UNEXPECTED MEDICARE PENALTIES AND INCOME-RELATED ADJUSTMENTS: CAN YOU APPEAL? HOW?

Medicare can be confusing and lead to unexpected costs. This is especially true if you’re not informed on the front end when you first become eligible for Medicare; or, if you delay enrollment, when you enroll that first time. The three most common surprise-cost culprits sprung on those new to Medicare include:

1.)   Medicare Income-Related Monthly Adjustment Amount (IRMAA)

• IRMAA is an amount you may pay in addition to your Part B and/or Part D premium if your income is above a certain level.  We wrote about IRMAA in this recent post 2020 Medicare Part B Monthly Premium and Income-Related Monthly Adjustment Amounts

2.)  Part B late enrollment penalty (LEP)

• For each 12-month period you delay enrollment in Medicare Part B, you may have to pay a 10% Part B premium penalty, UNLESS you have other credible coverage that is compliant with Medicare rules (such as insurance based on your or your spouse’s job-based insurance).

3.)  Part D late enrollment penalty (LEP)

• For each month you delay enrollment in Medicare Part D (Prescription Drug Plan), you may to pay a Part D late enrollment penalty unless you have creditable coverage that is as good or better than the basic Part D benefit or get “extra help” (Low Income Subsidy).

The good news, if you want to call it that, is if you get dinged for income adjustments or penalties – Yes, you can appeal.

In cases of IRMAA adjustments you can request a new initial determination right out of the chute if you have experienced a life-changing event that caused an income decrease, or if you think the income information Social Security used in making the initial determination is incorrect. If you don’t agree, you can also file for reconsideration or file an appeal.

You can also appeal your Part B and/or your Part D Late Enrollment Penalties (LEP) though the processes for doing so are different for Part B and Part D.

For Part B LEP, just follow the instructions on the notice that you received informing you of the penalty. You will need to prove that you were enrolled either in Part B or in coverage through current employment during the period of time for which you are being penalized.

For Part D LEP, you can appeal the penalty if you think you were continuously covered or if you think the amount of the penalty was calculated incorrectly. This appeal must be filed with Medicare’s contractor (MAXIMUS Federal Services) for handling appeals.

For more information on adjustments, penalties and how to file an appeal refer to this month’s Medicare Minute Newsletter courtesy of The Medicare Rights Center.

And go to:

Medicare Part B Premium Appeals | HHS.gov

Medicare IRMAA Life Changing Event Form

Late Enrollment Penalty (LEP) Appeals

If you have questions, we are happy to help:
Email: 65Plus@bbginc.net
Phone: 866-845-8600; Ext 130

bbg65Plus Certified To Facilitate National Medicare Educational Program

Medicare can be daunting and confusing and quite difficult to grasp.

This is true in the case of existing Medicare beneficiaries as well as their care givers.  And, it’s especially true for those prospective new enrollees who are about to turn 65 and have to deal with trying to understand their Medicare options for the very first time. 

The Medicare Minute was created and sponsored by the Medicare Rights Center to help address and alleviate some of the confusion surrounding Medicare. The program consists of an ongoing series of free monthly educational programs designed to equip people with the knowledge to more clearly understand their Medicare options, to make more informed decisions, and to ultimately utilize their Medicare coverage more effectively. 

Volunteers from across the country with experience in how health benefits work serve as facilitators for the Medicare Minute educational programs.  And, bbg65Plus is now certified and appointed to serve as a Facilitator of the Medicare Minute program. 

The Medicare Minute educational program is available free of charge to employers, organizations, and community groups interested in educating members on the ABC’s (and Part D) of Medicare. And now readers of our blog will be able to read a summary of some of highlights and key tips from those programs in this space each month. 

To learn more about the Medicare Minute educational programs and how you can schedule Medicare Minute presentations for your organization, contact Tom Barrett, Medicare Minute Facilitator for bbg65Plus at 866.845.8600 x130 or tbarrett@bbginc.net.

For more information — go here  1 Medicare Minute Overview and here 2 Medicare Minute FAQ

When It Comes To Lowering Healthcare Costs Do Workplace Wellness Programs Over-Promise And Under-Deliver?

Don’t get me wrong, I completely support the notion of promoting positive health behaviors and healthier lifestyles. Encouraging such things as regular exercise, good and balanced nutrition, the proper amounts of sleep, and all the things associated with taking better care of ourselves is all good. No question about that.

It’s just that for the most part you could color me the doubting Thomas when it came to believing the narrative that wellness programs definitively lead to lower insurance premiums and other healthcare-related cost savings.

And, it seems that most often that’s how wellness programs have been sold to employers. “Implement a wellness program and you will lower your company’s insurance premiums and other employee health-related costs” has commonly comprised a major part of the wellness sales pitch made to employers.

And many employers, especially large employers, have been buying this cost savings aspect of it. (80% of large employers in the U.S. offer wellness programs*).

I’ve long wondered if these corporate wellness programs provided any direct return on an employer’s investment (Workplace wellness is an $8 billion industry*). We sure haven’t witnessed it either in the way of lower insurance premiums or a decrease in the consumption of medical services and medical claims.

Harvard provides an answer via a major study on the Health and Economic Outcomes of Workplace Wellness Programs.

Results of the Harvard study were recently published in The Journal of the American Medical Association (JAMA). In a nutshell the Harvard study concluded that while there were significantly greater rates of some positive health behaviors among participating employees, there were no significant effects on health care spending.

In other words, when it comes to wellness programs and savings, the Harvard study verdict is in. Under-deliver.

For more on the Harvard study click here.

*Source: Axios

Déjà Vu, Again – Small Group Transitional Relief Plans (pre-ACA) Extended Through 2020

Buried far below the most recent headlines related to eliminating the ACA, The Centers for Medicare and Medicaid (CMS) once again announced that employers in the small group market still enrolled in Transitional Relief Plans (pre-ACA) may keep their existing policies and plans for another year. CMS stipulates that ultimately the discretion for granting an extension again rests with state regulators and the respective participating insurance carriers who continue to make those plans available.  As we learned last year a few insurance carriers (e.g. Aetna) elected not to extend the Transitional Relief Plans beyond 2018. They instead chose to eliminate the option of renewing the old plans thus requiring impacted employers to move to ACA plans or one of the market compliant alternatives (e.g. level funding, MEWA, etc).

For more info click on the link below:

Extended Non-Enforcement of Affordable Care Act-Compliance With Respect to Certain Policies