In this guide, we’ll walk you through everything you need to know about how to appeal IRMAA, who qualifies, and the exact steps to take to file a successful appeal.

What Is IRMAA?

IRMAA is a surcharge that Medicare beneficiaries must pay if their income exceeds a certain threshold. The Social Security Administration (SSA) determines this amount based on your Modified Adjusted Gross Income (MAGI) from your tax return two years prior.

For example, if you’re enrolling in Medicare in 2025, the SSA reviews your 2023 tax return to assess whether you owe IRMAA.

2025 IRMAA Thresholds for Individual Filers

Thresholds are higher for married couples filing jointly.

When Can You Appeal IRMAA?

There are two main reasons the SSA will allow an appeal:

1. You Experienced a Life-Changing Event

Certain qualifying life events can cause your income to drop significantly, which may allow you to appeal IRMAA. These include:

• Retirement or reduced work hours
• Death of a spouse
• Divorce or annulment
• Marriage
• Loss of pension or income-producing property
• Settlement from an employer

If one of these events has occurred and your income is now below the IRMAA threshold, you may be able to request a lower premium.

2. SSA Used Incorrect Income Data

In cases where the IRS or SSA made an error or used outdated income information, you can appeal to have the correct data reviewed.

How to Appeal IRMAA: Step-by-Step Instructions

If you’re ready to learn how to appeal IRMAA, follow these four simple steps:

Step 1: Review the SSA Notice

You’ll receive an “Initial Determination” letter from the SSA if you’re being charged IRMAA. This letter explains your current premium amount and the income level it’s based on.

Step 2: Complete Form SSA-44

To appeal based on a life-changing event, use Form SSA-44, titled “Medicare Income-Related Monthly Adjustment Amount – Life-Changing Event.”

You can download it directly from the SSA website:
Download SSA-44 Form (PDF)

On this form, you’ll:

• Select the qualifying event
• Provide the date of the event
• Estimate your current or future income
• Attach supporting documentation (e.g., retirement letters, tax documents, death certificates)

Step 3: Submit the Form to the SSA

Once you complete Form SSA-44, submit it along with documentation to your local Social Security office. You can deliver it:

• In person
• By mail
• By fax (call your office first to confirm)

Always keep copies of your submission and get a receipt when possible.

Step 4: Wait for a Response

The SSA typically takes a few weeks to a few months to process your appeal. If approved, your IRMAA adjustment will be reduced or removed, and any overpaid premiums may be refunded.

What to Do If Your Appeal Is Denied

If your appeal is denied, you have the right to request a further review:

1. Submit Form SSA-561-U2 – This is a Request for Reconsideration.
2. Request a Hearing – If reconsideration is unsuccessful, you can ask for a hearing before an Administrative Law Judge (ALJ).

It’s rare for IRMAA cases to go this far, but the option is available if needed.

Tips for a Successful IRMAA Appeal

Here are a few expert tips on how to appeal IRMAA effectively:

• Act Fast – You have 60 days from the date on the SSA letter to appeal.
• Be Precise – Carefully estimate your current or future income. SSA may request tax documents later to verify.
• Attach Proof – The more documentation you provide, the stronger your case.
• Seek Help If Needed – Medicare advisors, elder law attorneys, or financial professionals can guide you through the appeal process.

Real-World Example of Appealing IRMAA

Linda, age 67, retired in 2023. Her tax return from that year showed a MAGI of $155,000 due to a large severance package. In 2025, she received a notice from SSA indicating she owed over $170/month in IRMAA surcharges.

Since her 2024 income dropped to $42,000 after retiring, she filled out Form SSA-44 and submitted a retirement letter and recent tax documents. Within six weeks, her appeal was approved, and her IRMAA was removed.

What If You Don’t Qualify to Appeal IRMAA Right Now?

Even if you don’t meet the criteria for an IRMAA appeal at this moment, you’re not necessarily stuck paying higher premiums forever.

• IRMAA is reassessed annually. If your income drops in a future tax year, the surcharge may be removed automatically.
• Plan your income carefully. Consider financial planning strategies like Roth conversions or managing capital gains to stay under IRMAA thresholds.

Final Thoughts

If you’re wondering how to appeal IRMAA, the process is straightforward—but timing and documentation are key. Many Medicare beneficiaries don’t realize that IRMAA isn’t necessarily permanent and is re-evaluated annually. If your circumstances change, you may be eligible for a lower premium.

By filing Form SSA-44 and providing clear evidence of your income reduction, you can potentially save hundreds—if not thousands—of dollars annually.

Additional Resources

• SSA-44 Form: Medicare IRMAA Appeal
• Find Your Local SSA Office
• Medicare.gov – IRMAA Info

Need help appealing IRMAA or navigating Medicare enrollment? 65Medicare.org can help. We serve Medicare clients through all aspects of enrollment in Medicare and Medicare plans and ongoing, free support.

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65Medicare.org is a leading, independent Medicare insurance agency for people turning 65 and going on Medicare. We have worked with 10,000+ Medicare-eligible individuals over the last 10+ years, assisting with understanding and comparing the plans. You can get a list of Medigap quotes in your area. Or, if you have any questions about this information, you can contact us online or call us at 877.506.3378.

The post How to Appeal IRMAA: Step-by-Step Guide to Lowering Medicare Premiums appeared first on 65Medicare.org.

This guide will break down the steps and considerations for moving with Medicare, with specific sections on:

• Moving with Original Medicare and Medigap
• Moving with Medicare Advantage (Part C)
• Moving with Medicare Part D (Prescription Drug Plans)

Let’s look at each scenario in detail.

