Medicare and Employer-based Coverage

When you have both Medicare and employer-based coverage, Medicare will either pay primary or secondary for your medical costs. When Medicare is primary insurance, Medicare pays for your medical bills first.  When Medicare is the secondary insurance, Medicare pays after the employer-based coverage pays . Usually, secondary insurance pays some or all of the costs left after your primary insurance has paid (for example, deductibles and copays).

This month’s Medicare Minute (courtesy of the Medicare Rights Center) addresses these and other questions:

How does Medicare work with job-based insurance?

What are the differences between primary and secondary insurance?

How does Medicare work with retiree insurance and COBRA coverage?

To read or download it, click here — Medicare and Employer-based Coverage.

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

Medicare Basics: 5 Things to Know About Medicare Part A

There are four basic parts of Medicare: A, B, C, and D. Each part helps pay for certain medical services. Here are 5 things to know about Part A:

#1  Part A is one of two parts of what is considered “Original Medicare”. (Part B is the other).

#2  Most people don’t have to pay a premium for Part A. They’ve already paid into the system in the form of the Medicare tax deductions in their paycheck if they (or their spouse) worked at least 40 calendar quarters (10 years) in the U.S.

#3  Medicare Part A helps cover the costs of inpatient care in the hospital, short-term skilled nursing facilities, home health care, and hospice care.

#4  Benefit periods apply. These benefit periods measure the use of inpatient hospital and skilled nursing facility services. Medicare will stop paying for your inpatient-related hospital or skilled nursing facility costs (such as room and board) if you run out of days during your benefit period.

#5  Most people either add a Medicare Supplement (Medigap) Plan or they opt to enroll in a Medicare Advantage Plan.  Both of these options in different ways can serve to limit liability, extend benefit periods, and cover some out of pocket costs (like deductible and coinsurance) associated with Medicare Part A.

You can read more about Medicare Part A covered services in this Medicare Minute Newsletter courtesy of the Medicare Rights Center.

Cost of Employer-Provided Health Coverage Passes $20,000 a Year

An ‘Annual poll of employers by Kaiser Family Foundation finds premiums rose 5% for family plans; ‘It’s the cost of buying an economy car.’

Let us show you how we help our employees operate at substantially below this scary number through SharedFunding.

Click here for The Wall Street Journal article for more insights into the survey results.