Beware of medical provider changes in Medicare PPO plans

[VacationForever]

Mine is $4200/year, dh is closer to $5000. That is for standard Medicare, a supplement and a Plan D. What is an IRMMA?

Medicare's surcharge for higher income folks which applies to Part B and D. It is based on an income scale.

 

[Luanne]

Medicare's surcharge for higher income folks which applies to Part B and D. It is based on an income scale.

Yes, I know that. Social Security is very good about sending out that information showing exactly what your Social Security benefit is, what the Medicare amount is and any increase because of income.

I also should have mentioned that through my former employer both dh and I get an HRA. We don't put anything in, and we get between us $4200/year. That offsets quite a bit of our costs.

 

[VacationForever]

Yes, I know that. Social Security is very good about sending out that information showing exactly what your Social Security benefit is, what the Medicare amount is and any increase because of income.

I also should have mentioned that through my former employer both dh and I get an HRA. We don't put anything in, and we get between us $4200/year. That offsets quite a bit of our costs.

You had asked what is IRMAA?

 

[MULTIZ321]

Medicare's surcharge for higher income folks which applies to Part B and D. It is based on an income scale.

IRMAA is an acronym for Medicare's income-
related monthly adjustment amount (IRMAA).
This is a higher premium charged by
Medicare Part B and Medicare Part D to
individuals with higher incomes.

Richard

 

[DancingWaters]

We put our duplex up for sale, and today, found out that when it sells it will bump us into the higher Medicare premium bracket. We are shocked——not sure now if we should have put it up for sale. Two questions I have: Is there any age where this extra money from selling the property wouldn’t effect the Medicare premium? Also, will the Medicare premium return to the $144.50 amount the next year when we don’t have that kind of income?

 

[Luanne]

You had asked what is IRMAA?

Well I had hoped that someone like Richard, would explain what the acronym was. Thanks @MULTIZ321

I guess I just didn't get your explanation.

 

[VacationForever]

We put our duplex up for sale, and today, found out that when it sells it will bump us into the higher Medicare premium bracket. We are shocked——not sure now if we should have put it up for sale. Two questions I have: Is there any age where this extra money from selling the property wouldn’t effect the Medicare premium? Also, will the Medicare premium return to the $144.50 amount the next year when we don’t have that kind of income?

It only affects the one year, which is 2 years later. So if you sell in 2020, your income goes up for 2020. When Medicare calculates your premium at the end of 2021 for 2022, they look back at 2020 income. At end of 2022, they look at 2021 income to come up with the amount for 2023.

 

[VacationForever]

Well I had hoped that someone like Richard, would explain what the acronym was. Thanks @MULTIZ321

I guess I just didn't get your explanation.

IRMAA table for Part B: https://www.medicare.gov/your-medicare-costs/part-b-costs
IRMAA table for Part D: https://www.medicare.gov/your-medicare-costs/medicare-costs-at-a-glance and scroll to the bottom and click on "Medicare Part D (Medicare prescription drug coverage)" to expand the Part D cost table.

 

[DancingWaters]

Does it automatically go back down or is this something that has to be requested? If we wait until we are 66 years old will the extra bump in income for that year matter for Medicare?

 

[VacationForever]

Does it automatically go back down or is this something that has to be requested? If we wait until we are 66 years old will the extra bump in income for that year matter for Medicare?

Automatic. CMS / IRS recalculates every year. If you wait until say, 2024 when you turn 66, then at end of 2025 it will use 2024 income to compute Medicare premiums for 2026, which will affect you in the year of 2026 which presumbly you will be 68.

 

[DancingWaters]

Is it better financially to sell all 3 duplexes the same year, or sell one a year? This is something that never occurred to us. We knew we would have to pay a good chunk of taxes, but didn’t realize it effects our Medicare which is another chunk. And then as drama unfolds—- we contacted the one tenant that we would need to have realtors thru her half of the duplex periodically. She was ok with that, but proceeded to tell us the only place she feels safe from her ex husband is inside her rental and her ex FIL is a realtor and she doesn’t want him inside. Ok, I hope that can be prevented thru all these showings! I certainly don’t want her to give her reason to be more afraid. So now, I’m feeling very terrible that we even started the process of selling off.

 

[VacationForever]

Is it better financially to sell all 3 duplexes the same year, or sell one a year? This is something that never occurred to us. We knew we would have to pay a good chunk of taxes, but didn’t realize it effects our Medicare which is another chunk. And then as drama unfolds—- we contacted the one tenant that we would need to have realtors thru her half of the duplex periodically. She was ok with that, but proceeded to tell us the only place she feels safe from her ex husband is inside her rental and her ex FIL is a realtor and she doesn’t want him inside. Ok, I hope that can be prevented thru all these showings! I certainly don’t want her to give her reason to be more afraid. So now, I’m feeling very terrible that we even started the process of selling off.

Check the links which I had posted above... and here again. You look at the income scale and its corresponding IRMAA amount. You will have to do some what-ifs as to which bracket you will fall under if you sell them all in 1 year or one a year.
IRMAA table for Part B: https://www.medicare.gov/your-medicare-costs/part-b-costs
IRMAA table for Part D: https://www.medicare.gov/your-medicare-costs/medicare-costs-at-a-glance and scroll to the bottom and click on "Medicare Part D (Medicare prescription drug coverage)" to expand the Part D cost table.