Moving with Original Medicare and Medigap

Original Medicare includes Part A (hospital insurance) and Part B (medical insurance). It’s federally administered, which means it works the same way anywhere in the United States. However, if you also have a Medigap (Medicare Supplement) policy, moving may require a few additional steps.

How Moving Affects Original Medicare

Original Medicare travels with you. Since it’s a national program run by the federal government, you can see any doctor or healthcare provider in the U.S. who accepts Medicare, without worrying about network restrictions or needing a referral. (Read More: Medicare and Medigap – How Do They Work Together? | 65Medicare.org)

Key Points:

• No need to change your Part A or Part B enrollment if you move within the U.S.
• You should update your address with Social Security or the Railroad Retirement Board, depending on where you get your benefits. Updating your address with Social Security takes care of notifying Medicare of your new address.
• Make sure to find new healthcare providers in your new area that accept Medicare if you’re moving a significant distance.

How Moving Affects Medigap Policies

Medigap plans are sold by private insurance companies to help cover costs like copayments, coinsurance, and deductibles that Original Medicare doesn’t pay. The plans are Federally-standardized in most states, so it is easy to compare “apples to apples”. In other words, a Plan G, for example, is the exact same coverage regardless of the insurer.

When you move:

• If you stay within the same state, you should be able to keep your current Medigap policy.
• If you move to another state, especially one with different Medigap rules or pricing (community-rated vs. issue-age-rated vs. attained-age-rated plans), your plan options may change, and it is wise to check your options to ensure your current plan is still the right plan for you in your residence.

Possible Scenarios:

1. You can keep your Medigap policy:
   Some companies allow you to keep your current plan even if you move, although premiums might change to reflect the current premiums of your new location.
2. You may want to switch plans:
   If better or more affordable options are available in your new location, you might be able to switch, though depending on your situation, you could be subject to medical underwriting (health questions). An independent broker can help you evaluate whether a move to a new state would call for a corresponding move to a new insurer. Get Medigap rates for your new state delivered by email.
3. Special Rights:
   If you’re moving out of the service area of a Medicare SELECT policy (a type of Medigap policy that requires using specific hospitals and doctors), you have a guaranteed right to buy a standard Medigap policy without medical underwriting.

Action Steps:

• Notify your Medigap insurer of your move. You can do this by calling the number on your Medigap insurance card or contacting your Medigap broker.
• Review plan options and premiums in your new area. This can be done online through an independent broker or, in some states, through the state department of insurance.
• Consider enrolling in a different Medigap plan if it offers better coverage or lower premiums. (Medigap Premium Increases – Does Your Premium Change When You Move?)

Moving with Medicare Advantage

Medicare Advantage (Part C) plans are offered by private insurance companies and must cover at least what Original Medicare covers, but often include extra benefits like dental, vision, or hearing. These plans are regional, network-based, and they have specific service areas.

How Moving Affects Medicare Advantage Plans

Because Medicare Advantage plans depend on local networks of doctors, hospitals, and pharmacies, moving outside your current plan’s service area usually requires changing your plan.

Key Points:

• If you move outside your plan’s service area, you must switch plans.
• If you move within your plan’s service area but to a different county or ZIP code, you might still be allowed (or even encouraged) to change plans because different options may be available.
• You will get a Special Enrollment Period (SEP) to choose a new plan, as a result of a move outside of your plan’s service area.

Special Enrollment Period (SEP) Details

• You can switch to a new Medicare Advantage plan or return to Original Medicare (and enroll in a Part D plan separately).
• The SEP starts the month before your move and continues for two full months after you move.
• If you notify your current plan after you move, your SEP begins the month you notify them and lasts two additional months.
• If you have previously been “stuck” in Medicare Advantage due to medical conditions, a move outside of your Advantage plan’s service area represents an opportunity to move back to original Medicare and add a Medigap plan on a guaranteed issue basis.

Action Steps:

• Notify your current Medicare Advantage plan about your upcoming move.
• Research plans in your new area ahead of time.
• Choose a new Medicare Advantage plan or switch to Original Medicare with optional Part D and Medigap coverage.
• Be sure to avoid gaps in coverage by making timely decisions.

Moving with Medicare Part D (Prescription Drug Plans)

Medicare Part D offers prescription drug coverage through private plans that operate within specific regions. Like Medicare Advantage, Part D plans have networks, so moving could require a change depending on your destination.

How Moving Affects Medicare Part D Plans

Each Part D plan has a designated service area, and moving outside that area means you need to enroll in a new plan.

Key Points:

• You must be enrolled in a Part D plan that operates in your new location.
• Moving gives you a Special Enrollment Period (SEP) to join a new Part D plan.

Special Enrollment Period (SEP) Details

• SEP begins the month before you move and lasts two full months after you move.
• If you notify your plan after you move, the SEP begins the month you notify your plan and lasts for two months.
• If you don’t choose a new plan during the SEP, you could face a gap in coverage and a potential late enrollment penalty if you go without prescription drug coverage for 63 days or more.

Action Steps:

• Notify your current Part D plan provider. If your new location is outside the plan’s service area, you will be disenrolled as of the 1^st day of the next month.
• Compare available Part D plans in your new area using the Medicare Plan Finder tool or by working with a licensed broker.
• Check that your medications are covered under your new plan’s formulary.
• Enroll promptly to maintain continuous coverage.

