Medicare EnrollmentCategory:

How to pay Medicare IRMAA taxAre you in the lucky top 4% of earners? You will pay more for your Medicare benefits.  The more is IRMAA (Income-Related Monthly Adjustment Amount).  The amount you pay for your Medicare health and prescription drug coverage depends on your level of income.  There is a ladder.

Would you like to avoid paying that tax or possibly pay a smaller portion of it? We will guide you through the key IRS exceptions for Medicare IRMAA (Income-Related Monthly Adjustment Amount). By understanding and leveraging these exceptions, you can potentially lower your Medicare expenses and put more money back in your pocket.

Medicare IRMAA is an additional premium that high-income Medicare beneficiaries are required to pay. However, there are exceptions that may enable you to reduce or even eliminate this extra cost. Knowing the ins and outs of these exceptions can make a significant difference in your healthcare expenses.

In our comprehensive guide, we will break down each exception and provide you with the information you need to take advantage of them. From ‘Life-Changing Events’ to ‘Reconsideration Requests,’ we will explore all the options available to you.

Understanding the IRS Exceptions for IRMAAMedicare taxes

The Income-Related Monthly Adjustment Amount, or IRMAA, is an additional premium that high-income Medicare beneficiaries have to pay. However, the IRS provides exceptions that may allow you to reduce or eliminate this extra cost. Let’s explore these exceptions in detail.

Medicare tax exception Life-Changing Event

One of the exceptions to IRMAA is a life-changing event. This includes events like marriage, divorce, death of a spouse, or work stoppage. If you experience any of these events, you may be eligible for a reduction in your Medicare costs.

To qualify for this exception, you will need to provide documentation of the life-changing event and submit it to the IRS. Documentation is key. The IRS will not take your word for it. You need to prove your income decreased.

Examples of documentation may include a marriage license or divorce decree, death certificate, or proof of work stoppage. By leveraging this exception, you can potentially save a significant amount of money on your monthly Medicare premium.

Medicare IRMAA Exception 1: Marriage or Divorce

Getting married or divorced can have a significant impact on your income and, consequently, your Medicare costs.

If you are recently divorced and you are a lower income earner, you may drop below the IRMAA threshold or at least step down the ladder, which would reduce your tax.
For some individuals, marriage may reduce their income because alimony is lost. The threshold is increased because it is for two persons. The initial threshold for a single individual is $103,000. For married filing jointly, it is $206,000. Either of these lifestyle changes may affect your income in that year and, consequently, your IRMAA tax, even if your income was higher in the previous year.

To take advantage of this exception, you must provide documentation of the marriage or divorce and proof of the change in income. By doing so, you can potentially save a significant amount on your Medicare expenses.

Medicare IRMAA Exception 2: Work Stoppage or ReductionIRMAA work stoppage

If you experience a work stoppage or a significant reduction in your work hours, you may be eligible for an exception to IRMAA. This can happen if you retire, get laid off, or experience a reduction in your income due to other circumstances.  This is probably the most common reason high-income earners should apply for the exception.  Their income was significantly higher the previous year because of work, but the year they retire and must pay the Medicare premium, their income is drastically smaller.  That is what the exception is for.

To qualify for this exception, you will need to provide documentation of the work stoppage or reduction in work hours, along with proof of the decrease in income. By doing so, you can potentially reduce or eliminate the additional premium you have to pay.

Medicare IRMAA Exception 3: Loss of Income-Producing Property

If you experienced a loss of income-producing property, such as rental properties or investments, you may be eligible for an exception to IRMAA. This can happen if your rental property becomes unprofitable or if you experience significant losses in your investments.

IRMAA lost property income I had a high-net-worth client who lost significant rental income because of flooding in Missouri. His properties produced nothing for several years as he settled with insurance companies and repaired buildings.

To qualify for this exception, you will need to provide documentation of the loss of income-producing property, along with proof of the decrease in income. By leveraging this exception, you can potentially lower your Medicare costs and save money.

Medicare IRMAA Exception 5: Loss of Pension Income

Pension plans go bankrupt. Some pensions are for a particular duration. The cessation of a pension may impact your income significantly enough to affect the IRMAA tax.

