TTY 1-800-325-0778), or your local office to make an appointment.

Medicare changes for 2013 not yet announced

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Questions about potential change to the Medicare Part B (Medical) premium started coming in once the 2013 Social Security cost-of-living adjustment (COLA) was announced.  

As of today, Medicare premium and related Medicare information for 2013 is not yet available. When announced, the information will be at www.medicare.gov. 

Medicare premiums are established differently than Social Security COLAs. The Social Security cost-of-living adjustment (COLA) is based on the percentage increase in the Consumer Price Index for Urban Wage Earners and Clerical Workers (CPI-W) from the third quarter of the last year a COLA was determined to the third quarter of the current year.

The CPI-W is determined by the Bureau of Labor Statistics in the Department of Labor. By law, it is the official measure used by the Social Security Administration to calculate cost-of-living adjustments (COLA). If there is no increase in the CPI-W Consumer Price Index, there can be no COLA. Based on that measure, monthly Social Security and Supplemental Security Income (SSI) benefits will increase 1.7 percent in 2013. 

The 1.7 percent COLA will begin with benefits that more than 56 million Social Security beneficiaries receive in January 2013. Increased payments to more than 8 million SSI beneficiaries will begin on December 31, 2012. Overall, benefits will increase by the COLA amount. Since the exact computation is more complex, some individual variation will occur. 

Medicare Part B (Medical) premiums are established differently. Unlike the Social Security COLA, the CPI-W plays no part in the computation of the Medicare Part B premium. 

The Medicare Part B premium changes each year, if necessary, so that the premium is sufficient to fund approximately 25 percent of the projected cost of the Part B program. Any premium change is effective in January. When announced, the information will be at www.medicare.gov.  

Medicare is administered by the Centers for Medicare & Medicaid Services (CMS), a component of the Department of Health & Human Services (DHHS). 

On a different Medicare topic, remember that the Medicare Part D (Prescription Drug Coverage) open season is from October 15 to December 7, 2012. New plans begin January 1, 2013. Everyone currently enrolled in Medicare can purchase a Part D plan to help with prescription drug costs.  

Unlike Medicare Part A (Hospital) or Part B (Medical), Part D (Prescription Drug Coverage) is purchased through private insurers. You shop for the plan that best suits your personal needs. Joining a Medicare prescription drug plan is voluntary, and participants pay an additional monthly premium for the coverage. 

To compare plans, go to the Medicare website, www.medicare.gov, and select the Drug Coverage (Part D) link. Use the free Medicare Plan Finder to compare plans available in your state. Plan data for 2013 is already on the Medicare Plan Finder. The Medicare Part D (Prescription Drug Coverage) open season is from October 15 to December 7, 2012. 

 

Medicare Part D Extra Help

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The Medicare Part D (Prescription Drug Coverage) open season is from October 15 to December 7, 2012.  

As noted last week, even if you are completely satisfied with your existing Part D policy, the open season is an important time for you. You should review your plan coverage each year. A plan that previously fit your needs might not be your best choice now. 

Everyone currently enrolled in Medicare can purchase a Part D plan to help with prescription drug costs. Unlike Medicare Part A (Hospital) or Part B (Medical), Part D (Prescription Drug Coverage) is purchased through private insurers. You shop for the plan that best suits your personal needs. Joining a Medicare prescription drug plan is voluntary, and participants pay an additional monthly premium for the coverage. 

Although Social Security representatives cannot assist people in choosing a Medicare Part D plan, the agency does administer the Extra Help portion of Medicare Part D. While all Medicare beneficiaries can participate in the prescription drug program, some people with limited income and resources also are eligible for Extra Help to pay for part of monthly premiums, annual deductibles, and prescription co-payments. The Extra Help is estimated to be worth about $4,000 per year. Many people qualify for these big savings and do not even know it. 

There is no specific open season to apply for Medicare Part D Extra Help.  Applications are accepted all during the year.

To figure out whether you are eligible for the Extra Help, Social Security asks about your income and the value of any savings, investments, and real estate (other than the home you live in). To qualify, you must be receiving Medicare and have: 

Income limited to $16,755 for an individual or $22,695 for a married couple living together. Even if your annual income is higher, you still may be able to get some help with monthly premiums, annual deductibles, and prescription co-payments. Some examples where your income may be higher include if you or your spouse:

                —Support other family members who live with you

                —Have earnings from work

                —Live in Alaska or Hawaii

Resources for Extra Help are limited to $13,070 for an individual or $26,120 for a married couple living together. Resources include such things as bank accounts, stocks, and bonds. Not all resources count. For example, personal possessions, your house (if living in it), your car and some life insurance do not count as resources.

You can complete an easy-to-use online application for Extra Help at www.socialsecurity.gov. Click on Medicare on the top right side of the page. Then click on “Get Extra Help with Medicare Prescription Drug Plan Costs.”

Note:  Do not apply for Extra Help if you have Medicare and Supplemental Security Income (SSI) or Medicare and Medicaid.  You automatically will get the Extra Help.

Applying for the Medicare Extra Help does not enroll you in a Medicare prescription drug plan.