Important Things to Remember When Moving with Medicare

• Update Your Address: Contact Social Security (1-800-772-1213) or update your information online at ssa.gov.
• Keep Documentation: Save any notices and correspondence from your Medicare plan and Social Security Administration.
• Evaluate Your Options Carefully: Moving gives you a unique opportunity to reassess your healthcare needs and possibly find a plan that better fits your situation or reduces your monthly premiums.
• Timing Matters: Acting quickly ensures you don’t experience a lapse in healthcare or prescription drug coverage.

Moving with Medicare: The Bottom Line

Moving, in general, can be stressful, but staying informed about how Medicare is affected helps simplify the transition.

• If you have Original Medicare, it’s mostly just updating your address — but if you have a Medigap policy, you’ll want to review it closely and possibly make a change to a plan that offers a lower premium in your new location.
• If you have Medicare Advantage or Part D, you’ll need to use your Special Enrollment Period to pick a new plan.
• Always act within your Special Enrollment timelines to prevent interruptions in your health or prescription coverage.

By staying proactive and organized, you can ensure that your move is smooth not only for your personal life but for your healthcare coverage as well.

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65Medicare.org is a leading, independent Medicare insurance 

agency for people turning 65 and going on Medicare. We have worked with 10,000+ Medicare-eligible individuals over the last 10+ years, assisting with understanding and comparing the plans. You can get a list of Medigap quotes in your area. Or, if you have any questions about this information, you can contact us online or call us at 877.506.3378.

The post Medicare and Moving to Another State – What You Need to Do appeared first on 65Medicare.org.

While this can be unsettling to some, there are protections in place, and you do still have options. Read on to learn more about what to do when your Medicare Advantage drops you.

What Type of Plan Can You Get When Your Medicare Advantage Non-Renews?

When your Medicare Advantage plan drops you, you have two options for coverage moving forward. We’ve detailed both of those options below:

A New Medicare Advantage Plan: One option that you have when your Medicare Advantage plan non-renews is to choose a new Medicare Advantage plan that IS going to be offered in your county for the following calendar year. You can do this during the annual election period (October 15-December 7) and it would take effect on January 1 of the following year. The transition would be seamless in that the current plan will cover you through the end of the calendar year, and the new plan would start on 1/1. 

It is very important, when considering/comparing Advantage plans, that you do your due diligence to make sure that the plan you are choosing is accepted by your doctors, covers your medications and just altogether meets your medical coverage needs. There are many variables to consider when comparing this type of plan.

Return to “Original” Medicare with a Medigap Plan: The 2nd option that you have when your Medicare Advantage plan non-renews is to return to “original” Medicare (Part A – hospital coverage; Part B – doctor/outpatient coverage) and add a Medigap plan, sometimes called a Medicare Supplement. Medicare gives you a mandated “guaranteed issue” right into certain Medigap plans, when your Medicare Advantage drops you through no fault of your own. So, many Medicare beneficiaries take the opportunity, when dropped by their Advantage plan, to get the comprehensive Medigap coverage that they may have not otherwise qualified for. 

Normally, to switch from an Advantage plan to a Medigap plan, you would have to go through medical underwriting and get approved. However, this is one of the few instances that would allow you to make this change with no medical underwriting or restrictions. Medigap plans pay the 20% that Medicare does not cover, and the most comprehensive Medigap plans (Plan F and Plan G) essentially pay all of your medical costs with no co-pays or out of pocket (with the exception of the Medicare Part B deductible of $240/year on the Plan G). Moreover, the Medigap plans do not ever non-renew and don’t change from year to year. They also do not have networks so you can go anywhere in the country that accepts Medicare. 

How Do You Get Another Plan After Your Medicare Advantage Plan Drops You?

So, if your Medicare Advantage drops you for 2025, you have options to get another plan. Here are a few tips:

• You should save all documentation that comes to you via mail regarding your plan’s changes, as you may need it to prove your eligibility for another plan.
• Make sure you read any documentation carefully and observe all deadlines and requirements.
• When choosing a new Advantage plan, make sure that the Advantage plan is accepted by your doctors/hospital. Also, make sure that your medications are covered under it and review any restrictions on coverage. 
• If choosing a Medigap plan, the plans are standardized (same coverage with every company) so you should compare the rates and pick the one with the best rates and ratings. A Medigap broker can provide you with a list of all the options. 

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65Medicare.org is a leading, independent Medicare insurance agency for people turning 65 and going on Medicare. If you have any questions about this information, you can contact us online or call us at 877.506.3378.

The post What To Do When Your Medicare Advantage Plan Drops You? appeared first on 65Medicare.org.

First and foremost, we should clarify that the technical name for this period is the “Annual Election Period” (AEP). It runs from October 15, 2023 to December 7, 2023. Even Medicare itself sometimes mistakenly and confusingly calls it the “open enrollment period”. Open enrollment for Medicare is actually when you turn 65. And open enrollment for Medicare Supplement plans is when you start on Medicare Part B for the first time (either due to turning 65 or starting on it later than that). But since most people call it open enrollment and so as not to get to hung up on jargon, we’ll use both terms interchangeably – annual election period and Medicare open enrollment.

What Changes Can You Make During Medicare Open Enrollment?

So, what changes can you make during the annual election period? This period is all about changing your Medicare Advantage plan or your Medicare Part D prescription drug plan. With either of those two types of plans, you have the opportunity to switch to another plan within your same insurance company or a different insurance company. Any changes that you make to your coverage will take effect on January 1 of the following calendar year.