To qualify for this exception, you will need to provide documentation of the change in income, along with proof of the decrease in income. By taking advantage of this exception, you can potentially reduce or eliminate the additional premium you have to pay.

Medicare IRMAA Exception 6: Employer Settlement Payment

Employers pay out settlements to employees for many reasons.  These settlements may increase income in a given year or for several.  The settlement may have its own legal stipulations.

To qualify for this exception, you will need to provide documentation of the change in income, along with proof of the decrease in income. Some legal settlements may be placed legally outside of your modified adjusted gross income.  By taking advantage of this exception, you can potentially reduce or eliminate the additional premium you have to pay.

Medicare IRMAA Exception 7: Correcting An Erroneous Determination

Sometimes, the IRS may make an erroneous determination regarding your Medicare costs. If you believe that the IRS made a mistake in calculating your IRMAA, you can submit a reconsideration request and provide additional documentation to correct the error.

To qualify for this exception, you will need to provide evidence that the IRS made an error in its determination. This can include documentation of your income, tax returns, or any other relevant information that supports your case. Correcting an erroneous determination can potentially save you a significant amount on your Medicare expenses.

Applying for a IRMAA exception

To apply for an exception to IRMAA and reduce your Medicare costs, you will need to follow a few steps.

First, gather all the necessary documentation to support your case. This includes marriage or divorce certificates, death certificates, proof of work stoppage or reduction, documentation of the loss of income-producing property, proof of a change in tax-exempt income, or evidence of an erroneous determination.

Next, complete the appropriate forms provided by the IRS SSA-44 (12-2023). These forms may vary depending on the exception you are applying for. Make sure to fill them out accurately and include all the required information.
Once you have completed the forms, submit them to the IRS along with the supporting documentation. It is crucial to keep copies of all the documents and forms for your records.

After submitting your application, the IRS will review your case and make a determination. If your exception is approved, you will receive a notification informing you of the reduction or elimination of your IRMAA.
By applying for an exception and reducing your Medicare costs, you can put more money back in your pocket and have a significant impact on your overall healthcare expenses.

Bottom Line: Don’t Ignore the IRMAA Exceptions

Leveraging the key IRS exceptions for IRMAA can reduce your Medicare costs. Whether you have experienced a life-changing event, a change in income, or an erroneous determination, understanding these

Medicare Omaha Nebraska

Christopher J. Grimmond

exceptions can significantly reduce your healthcare expenses.

Don’t let high-income Medicare premiums burden your finances. Take the necessary steps to apply for an exception and potentially reduce or eliminate your IRMAA. By doing so, you can save money and have more control over your healthcare expenses.

Is Medicare health insurance an option for you?  Medicare is not a one-and-done choice.  Medicare is a journey that is quick and short for some.  For others, it takes place over years on a road with many twists and turns.  What will your Medicare enrollment path look like for 2024?

The Essential Medicare Enrollment Guide is something to read and re-read as you approach each leg of your Medicare journey.  As your situation changes, you will need information from different parts of this pamphlet for the various twists and turns in your path.  So, your Medicare journey begins.

Medicare Enrollment for 2024

Medicare Enrollment in 2024: the Twists and Turns

Are you wondering,

  • What is this Medicare thing about?
  • How does it work?
  • What do I have to do & when do I have to do it?
  • What are the costs?
  • What about my employer health plan? I plan to continue working.    

Get these questions answered in the upcoming pages as you consider Medicare enrollment for 2024.

Medicare Vs. Employer Health Insurance: Which is Better for You?Which is better? Medicare Enrollment or employer health plan?

In the landscape of retirement decisions, a challenge arose in the 1980s when Congress upped the eligibility age for Social Security benefits from 65 to 67.  Despite this shift, Medicare eligibility remained at 65, prompting many to defer their retirement until they can enjoy full Social Security benefits at 67.

The issue for those who continue to work is whether they should go on Medicare at age 65 or stay on their employer health plan.  The quandary is which is a better deal: Medicare OR my employer-provided health insurance?  People are stumped.  ‘Which way should I go?’

