By M. Margaret O’Brien, CEBS, HIC
When I work with clients approaching Medicare, they are often surprised to learn that Medicare is not free. Unless you qualify as “low-income,” everyone pays for Medicare.
Medicare Part A, which covers in-patient hospitalization, home-healthcare, Skilled Nursing Facility, and hospice care, is usually “premium-free.” Part A premiums are paid during your working life. Some people do pay a premium for Part A. If you did not work for 40 Quarters or ten years, and you do not qualify through a spouse, you will pay a premium for Part A.
Medicare Part A has a $1,556 per occurrence deductible. The plan then pays most of the facility costs for in-patient hospital stays and Skilled Nursing Facilities, Home Healthcare costs, and hospice care. But Medicare Part A does not pay for the providers who treat you in the hospital.
Medicare Part B covers most of your medical services – doctors, nurses, surgery, physical therapy, occupational therapy, durable medical equipment, etc. Part B has a standard premium for everyone. In 2022, the standard Part B premium is $170.10/month.
Medicare Part B has a $233 deductible and a 20% coinsurance with no limit to the out-of-pocket costs. As you can imagine, these costs can become quite significant.
Furthermore, some people pay more than the standard Part B premium. If your Modified Adjusted Gross Income (MAGI) is higher than $91,000/year or $182,000/year if you file jointly, you will pay more than the standard premium using a two-year lookback (2022 premium is based on 2020 income). This adjusted amount is called IRMAA – the Income-Related Monthly Adjustment Amount. The IRMAA table will indicate your premium based on your income. IRMAA Part B premiums for 2022 range from $238.10 – $578.30 a month.
In addition to the IRMAA for Part B, there is an IRMAA for Part D, Medicare Prescription Drug coverage. These values are adjusted every year. But range from $12.40 – $77.90 per month. Medicare Part B And Part D Prescription Drug Coverage for 2022 IRMAA tables can be found here- https://secure.ssa.gov/poms.nsf/lnx/0601101020
Once you are enrolled in Medicare, the Social Security Administration will pull your tax records and notify you of your IRMAA. If your income has changed significantly, you can appeal your IRMAA. Instructions for how to do so are included in your IRMAA letter.
To limit your financial liability for Medicare expenses, many people buy either a Medicare Supplement and a Medicare Part D prescription drug plan, or a Medicare Advantage plans. Making the decision about which solution is right for you can be guided by licensed Medicare agents. The right solution for you is unique – it should not be made based on what your spouse chooses, your brother-in-law prefers, etc.
Make sure you talk to someone who will help you evaluate your situation, advise you about your decisions, help you understand which decisions can be changed later, and help you enroll in the right plan for you. Medicare advisors are not allowed to charge you for their services – we get paid by insurance companies.
Enrolling Medicare is only one part of your retirement planning. Let a professional advisor help you make a decision that will give you peace of mind on your healthcare for the next stage of life.
We are here to help you through every stage of your financial life and retirement. Don’t hesitate to get in touch with us at 800-871-1219 or info@scarletoakfs.com. If you would like to speak to Margaret O’Brien directly, her contact information is below.
Margaret O’Brien is a Certified Employee Benefits Specialist with 25 years of experience in the health insurance industry. She spent 17 years at Aetna and then launched her independent brokerage in 2014, focusing on Medicare and individual health insurance. She is a graduate of Georgia Institute of Technology and a veteran traveler.
M. Margaret O’Brien, CEBS, HIC can be reached:
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This material was prepared by M. Margaret O’Brien and does not necessarily represent the views of the presenting party (Scarlet Oak Financial Services), nor their affiliates Capital Asset Advisory Services, LLC. This information has been derived from sources believed to be accurate.
The information in this material is not intended as Medicare advice. This article is for informational purposes only and is not a replacement for real-life advice, so make sure to consult your tax, legal, and financial professionals before modifying your retirement strategy.