If you are already on a Medicare Advantage plan or a Medicare Part D plan, you should receive something from your plan, by mail, in late September/early October detailing the plan’s changes for next year. This is called the annual notice of changes (ANOC), and it is a requirement that plans send this out and do so in a timely manner.

The plan coverage for the next calendar year will be available on Medicare.gov on or around October 1. So you would be able to log in and compare your current plan to what else is available after that date. But you cannot make any changes or enroll in a new plan until October 15.

Comparing all aspects of your plan is crucial to do if you are on Medicare Part D or Medicare Advantage. Both types of plans can change each year in terms of premiums, coverage levels, deductibles, and networks.

Can You Change Medicare Supplements During Medicare Open Enrollment?

The types of plans that are not in any way connected with the Annual Election Period are Medicare Supplement plans, also called Medigap. Medigap plans are plans from private companies that fill in the gaps in Medicare Parts A and B.

Open enrollment for Medigap is a 6-month period that begins on the first day you are in Medicare Part B, whether that is the month of your 65th birthday or later than that if you delay Part B enrollment. During that time period, you do not have to answer medical questions or qualify to get a Medigap plan. You can choose any plan from any company on an open enrollment basis.

After that initial 6 month window, regardless of the time of year that it is, you DO have to answer medical questions to get a Medigap plan (with a few exceptions of some states that prohibit underwriting in certain situations or at all).

So, yes, you can change your Medicare Supplement during the annual election period. However, you cannot do so an “open enrollment” basis – you will have to answer medical questions and get approved by the new insurance company in order to change your plan.

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65Medicare.org is a leading, independent Medicare insurance agency for people turning 65 and going on Medicare. If you have any questions about this information or would like to see if there is a mutual fit to work together, you can contact us online or call us at 877.506.3378.

The post When Does Medicare Open Enrollment Start? appeared first on 65Medicare.org.

As part of the government’s fight on opioid addiction, pain treatment has been expanded to other modalities of therapy, one of which is acupuncture. Statistics show that opioids have become a public health crisis. There were 47,600 overdose deaths in 2017 due to opioids, and CMS wants to support these alternative treatments that can replace these addictive drugs. Studies on adults 65 years of age or older show that patients with chronic low back pain in these studies demonstrated improvements in overall function and pain level. In addition, all the evidence reviewed for this decision supports various strategies for chronic low back pain including non-prescription drug therapies.

According to the CMS, while there is variation in covered indications and frequency of services, many private health plans provide at least some acupuncture coverage for their subscribers today. Furthermore, as a result of the CMS decision in covering acupuncture, more health plan administrators may consider adding or expanding their coverage to include acupuncture.

You’ve probably heard of the field of “naturopathy”, of which acupuncture is one facet – it is a form of alternative medicine. It is most commonly practiced by naturopathic doctors. Although acupuncture might be synonymous with naturopathy, it is a practice based in ancient oriental roots. It originated in China thousands of years ago. It is a form of therapy using needles which stimulate channels of energy or meridians of the body to improve energy flow (chi). This “chi” restores a sense of balance and health to the body. Over time, Western medicine has evolved to be more accepting of this ancient practice and is used by health practitioners in addition to traditional forms of treatment.

According to proponents, the benefits of acupuncture are many, including the following:

• Stress reduction
• Reduction in neck tension and joint pain in the hands and arms;
• Relief from headaches;
• Insomnia
• Sciatica
• Reduced eye strain
• Improved immune system
• Increased energy
• Relief from digestive ailments
• Allergy relief
• Reduced desire for nicotine
• Weight loss

The World Health Organization (WHO) also says that acupuncture may help the following conditions, although more evidence is needed to confirm efficacy:

• fibromyalgia
• neuralgia
• post-operative convalescence
• substance, tobacco and alcohol dependence
• vascular dementia
• whooping cough, or pertussis
• Tourette syndrome

The WHO also suggests that it may advantageous to treat a number of infections, including urinary tract infections and epidemic hemorrhagic fever.

The overall benefits of having acupuncture can be life-changing for some people, if it is performed correctly. Unlike many prescribed medications, there are very few side effects when performed correctly. It can be effectively integrated with other modalities of treatment. However, the number of treatments needed depend on the patient, and whether the condition(s) for which he/she is being treated is/are chronic or acute. A chronic problem may take longer to be eradicated than an acute one.

It is advised that acupuncture is not used as the sole means of treatment. It is advisable to use it in coordination with conventional treatments in cases of chronic or severe illness.

All therapies have risks as well as benefits. Some possible risks of acupuncture are:

• Excessive bleeding if a patient has a bleeding disorder or takes blood thinners
• Bleeding, bruising, and soreness may occur at the insertion sites
• Infection resulting from unsterilized needles
• In rare cases, a needle may break and damage an internal organ
• In rare cases, risk of collapsed lung when needle inserted deeply into chest or upper back

The United States (U.S.) Food and Drug Administration (FDA) regulate acupuncture needles as medical devices. Their manufacture and labeling must meet specific standards. The needles must be sterile, nontoxic, and labeled for one use only, by a licensed health care practitioner.

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65Medicare.org is a leading, independent Medicare insurance agency for people turning 65 and going on Medicare. If you have any questions about this information, you can contact us online or call us at 877.506.3378.

The post Medicare Announces Coverage for Acupuncture in Some Situations appeared first on 65Medicare.org.

CMS (Centers for Medicare & Medicaid Services) has surged ahead with a campaign to review their billing processes for fraud. Nonetheless, you should still take a proactive approach in helping to protect yourself, your family and Medicare itself against fraudulent practices involving seniors.