To apply by phone or have an application mailed to you, call the Social Security national toll-free number,1-800-772-1213 (TTY 1-800-325-0778), and ask for the Application for Extra Help with Medicare Prescription Drug Plan Costs (form SSA-1020). You can also contact your nearest Social Security office.

 

Medicare Part D open season

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The Medicare Part D (Prescription Drug Coverage) open season is from October 15 to December 7, 2012.  New plans begin January 1, 2013.

Even if you are completely satisfied with your existing Part D policy, the open season is an important time for you. Due to your changing needs and annual plan changes, review your plan coverage each year. A plan that previously fit your needs might not be your best choice now. 

Everyone currently enrolled in Medicare can purchase a Part D plan to help with prescription drug costs. Unlike Medicare Part A (Hospital) or Part B (Medical), Part D (Prescription Drug Coverage) is purchased through private insurers. You shop for the plan that best suits your personal needs. Joining a Medicare prescription drug plan is voluntary, and participants pay an additional monthly premium for the coverage.

Now is the time to list your medicines, including dosages and frequency, in order to review and compare available plans. Based on individual needs, spouses might choose different plans.    

Social Security representatives cannot assist people in choosing a Medicare Part D plan. To compare plans, go to the Medicare website, www.medicare.gov, and select the Drug Coverage (Part D) link. Use the free Medicare Plan Finder to compare plans available in your state. Plan data for 2013 is already on the Medicare Plan Finder. The Medicare Part D (Prescription Drug Coverage) open season is from October 15 to December 7, 2012. 

 In North Dakota, the State Health Insurance Counseling Program (ND SHIC) will again travel to several cities around the state to provide free assistance in choosing a Part D plan. View the current schedule on the ND SHIC website (bottom of home page). The ND SHIC toll-free number is 1-888-575-6611 (TTY 800-366-6888). 

In Minnesota, the Senior LinkAge Line ®, part of the MN Board on Aging, offers the same free service. The toll-free Senior LinkAge Line ®  number is 1-800-333-2433.

Although Social Security representatives cannot assist people in choosing a Medicare Part D plan, the agency does administer the Extra Help portion of Medicare Part D. While all Medicare beneficiaries can participate in the prescription drug program, some people with limited income and resources also are eligible for Extra Help to help pay for monthly premiums, annual deductibles, and prescription co-payments.  

More about Extra Help next week.

Just want Medicare? Use the online Medicare application.

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The Medicare Initial Enrollment Period was discussed last week. Today’s topic is the online Medicare application, applicable for people approaching age 65 and not yet wanting to receive Social Security benefits. 

People already getting Social Security benefits are enrolled in Medicare Part A (Hospital) and Part B (Medical) automatically. Since there is a monthly premium for Part B coverage, there is an option of turning it down. Learn about the different parts of Medicare at  http://www.socialsecurity.gov/pgm/medicare.htm.

Automatic enrollment does not apply if you are not receiving Social Security payments. In this case, complete the online Medicare application or contact Social Security about three months before your 65th birthday to sign up for Medicare. 

Sign up for at least Medicare Part A (Hospital). Not everyone needs to enroll in Medicare Part B (Medical) at age 65. Whether you do or not is something that you must research and decide.  No one at Social Security can decide this for you. 

A major reason for deferring Part B enrollment is when a person is covered under a group health plan, either from their own or a spouse’s current employment. For more about this, see Medicare, SSA publication 05-10043. Go to the “Signing up for Medicare” section and the “special enrollment period for people covered under an employer group health plan.” 

Do you have TRICARE coverage? See the Tricare website before making your Part B decision. 

Now you are ready to file for Medicare. How do you do this? 

You have two basic options. One is to contact Social Security (national toll-free number 800-772-1213 / TTY 800-325-0778 or your local office), make an appointment, and file for Medicare at a SSA office or over the telephone. The second option is to take about 10 minutes, at your convenience including weekends, and complete the Medicare application online at www.socialsecurity.gov. 

Social Security encourages you to file online.  It’s easy. 

At the Benefit Application screen, start your application by selecting “Apply For Benefits. Then you provide identifying information and receive an application number. This number lets you leave a started application and complete later. It also lets you track the status of a completed application. Moving along, you confirm that you are filing only for Medicare, not for monthly Social Security benefits, provide information about other health insurance coverage, and state if you want Medicare Part B. Drop down boxes provide information about specific questions. After a few minutes, you reach the summary screen. Review your application for accuracy, then sign it electronically. You get a receipt. 

What happens next? Your local Social Security office, based on zip code, receives your electronic application for review. If there are questions, you are contacted. If none, the office completes its part of the process. 

What about proving your age? The Social Security representative matches identifying information from the application against existing Social Security records. Often your application is completed without additional age evidence from you. Sometimes a birth certificate is requested. 

A word of caution: Filing only for Medicare, and not Social Security benefits, might be a good decision for you but consider your options. For example, will your expected earnings prevent Social Security benefits from being payable? Can family members receive on your record? Use the Social Security retirement planner tools when making your decision.