 

[bogey21]

Deleted. I was answering a question already answered well...

George

 

[WinniWoman]

Is anyone wishing for the Canadian healthcare system now? Just listen to these conversations. I don't know about you, but I don't want to spend the rest of my life obsessing about how to deal with all of this all this nonsense.

BTW- I pretty much decided to stay on the retiree medical instead of COBRA and when I move just go on Obamacare EPO and call it a day no matter what. Take my chances. Then we will call that stupid VIA Benefits and change hubby's Part D and also call Empire and change to Anthem in NH.

ENOUGH ALREADY! This is ridiculous with this health insurance stuff! Where is geekette? She is right- maybe just forget having insurance altogether. It is a big scam!

 

[bogey21]

Is anyone wishing for the Canadian healthcare system now?

Not me. I have a friend in Canada who says he got jacked around getting tested for some throat problems. After 9 months they finally decided he had throat cancer and operated. In the process they removed his voice box. Not only is he now being fed by tubes he also can't talk. He is now wasting away and feels that if he hadn't been jacked around for 9 months, he would have had a better chance...

George

 

[Rolltydr]

I don’t believe stories like this are limited to Canada or countries with national healthcare plans. I’ve heard similar stories over the years, and actually have a nephew with cancer here in the USA who was misdiagnosed and had treatment delayed for several months.


Harry - Sent from my iPad using Tapatalk

 

[Sugarcubesea]

It only affects the one year, which is 2 years later. So if you sell in 2020, your income goes up for 2020. When Medicare calculates your premium at the end of 2021 for 2022, they look back at 2020 income. At end of 2022, they look at 2021 income to come up with the amount for 2023.

Vacation Forever, this is such good information to have. I will not be retiring till 2026 at the earliest and when I retire my medicare calculation will make me pay a premium for two year after this? Is there a way to get around this? After I retire my income will drop by about 60%, so if thats the case I need to save an additional amount of cash to pay for this premium now for when I retire....

I love following these posts because it helps me to forecast for my future....

 

[WinniWoman]

I don’t believe stories like this are limited to Canada or countries with national healthcare plans. I’ve heard similar stories over the years, and actually have a nephew with cancer here in the USA who was misdiagnosed and had treatment delayed for several months.


Harry - Sent from my iPad using Tapatalk

And things are about to get worse and worse.

 

[VacationForever]

Vacation Forever, this is such good information to have. I will not be retiring till 2026 at the earliest and when I retire my medicare calculation will make me pay a premium for two year after this? Is there a way to get around this? After I retire my income will drop by about 60%, so if thats the case I need to save an additional amount of cash to pay for this premium now for when I retire....

I love following these posts because it helps me to forecast for my future....

When you retire in 2026, they will use that income plus household income to calculate 2028 rates. Upon receiving the rates letter in 2027, you need to send in an appeal form, letter and proof of your retirement. They will send you a letter with the approval and eliminate that earned income amount and recalculate to come up with a new Medicare cost amount. If they have already started deducting premiums using the old higher amount they will either send you a refund check if the amount was taken out of your social security check or stop pulling money from your account if you have not started taking social security. You have to stay on top of the adjustment and call them if you don't see a refund check or that deduction is still going on at the higher amount etc.

Link to the life changing event appeal form. https://www.ssa.gov/forms/ssa-44-ext.pdf

You can find full list of change of life events accepted reasons in the pdf file.

 

[VacationForever]

Is anyone wishing for the Canadian healthcare system now?

Not me. Socialized medical systems have its problems. I was on email with my sister yesterday and she said a month ago my brother-in-law was admitted for a day and discharged even when he was still unwell because of under capacity in a public hospital. He is not scheduled to see his doctor until next week. Alot can happen in 4 weeks and you are under the mercy of their schedules and what/when they decide to see you. Right now we have choice. When I could not get into my first ENT specialist because he was booked solid for the next 6 months, I went back to my PCP to get me someone else whom he recommends and I got in the following week. I like having consumer choice.

 

[Brett]

And things are about to get worse and worse.

Oh sure.
And pity the poor people on "socialized" medical care ... aka Medicare

 

[DancingWaters]

Yes, thank you VacationForever and others for the information. Have you had this happen to you since you seem very knowledgeable on this topic? It’s just a surprise to us that our Medicare
premium would be raise. Here I thought once we sold the rental properties most of the unforeseen expenses would be gone and we would be “headache free” without all those extra problems. Live and Learn as they used to say. I love reading all these topics and feel tuggers are a great asset.

 

[Luanne]

Not me. Socialized medical systems have its problems. I was on email with my sister yesterday and she said a month ago my brother-in-law was admitted for a day and discharged even when he was still unwell because of under capacity in a public hospital. He is not scheduled to see his doctor until next week. Alot can happen in 4 weeks and you are under the mercy of their schedules and what/when they decide to see you. Right now we have choice. When I could not get into my first ENT specialist because he was booked solid for the next 6 months, I went back to my PCP to get me someone else whom he recommends and I got in the following week. I like having consumer choice.