Here are the 4 R’s of helping you protect yourself:

1. RECORD: Keep a running list of all your appointments with your health care providers. This also includes laboratory tests, x-rays and any other diagnostic imaging or tests performed. Write down the exact admission and discharge dates, if you were in the hospital, as well as your diagnosis. Finally, remember to save any invoices and statements from all those providers.To help you with the recording tasks, if do not have a calendar, a local Senior Medicare Patrol program can assist you. They can provide you with a free Personal Health Care Journal. To find a local SMP, you can go online at smpresource.org. Alternatively, you can call them at 877-808-2468.
2. REVIEW: Review your Explanation of Benefits (EOBs) or Medicare Summary Notices (MSNs) for any entries you think are incorrect or should not be there in the first place. Be aware of any charges for services, medical equipment or other items that you did not receive. If you had any hospital admissions, read your statements very closely. There may be medications listed which you had not taken. It is within your patient rights to question anything on your bills/EOBs/MSNs that do not appear justified.Whenever you pick up medication from a pharmacy, make sure you have the exact number of pills you were supposed to get. In addition, pay attention to the label on the bottle to verify that your name and medication, along with dosage is correct. Take charge of your health care and educate yourself on knowing what a provider can and cannot bill to Medicare.
3. REPORT: How Do I report Medicare Fraud? If an error has been made on your bill or think that Medicare fraud has been committed, please see below for instructions on how to report it:
   • Call Medicare at 1-800-MEDICARE. Be sure to have your Medicare number available.
   • You may contact the Office of the Inspector General to report any fraud by calling 1-800-HHS-TIPS (1-800-447-8477). TTY users call 1-800-377-4950.
   • You can also contact your local Senior Medicare Patrol office, which will help you in reporting fraud.
4. REMEMBER: Be careful to protect your information against Medicare fraud by remembering these crucial tips.

• For your security protection, do not divulge your Medicare number to anyone, other than your physician or other health care provider. In addition, be vigilant regarding your Social Security number. Do not give it out to anyone asking for it except people you know and trust.
• Be careful not to be taken in by any media advertisements that offer special deals asking you to give out your Medicare number. Some unscrupulous Medigap companies may try to obtain your number for the purpose of signing you up for insurance you do not want.
• Medicare will never contact you, nor ask you for your personal information, and that also pertains to your bank information.
• Keep an eye on your bank accounts to make sure any premiums, such as your Medigap premiums, are not higher than they are supposed to be.

In addition to the 4Rs above, be on your guard and pay close attention to the following:

• Never give your Medicare card to anyone else to use. Vice-versa, you should never use anyone else’s card.
• Never let someone else urge you to see a healthcare provider, unless you absolutely need to see one.
• Never buy any medical supplies or equipment from any door-to-door salesperson, if you did not talk to them prior to showing up. Medicare and Medicaid will never send a representative in person to your home.

The bottom line is that you have to take an active role in controlling your health and your information! Watch out for your medical records, which contain your personal health information. Be on the lookout for any Medicare scams, including fraudulent billing claims, drug prescriptions or medical equipment or services given by health care providers. Lastly, if you have a suspicion that any type of fraudulent activity has been committed, immediately contact your health care provider. Alternatively, you can get in touch with the fraud hotline, provided by the Dept. of Health and Human Services Office of the Inspector General, contact Medicare, or your SMP.

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65Medicare.org is a leading, independent Medicare insurance agency for people turning 65 and going on Medicare. If you have any questions about this information, you can contact us online or call us at 877.506.3378.

The post Medicare Fraud Watchlist – Protect Yourself appeared first on 65Medicare.org.

It is a common misconception that seniors have access to free healthcare. That may generally be true for Part A. However, that is not the case for Medicare Part B, Medicare Advantage, Medicare Part D, or Medicare Supplement (Medigap) plans. Below you will see pertinent information on 2019 Medicare costs, including those that are premium-free.

MEDICARE PART A – Premium

Medicare Part A covers inpatient hospital stays, skilled nursing, and rehabilitation up to certain limits, once a deductible is met. If you are hospitalized for longer than 60 days, you will need to pay a share of the expenses; after 90 days, if you’ve already used up your 60 lifetime reserve days, you will be responsible for 100% of your bill.

You Can Get Part A Premium-Free If:

• You already receive Social Security benefits or Railroad Retirement Board benefits.
• You’re eligible to collect Social Security or Railroad benefits but have not yet filed for them.
• You or your spouse had Medicare-covered government employment.

If you’re under 65, you can get premium-free Part A if:

• You have already collected Social Security or Railroad Retirement Board disability benefits for 24 months.
• You have End-Stage Renal Disease (ESRD)and meet certain requirements.

The Part A premium, for most people, is free. Hence, it is usually called “Premium-free” Part A – it is not one of the normal Medicare costs; however, it is not free for those who do not qualify. To qualify, you are required to have completed at least 40 quarters of employment (10 years) of paying Medicare and FICA taxes while working. If you paid Medicare taxes for 30 quarters or less, Part A premium is $437. If you paid Medicare taxes for 30-39 quarters, the Part A premium is $240.

Usually, if you decide to buy Part A, you are required to also have Medicare Part B (Medical Insurance) and pay monthly premiums for both Part A and Part B. For more information about Part A, contact the Social Security Administration.