Many of my clients who stayed on their employer health plan complain that they should have gone on Medicare instead of staying on their employer’s health insurance plan.  Medicare would have been better, but they didn’t know it.

Medicare typically costs less and provides more coverage than most employer health plans, but no one explains the difference.  They didn’t understand Medicare, the rules, the penalties, and the costs.  Medicare was a mystery to them.  Consequently, they made misinformed decisions.

Find out what they didn’t know before Medicare enrollment for 2024.

What Is Medicare? 

Medicare is a federal health insurance program that Congress created in 1965.  Congress designed the program to provide health insurance for those who work in the US and are 65 and older.  At the time, there was little access to reliable, low-cost health insurance once you retired and lost employer-provided health insurance.

How Do You Qualify for Medicare?

Work History:  You must have worked at least 40 quarters (10 years) and paid FICA (Federal Insurance Contribution Act) payroll taxes.

Age or Disability:  Once you turn 65 OR are certified as disabled by the Social Security Administration (SSA) with a 24-month waiting period, you can enroll in Medicare.

Special Cases:

  • Medicare also immediately covers those with End-Stage Renal Disease (ESRD), which means kidney failure requiring dialysis.
  • Medicare likewise immediately covers those with ALS (Amyotrophic Lateral Sclerosis, also called Lou Gehrig’s Disease).

Most of my clients are 65 and older, but I have a number who are disabled or suffer from ESRD and ALS.

What Is Medicare Part A?

Hospital

Medicare health insurance is divided into two parts–Part A and Part B.  Medicare Part A is hospital insurance, but Part A covers more than just inpatient hospital stays.Enroll in Medicare Part A

Skilled Nursing Facility Care

After major medical events, the patient may no longer need the intense care an inpatient hospital stay provides.  The patient is in recovery.  They may need intravenous drugs, wound care, and daily physical or occupational therapy.  These are not services ordinarily provided for prolonged periods in a hospital.  Instead, a skilled nursing facility is the perfect setting.  Part A pays for Skilled Nursing.

Home Health Care   

As a patient recovers, they do not need the same level of intense skilled nursing.  The next step is to transition to home health care, which, as the name suggests, takes place in the home.

Home health care is intermittent skilled nursing care in the home.  Physical therapists, occupational therapists, and speech pathologists come to your home a few times each week to continue your treatments and recovery.  Nurses come to care for and rebandage wounds.  Part A pays for home health care.

Hospice Care

Part A covers Hospice care exclusively.   Hospice is palliative care, which means specialized medical care to relieve pain and other symptoms of serious illness.  The intent of hospice care is not to cure or prolong life but to allow the natural processes to proceed with the greatest amount of dignity and the least amount of discomfort.  Medicare Part A pays for the hospice medical staff and medications during this process.

Medicare Late Enrollment Penalty

If you are eligible for Medicare Part A, there is no penalty for not enrolling in Part A when first eligible at 65.

People call me in a panic because they heard about a “Medicare penalty.” Relatives or friends told them they must enroll in Medicare at 65.  If they don’t, there will be a huge penalty!

There is NO penalty for NOT enrolling in Part A when you turn 65. 

There is a penalty, however, for not enrolling in Part B when NOT an active member of an employer health plan.

Not enrolling in Medicare at 65 or older when not an active participant in an employer group health plan will result in the dreaded Medicare penalty.

Many people, however, do belong to employer health plans, and they do not receive any penalty for delaying their Medicare Part B enrollment.

Why Medicare Enrollment for Part A in 2024?

If there is no penalty for not enrolling, then why bother?

I encourage people to enroll in Medicare Part A when they are eligible, even if they have employer health insurance.  The reason is you establish your identity with the Social Security Administration (SSA) and CMS (Center for Medicare & Medicaid Services).

Medicare Enrollment TroubleMedicare enrollment problems

Sometimes, clients attempt to enroll in Medicare and discover they are blocked.  There are errors with their personal information in the government’s database that result in problems and delays.