Yes, socialized medical systems have issues. But have you EVER heard anyone who lives somewhere where they have that system, or something similar, wish for a health care system like ours? Most people who live in other countries, like our friends in Canada, are appalled at what we have here and what we have to pay for it.

 

[WinniWoman]

Well, today was hell on the phone with this health insurance stuff. I know more than anyone I called. Hours on the phone- I am so tired of trying to get to the bottom of this.

Back in November my husband's employer told us to enroll in active employee health insurance during open enrollment so just in case for some reason he didn't retire we would be covered. Ok- made sense so we did. We just received notice that we have been disenrolled- ok - right. Hubby is retired now.

I also got notice that I am now enrolled in retiree medical at a premium of $545 per month and I can enroll in COBRA if I want for $16 per month less. No thanks. I am leaving well enough alone. (originally the benefits dept told me I would have to enroll in one or the other, but it turns out I was automatically enrolled in retiree medical. Once again- no one knows what they are talking about).

So, as I mentioned, first I try to find out what the network is in NH where we are moving. Turns out that on the employer website where I access this info. it is stating everything is out of network except a few docs in VT and upstate NY. Huh? Same plan but different network from active employees who now have the Premier network, We evidently have the Choice POS II network, which we had last year. The employer benefits dept had assured me for months that the plan was the same and there was a network in NH so I was good to go. ???

On top of this, we received insurance ID cards for the ACTIVE employee plan of which neither of us is a part of, so those cards are useless. Very upset, I yet again call, but now there is another number I have to call for Quantum Health, who is handling stuff for the employer and also find out that the Aetna networks and claims are now handled by a company called Meritain. Here we go- more convolution!

Suffice it to say I was on the phone a looooong time, even getting the employer benefits person to be on the phone with me with the so - called care coordinator at Quantum because she did not even know anything about what was involved. I had complained about the lack of in network providers- the employer benefits rep. is actually very good to deal with but even she did not know about the difference in networks.

I explained I need a card. Asked me when my MD appt was. Told them I don't have one but what if I needed to see a doc or go to the hospital and I have no card? I originally was told I could just keep using my old card. That the doctor's office could call to get confirmation. Really? Well guess what? I called the Aetna phone number on that card and they do not have any info on me! Do they know what a nightmare it would be if I had to go to a doctor or hospital? No one cares!

I call another employer benefits coordinator again this evening. She is rushing me off the phone. Telling me active and retiree medical cards are being sent this week. Really? I got the cards this week and they are the ones for active employees! I ask her when I will be billed. She says 1/10 and expect the bill within 15 days after that. I tell her we will be moving, can I pay on line. She claims I can. You would think she would have volunteered this information.

I ask her what the stupid people do. She says they don't worry about anything. I bet.

Then I call Quantum again. I am paying $545 per month for a high deductible plan with no network? The guy tells me to go on this other website- can't even tell you how long that took- and to check off the Choice POS II plan on there and the network for NH would show up. That box stated it was Choice POS II (Open Access). I ask him if he is sure it is what I have because my old card never said Open Access. He said it was, but I am not buying it. The devil is in all these little details with these notorious insurance companies!

He says once we update our new address with Allstate the networks will be more updated. Really? What does our address have to do with anything? This plan is not an EPO or an HMO! If that were true, why do a couple of VT providers 85 miles away come up as in network!? he then tells me when I make a doctpr appt to make sure to ask if the doc is in network. DUH? Really? And if you are very sick in an ambulence? OMG! I can't take it! How the heck can anyone make an informed decision about anything in this nightmare?!

For sure, once I move to NH, Obamacare it will be. For this kind of money, who needs this. A silver plan there with no deductible, and cheap copays is $103 per month for an income of $30,000 per year, which I will be talking to our financial advisor about this weekend. They have a clear network and frankly I don't even care. I am sick of it all. And the premiums would be cheap.

In NY, the Aetna plan is ok in terms of providers- I just need a card for proof. Once we move I will immediately apply for Obamacare. If something happens to me in the meantime I am just going to say I have no insurance. I am not going to fight this cr%$((p! anymore. It is complete BS.

I am a person that thinks government should not be involved in anything, including health care, but that will never happen and that is why I feel a system similar to Canada's is the best bet.

Did I mention that providers in NH I called- some did not even know what they took and another said hardly anyone accepts Aetna in NH? This only adds to my anxiety.

On top of this, I ask about my husband's pension lump sum money which is supposed to be released on Friday. Tells me to call our financial company (she referred to as a bank) to check because a notice was sent to them. I call and they have nothing.

I need to get ready to move. I am really tired of incompetence and misinformation. If I don't have a stroke before we move it will be a miracle.

Dealing with this and still dealing with the builder and his subcontractors who messed up a lot of stuff at the new house I don't know if I will ever be free and at peace. This whole retirement thing, the health insurance, and moving and buying and selling a house has zapped the joy right out of me.

 

[Luanne]

@WinniWoman What a mess!