MEDICARE PART A – Inpatient Hospital Deductible & Coinsurance:

Deductible: $1,364 (for each benefit period)

Coinsurance:

• Days 1-60 $0 (for each benefit period)
• Days 61-90 $341 (per day for each benefit period)
• Days 91+ $682 (per each “lifetime reserve day” after day 90 for each benefit period, up to 60 days over your lifetime)
• Beyond lifetime reserve days: You pay all costs

MEDICARE PART B – Premium

The 2019 monthly Part B premium is $135.50, or higher depending on your income (see IRMAA below). However, if you are already collecting Social Security benefits, the premium may be less, on average $134.

The standard premium amount of $135.50 pertains to you if:

• You are signing up for Part B for the first time
• You are not collecting Social Security benefits
• You are on direct bill for the premiums
• You are on Medicare and Medicaid, and your premium is paid by Medicaid (your state pays the standard $135.50 premium amount)

What is IRMAA?

IRMAA stands for “Income Related Monthly Adjusted Amount”. If your modified adjusted gross income on your IRS tax return 2 years prior is over a certain amount, you will have to pay the standard premium amount plus an IRMAA. In short, it is an additional charge on your premium. See table below.

If your yearly income in 2017 was:

Individual                  Joint                           Married/Separate Tax Return                 Monthly Premium

$85,000 or less            $170,000 or less                        $85,000 or less                                    $135.50

$85,000-170,000         $170,000-214,000                        Not Applicable                                   $187.50

$107,000-133,500       $214,000-$267,000                        Not Applicable                                   $267.90

$133,500-160,000       $267,000-$320,000                        Not Applicable                                   $348.30

$160,000 +                  $320,000 +                              Above $85.000                                   $428.60

Important Note: If you’ve had a life changing event, i.e. you just retired, you might be qualified for a reduction on any of the above amounts. Call Social Security at 800-772-1213, to find out more.

MEDICARE PART B – Annual Deductible

The annual deductible in 2019 for Part B is $185/year. Once you meet that deductible, then you pay 20% coinsurance (the Medicare-approved amount) for covered services, which includes:

• Most doctor services (including while you are in the hospital)
• Any outpatient therapy
• Durable medical equipment

Clinical laboratory services: Cost is $0 for Medicare-approved services

Home health services:

• $0 for home health care services
• 20% of the Medicare-approved amount for durable medical equipment

Outpatient mental health services:

• You are entitled to a free yearly depression screening, provided that your physician or health care provider accepts assignment.
• You pay 20% of the Medicare-approved amount for doctor or other health care provider visits, to diagnose or treat your condition. Part B deductible will apply.

Please note: you might be obligated to pay an additional copayment or coinsurance amount to the hospital, if you receive your services in a hospital outpatient clinic or outpatient department, i.e. if you have x-rays taken by a physician whose office is in a Medical Center or hospital,

Mental health services requiring partial hospitalization:

• You pay a percentage of the Medicare-approved amount for doctors’ services or other qualified mental health professionals, provided they accept assignment.
• You will also pay coinsurance for services in a hospital outpatient setting or community mental health center, while you are an inpatient, and the Part B deductible will apply.

Please be aware that in 2019, there may be limits on physical therapy, occupational therapy, and speech language pathology services. If there are, there may be exceptions to these limits.

Outpatient hospital services:

• Your share is 20% of the Medicare-approved amount for physician or other health care provider’s services. Part B deductible will apply.
• You will usually pay a copayment for all other services in a hospital outpatient setting. That copayment might be higher if in a hospital outpatient setting as opposed to a doctor’s office.
• Some screenings/preventive services might be at no cost, since your coinsurance, copayments and Part B deductible will not apply.

MEDICARE PART C – Medicare Advantage

• Deductibles, copayments, & coinsurance:

The cost for Part C (Medicare Advantage) deductibles, copayments, and/or coinsurance also varies according to which plan you have. To see a list of Medicare Advantage plans in your service area, you can go online at https://www.medicare.gov/find-a-plan. Once you find a plan, you can call that provider for further information and to enroll. Also, note that, on this type of plan, the deductibles, co-pays and overall out of pcoket costs change annually.

MEDICARE PART D – Prescription Drug Coverage

• Part D monthly premiums vary considerably by plan and where you live. Also, if you earn a higher income, you may pay more (IRMAA).

Medigap / Medicare Supplement Plans

• Medigap plans are plans that fill in the gaps in Medicare Part A and B. The premiums for this type of plan are based on several variables including: age, zip code, gender, tobacco use, health, and others in some cases.
• Costs vary tremendously in different parts of the country – in some states, Medigap premiums are as much as 3x other states
• Go here to get a list of current Medigap rates delivered via email

If you have any questions about what your Medicare costs will be in 2019, please visit Medicare.gov or call 1-800-MEDICARE (1-800-633-4227) for more information. TTY users call 1-877-486-2048.

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65Medicare.org is a leading, independent Medicare insurance agency for people turning 65 and going on Medicare. If you have any questions about this information, you can contact us online or call us at 877.506.3378.

The post 2019 Medicare Costs appeared first on 65Medicare.org.

Signing up for Medicare is daunting enough, but what about all the years that follow? There are an unlimited number of Medicare questions that Medicare recipients come up with after they have made their decisions. Whether they chose Original Medicare, or a Medicare Advantage Plan (including a Prescription Drug Plan), or Original Medicare plus a Medicare Supplement (Medigap) plan, there may be unanswered questions from when they first enrolled, or questions that may have arisen afterwards. We have put together a list of the most frequently asked questions among this segment of the population, in hopes that clarity may be gotten from this information.

If I enrolled in a Medigap plan, do I need to renew it every year?