  • For example, SSA has a different spelling for your name. I had a client who thought he was a Michael all his life.  He didn’t know his legal name was “Mike” until he tried to enroll in Medicare.
  • I’ve had multiple clients’ Medicare delayed because their birthday was one digit off.
  • Social Security still had Billy’s old address even though he had been divorced from his wife for three years. She got the house.
  • Another client divorced her husband, married another man, divorced him, and remarried her first husband. SSA had her maiden name as her legal name.
  • Places of birth are another hidden gem. Clients think they were born in one city but find out it was in a hospital outside the city limits.
  • Those born on military bases overseas present a problem in a completely different class of difficulty.

A delay in enrollment in Medicare may be critical when there is a strict timeline.  For example, I have had clients scheduled to lose their health insurance in a few weeks.  They need a Medicare number to enroll in a Medicare plan, Medicare drug plan, or Medicare Supplement.  We could not process the application because there was no Medicare number.

Until the errors are corrected, Social Security cannot enroll you in Medicare.

I have had clients begin the process as early as Social Security allows, which is three months, and they still did not have Medicare coverage in time.  SSA or CMS was backed up.  There were mistakes in personal data, and/or documents, like birth certificates, were lost and needed to be resubmitted.

Medicare Enrollment On Time for 2024

Starting Medicare insurance on time is critical because essential prescriptions may need to be filled.  Hard to get doctor’s appointments are set,Medicare Enrollment problems vital surgeries are scheduled, and certain treatments cannot wait.  Plans fall apart when Medicare delays enrollment past the expected start date.

While these incidents are a small percentage of clients, I guarantee you are stressed when it happens to you.  We coach clients across the finish line, and coverage starts on time.  But time crunches are uncomfortable.

The added benefit is Medicare Part A acts as a secondary payor on medical bills for the areas Part A covers.  In other words, your employer plan pays first, then Medicare Part A may pay the remainder of the bill if it falls within Part A’s purview–inpatient hospital, skilled nursing, home health care, etc.

Enrolled in Medicare Part A & HSA

The exception to enrolling in Part A when first eligible is if you plan to contribute to a health savings account (HSA).  You cannot actively participate in an HSA and be enrolled in Part A or Part B.  The penalties are severe.

Medicare Enrollment at age 65At Least Enroll in Part A at 65

With the exception of being in an HSA, enrollment in Medicare Part A for 2024, when on an employer health plan, is the intelligent thing to do.

You don’t have to worry about a timeline to get it done because you have employer health coverage.  You have plenty of time to fix any problems that may arise without rush or pressure.  It’s smart.

When you have Part A and your Medicare number, the process is much easier and quicker when you decide to activate your Medicare Part B later.

Your identity is already established, you have a Medicare (MBI) number, and you have some benefit from Part A coverage.  Activating Part B is simply a matter of submitting a couple of SSA forms.

How Early Can You Sign Up for a Medicare Supplement?

Previously, some insurance agents would enroll people in Medicare Supplements as early as six months before their 65th birthday.  The aim was to lock down the business before another agent signed them up.

Then Medicare changed the Medicare number from the HICN, which was the Social Security number with a letter, to the MBI, which is a unique Medicare Beneficiary Identifier number.  CMS (Center for Medicare & Medicaid Services) will not issue the MBI until 3 months before your 65th birthday.

Some insurance agents, however, still continue to complete Medicare Supplement applications 6 months ahead of time without the MBI in an attempt to lock down the business and discourage other agents.  They write in your number on the already signed application.  In legalize, it is called materially altering a signed contract.

What Is Medicare Part B?

Medicare Part B is Medicare insurance covering doctor visits and outpatient procedures.  Part B pays for medically necessary services in these areas as well as preventative care.

How Do You Pay for Part B Medicare?

Your Medicare Part B health insurance has a monthly premium.  You pay your Part B premium in one of three ways.

  1. SSA will deduct your Part B premium from your monthly Social Security benefit check if you are getting benefits.
  2. You can use Easy Pay on the gov website. Once you have created your MyMedicare.gov account, you can check bills and medications, get a printed or ordered Medicare card, and set up an automatic ETF deduction from your bank account for your Part B premium through Easy Pay.
  3. You may request SSA send you a paper bill quarterly.

