Medicare Tips and Tricks

 

2023 Medicaid Income Limits
$914 per month for individuals and $1,371 for married couples.

4 Types of Medicare Savings Programs

1. QMB- Qualified Medicare Beneficiary Program
   1. Helps pay premiums for Part A and Part B, as well as copays, deductibles, and coinsurance. This is the most robust MPS, and has the lowest income limits for eligibility. A single person can qualify in 2021 with an income of up to $1,094 per month or $1,472 per month for a couple.
2. SLMB- Specified Low Income Medicare Beneficiary Program
   1. Helps to pay premiums for Part B. A single person can qualify in 2021 with an income of up to $1,308 per month or $1,762 per month for a couple.
3. QI- Qualified Individual Program
   1. Helps to pay premiums for Part B. A single person can qualify in 2021 with an income of up to $1,469 pe month or $1,980 per month for a couple.
4. QDWI- Qualified Disabled and Working Individuals Program
   1. Helps to pay Part A premiums. This MSP is for people who are disabled but have returned to work and lost their premiums- free Medicare Part A. The income limits are higher (up to $4,379 per month for an individual and $5,892 for a couple in 2021), but the asset limit is lower, at $4,000 for an individual and $6,000 for a couple.

If you qualify for QMB, SLMB, or QI you will also receive extra help, a federal program that lowers prescription drug and premium costs under Medicare Part D.

1. LIS Yearly Limits
   1. Individuals with an income of $22,470 or less and $14,790 or less in resources.
   2. Married Couples with an income of $30,300 or less and $29,520 in resources.
2. For all beneficiaries with LIS both Full or Partial, they pay no more than $3.70 for generic and $9.20 for brand drugs.
3. MSP Programs help with premiums, deductibles, copays, and coinsurance.

To enroll a client with Extra Help for PDP plans go to secure.ssa.gov/i1020/start

Part A Premiums- Most people get premium-free Part A if they have to pay for their Part A premiums are either $259 (If they paid Medicare taxes for 30-39 quarters) or $471 (if they paid Medicare taxes for less than 30 quarters) each month in 2021 depending on how long they or their spouse worked and paid Medicare taxes. If they chose not to buy Part A, you can still buy Part B. In most cases, if you choose to buy Part A, you must also have Medicare Part B and pay monthly premiums for both Part A and Part B.

Part B Premiums- The standard Part B premium amount in 2021 is $148.50. Most people pay the standard Part B premium amount. Here are the income limits which will cause and Income Related Monthly Adjustment Amount (IRMAA)

Standard Premium ($148.50) income limit is $88,000 per individual or $176,000 for joint tax returns
Level 1 IRMAA premium ($207.90) income limit is $111,000 per individual or $222,000 for joint tax returns
Level 2 IRMAA premium ($297.00) income limit is $138,000 per individual or $276,000 for joint tax returns
Level 3 IRMAA premium ($386.10) income limit is $165,000 per individual or $330,000 for joint tax returns
Level 4 IRMAA premium ($475.20) income limit is $500,000 per individual or $750,000 for joint tax returns
Level 5 IRMAA premium ($504.90) income limit is anything above Level 4 IRMAA incomes

Late enrollment penalty: 

• In most cases, if you don’t sign up for Part B when you’re first eligible, you’ll have to pay a late enrollment penalty. You’ll have to pay this penalty for as long as you have Part B. Your monthly premium for Part B may go up 10% of the standard premium for each full 12-month period that you could have had Part B, but didn’t sign up for it. Also, you may have to wait until the General Enrollment Period (from January 1 to March 31) to enroll in Part B. Coverage will start July 1 of that year.

Part D Late Enrollment Penalty

You may owe a late enrollment penalty if, for any continuous period of 63 days or more after your Initial Enrollment Period is over, you go without one of these:

• A Medicare Prescription Drug Plan (Part D)
• A Medicare Advantage Plan (Part C) (like an HMO or PPO) or another Medicare health plan that offers Medicare prescription drug coverage
• Creditable Prescription Drug Coverage

In general, you’ll have to pay this penalty for as long as you have a Medicare drug plan. The cost of the late enrollment penalty depends on how long you went without Part D or creditable prescription drug coverage.

The cost of the late enrollment penalty depends on how long you went without Part D or creditable prescription drug coverage.

Medicare calculates the penalty by multiplying 1% of the “national base beneficiary premium” ($33.06 in 2021) times the number of full, uncovered months you didn’t have Part D or creditable coverage. The monthly premium is rounded to the nearest $.10 and added to your monthly Part D premium.
The national base beneficiary premium may change each year, so your penalty amount may also change each year.

To learn more go to https://www.medicare.gov/your-medicare-costs/medicare-costs-at-a-glance

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