No, you do not have to renew it again. It is “guaranteed renewable”, which means you cannot be terminated from the plan for any reason, including any new health conditions you have developed.

Does a Medigap plan include prescription drugs?

No, it does not. You will have to get a stand-alone drug plan besides the Medigap plan.

When can I disenroll in or switch from one Medicare Advantage plan to another?

You can switch or drop your Medicare Advantage plan, but only during certain periods of the year:

• The annual open enrollment each year from Oct. 15 – Dec. 7. However, your new plan will not become effective until Jan. 1^st of the following year.
• The Medicare Advantage Disenrollment Period, Jan. 1 – March 31, each year.
• The Special Enrollment Period – there are certain circumstances which will allow you to change, i.e. moving out of the service area of your plan; you decide to switch during the first year you joined a Medicare Advantage plan (trial period).

I’m planning to retire, what will happen when my employer coverage ends?

When your employer coverage ends, you have 8 months within which to enroll in Part B (or choose COBRA). You will need to complete an Application for Enrollment in Part B (CMS-40B) and a Request for Employment Information (CMS-L564). Even if you choose COBRA, be aware that if you do not enroll in Part B during the 8-month period following your termination of coverage, the following may occur:

• You may incur a penalty for the duration that you have Part B.
• You will not be able to enroll until January 1–March 31. If that happens, you will then have to wait until July 1 of that year before your coverage starts.

Are pre-existing conditions immediately covered, or is there a waiting period?

Original Medicare and Medicare Advantage plans do not generally take into consideration pre-existing conditions or disabilities. However, if you have end-stage renal disease (ESRD) or want to enroll in a Medicare Supplement (Medigap) plan, there are some exceptions. It is the insurance company who determines what their guidelines are and which, if any, pre-existing conditions they want to include. Each company also decides on the length of the waiting period if any.

The exception to this is if you apply for a Medigap plan during the open enrollment period when you first turn 65 or start on Medicare. During this time period, there are no health questions, no pre-existing conditions, and you are automatically approved.

If I apply for a Medigap plan, will I be immediately approved?

Unless you are in “open enrollment” or are entitled to be a guaranteed issue, then no. Your application will have to go through medical underwriting and you will be obligated to answer medical questions. This is why it is important to choose a Medigap plan when you are first eligible for Medicare if you intend to get one at any point.

How often can I change my Part D, Prescription Drug Plan?

You can switch your PDP during the annual open enrollment period, Oct. 15 to Dec. 7, each year. Otherwise, there are certain circumstances which would allow you to change, i.e. you moved out of your plan’s service area; your plan was dropped from being offered in your service area. If you are eligible for Extra Help, you can change your PDP at any time during the year. You can also change at any time if switching to a 5-star rated prescription drug plan.

What is IRMAA and why do I have to pay it?

IRMAA stands for Income Related Monthly Adjustment Amount. It is an additional amount which is added to your premium. If your modified adjusted gross income is above a certain amount (according to your IRS tax return from 2 years ago), you will pay the standard premium amount ($135.50), plus an Income Related Monthly Adjustment Amount. To learn more, please go to https://www.medicare.gov/your-medicare-costs/part-b-costs.

What are the rating methods used to set the rates for Medigap plans?

Attained-age rates are determined by your age when you are on the policy. They go up as you get older. Issue-age policy rates are determined by your age at the time the policy is issued. Community-rated policies charge the same rates to everyone within the same geographic area.

What should I do if my Medigap premium goes up?

Medigap premiums, just like any other type of insurance, do go up over time. The premiums are typically determined by your age, so they will typically increase as you get older. Additionally, rates change as Medicare makes changes to the coverage offered by traditional Medicare, since Medigap plans automatically “expand” to cover Medicare gaps.

If and when your premium increases, it is a good idea to “shop” to ensure that you have the best available deal. If you are in good health, you can very easily change to equivalent coverage from a different company, potentially saving yourself money for equal coverage.

Other Medicare Questions?

You probably have Medicare questions that are not covered by this brief list. We have answers. If you have a question about Medicare itself, Medigap or Medicare Advantage or Part D, please feel free to contact us.

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65Medicare.org is a leading, independent Medicare insurance agency for people turning 65 and going on Medicare. If you have any questions about this information, you can contact us online or call us at 877.506.3378.

The post Frequently Asked Medicare Questions appeared first on 65Medicare.org.

With the enrollment period formerly known as the Medicare Advantage Disenrollment Period (MADP), which ran from January 1 to February 14 each year, you could disenroll from whatever Medicare Advantage plan you had.  Once this occurs, you will only have your Original Medicare (Parts A and B).  Since your prescription drug plan will also be terminated, you are able to enroll in a stand-alone Medicare Part D Prescription Drug Plan.

However, beginning in 2019, new changes give you a wider window of opportunity – the length of time to make changes will be extended from January 1 to March 31 each year. According to the new rules, you will have an opportunity to:

• disenroll from you current Medicare Advantage plan, return to Original Medicare, Parts A and B), and enroll in a stand-alone prescription drug plan.  (this has not changed from the previous MADP open enrollment period). This allows you to also, if you choose, enroll in a Medigap plan.
• switch from your present Medicare Advantage plan and choose a different Medicare Advantage plan.

What are the advantages of switching from one Medicare Advantage plan to another?

If I’m happy with my Medicare Advantage plan, why should I make a change?  Well, there are many plans that offer additional perks, like vision, hearing and dental benefits.  It’s possible that your plan may drop one or more of these benefits if you already have them.  There may be a better plan available in your service area with your existing insurance company or a different company altogether.

Each year, your Medicare Advantage plan will send you an Annual Changes Notice.  This booklet compares the changes that will occur for the following year with your current plan.  Carefully read these changes!  Your benefits may increase or decrease for certain services or medical supplies.  Some examples of these are:

• lowering your copay for a specialist
• increasing the copay for a hospital stay
• increase or decreasing the percentage you pay for imaging or lab tests
• decreasing your out-of-pocket expenses for the year
• vision exams – increasing the amount you get towards lenses or frames
• Silver Sneakers – this is a perk that may or may not be included with your plan. It is not in the plan contract, but an additional benefit, which your plan can take away at any time.  Note:  Pay attention even if you switch your plan within the same company, as one plan may have this benefit, but another one might not!

Another important factor in helping you decide to switch or not to switch your plan, is the “formulary” (list of medications) that your plan sends out every fall for the following year.  If you are taking medications, make sure that your current medication will still be covered.  It is possible that the tier your medication is in will move to a more expensive tier or be less expensive next year.  If not, you may end up paying through the roof, when you find out your medications will be costing much more.

If you choose to change your Medicare Advantage plan during this new enrollment period, it will become effective the first of the month following your enrollment. Please be advised that you are entitled to make only ONE change during the open enrollment period.

To summarize, starting this year, in 2019, Medicare beneficiaries who are enrolled in a Medicare Advantage plan will now have more options to better suit their needs – they will now have additional time to decide if they want to disenroll from their current Medicare Advantage plan.

Instead of only January 1-February 14, this new open enrollment period will run from January 1-March 31 each year.  Furthermore, beneficiaries will now be able to switch from their existing plan to a different plan, if available in their service area.  With the previous open enrollment period arrangement, you could only drop your plan and return to Original Medicare – you could not add a new Advantage plan. Now, you can switch to a new Advantage plan during this time period. Or, you can still elect to drop your Advantage plan, enroll in a stand-alone Part D plan, and if you want, sign up for a Medigap plan. See more about the differences between Medicare Advantage and Medigap.

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65Medicare.org is a leading, independent Medicare insurance agency for people turning 65 and going on Medicare. If you have any questions about this information, you can contact us online or call us at 877.506.3378.

The post Medicare’s New Open Enrollment Period (OEP) – Last Chance to Make Changes appeared first on 65Medicare.org.

Each year, millions of Medicare beneficiaries and their families rely on the information in the “Medicare and You” publication to make healthcare and insurance decisions for the following calendar year. The draft of the 2019 “Medicare and You” book was published in May, and soon after, the three non-profit groups issued a joint letter to Seema Verma, Administrator of the Centers for Medicare & Medicaid Services (CMS). The letter urges CMS to rectify errors in the draft version prior to issuing the 2019 version of the booklet.

The three groups, which advocate for Medicare beneficiaries as opposed to one specific type of insurance plan, outline several significant inaccuracies/biases in the book, including:

• The book does not adequately inform Medicare beneficiaries about the network-based requirements that are inherent in Medicare Advantage programs
• It presents “prior authorization” that is required in Medicare Advantage plans as a “right” that is not available in “original” Medicare. In reality, this is an extra step required of Medicare Advantage members before they can access care, as opposed to Medicare itself, which does not have that requirement.
• Third, the draft version of 2019 “Medicare and You” implies that Medicare Advantage is the clear-cut less expensive option for all beneficiaries. This is a sweeping generalization that does not take into account the numerous variables that impact a Medicare beneficiary choosing the coverage options that are most suited to their individual needs.

This is not the first time there have been widespread objections to the information published in “Medicare and You”. Many stakeholders in the Medicare and Medicare insurance market have encountered Medicare beneficiaries that have been misinformed or confused by the information presented in the book in previous years.

As one example, the “Medicare and You” book always lists all available Medicare Advantage plans for a beneficiaries county, while not listing any Medigap providers or Medigap rates. While the reasons for this are obvious – CMS has oversight of Medicare Advantage and not Medigap – this does cause confusion and misunderstanding for many beneficiaries when selecting a plan.

Medicare Rights President Joe Baker issued a written statement:

“From the Medicare Rights Center’s experience assisting people with Medicare and their families, we know how challenging it can be for beneficiaries to make the best coverage decision for their unique circumstances. The Medicare & You Handbook must support this decision-making process by accurately describing the rules, restrictions, and benefits of both Original Medicare and Medicare Advantage. Regardless of the coverage they ultimately select, all people with Medicare deserve the opportunity to make an informed choice. We commend CMS for incorporating many of the language changes we suggested in prior years, and urge the agency to address our concerns with the draft 2019 Handbook prior to its publication.”

It remains to be seen what will be done in response to the groups’ letter to CMS, if anything. What is certain is that Medicare beneficiaries absolutely must take the time and due diligence to understand Medicare and their Medicare options for themselves. Just like you cannot take what a friend, insurance agent or neighbor says about Medicare as the absolute truth without examining for yourself, you likewise should take carefully consider anything you read from Medicare itself. This can be challenging, but it is essential to making an informed, prudent choice on these important matters.

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65Medicare.org is a leading, independent Medicare insurance agency for people turning 65 and going on Medicare. We have worked with 10,000+ Medicare-eligible individuals over the last 10+ years, assisting with understanding and comparing the plans. You can get a list of Medigap quotes in your area. Or, if you have any questions about this information, you can contact us online or call us at 877.506.3378.

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