How Much is Part B?Enroll in Medicare Part B

The Medicare Part B premium changes as medical expenses and Medicare administrative costs increase.  The current monthly premium for Medicare enrollment for 2024 is $174.70 (2023-$164.90, 2022-$170.10, 2021-$148.50, 2020-$144.60, 2019-$135.50, 2018-$134.00).

You can see the increasing trend.  Your Part B premium increasing cost will probably accelerate with current inflationary pressures.

If you are in the top 4% of income earners, your Medicare Part B and Part D premiums will be higher depending upon your level of income.

Medicare Lifetime Late Enrollment Penalty

If you do not enroll in Medicare Part B when first eligible, you will pay a late enrollment penalty for the rest of your life.

You will also be required to wait until the General Enrollment Period (from January 1st–March 31st) to enroll in Part B.  Your coverage will begin the 1st of the month following when you enroll.

A permanent 10% penalty will be added to your Part B premium for every 12 months you were not enrolled when you should have been.  The penalty is not a one-time late fee.  The penalty lasts for as long as you have Part B.

Medicare Late Enrollment Penalty Waiver

Suppose you actively participate in an employer health insurance plan as good as Medicare or other qualifying health plans.  In that case, you may delay your Medicare enrollment for 2024 in Part B indefinitely without penalty.

You will also have an open enrollment period whenever you decide to activate your Medicare Part B at any time after 65 when you are actively covered by employer health insurance.

Many people, unfortunately, are entirely unaware of this exception to the rule.  As a matter of fact, insurance agents will take advantage of this rule and omit the exception in their discussions to induce people to meet with them and enroll in a Medicare plan.

When Can I Enroll in MedicareMedicare Initial Enrollment Period

If you are eligible for Medicare when you turn 65, you can sign up

  • 3 months before the month of your 65th birthday,
  • The month of your 65th birthday,
  • The 3 months following your 65th birthday.

Medicare Initial Enrollment Period

  • When you enroll in Medicare months 1-3 before the month you turn 65, your Medicare will start the month you turn 65.
  • Medicare will start the following month if you enroll in the month in which you turn 65.
  • If you enroll the month after you turn 65, Medicare will start the 1st of the following month. The same is true for the next two months.

 

Medicare Initial Enrollment turing 65

 

Medicare enrollment for 2024, when you are first eligible, is vital in case of problems.  The Social Security Administration (SSA) and Center for Medicare & Medicaid Services (CMS) are slow.  Also, there may be errors in your personal information that will require time for correction.  Corrections may require supporting documentation, like a birth certificate or naturalization papers.  The SSA bureaucratic process does not always function efficiently or quickly.  So begin your enrollment process as early as possible.

Part A Post-Dated

After your Initial Enrollment Period (IEP), you may enroll in Medicare Part A anytime.  However, Medicare will back-date your Part A six months or to the month you turned 65, whichever is shorter.  This rule applies only to Part A.

The six-month back-dating is vital to be aware of if you contribute to an HSA (Health Savings Account).  An HSA is attached to an employer’s high-deductible health insurance plan.  Medicare has rules and penalties around HSAs.  To avoid penalties, you must stop contributing to your HSA at least six months before your Medicare Part A starts if you are older than 65.

First of the Month BirthdayMedicare enrollment for birthdays on the 1st of the month

If your 65th birthday is on the first day of the month, your Medicare coverage starts the first of the prior month.

For example, Mr. O’Shea’s 65th birthday is May 1st.  His Medicare will start April 1st if he enrolls three months ahead of time–January, February, or March.

Mrs. O’Shea’s 65th birthday is May 2nd.  Her Medicare will start May 1st.

Medicare Special Election Period lost of employmentSpecial Election Period

Once your Initial Enrollment Period ends, you have another chance for Medicare enrollment for Part B in 2024.  This new election period is called a Special Enrollment Period.  You need to meet specific criteria for the window of opportunity to open.

Suppose you are covered under an employer health insurance plan that is as good as Medicare.  Then, you have a Special Enrollment Period to sign up for Part B as long as you (or your spouse) are working and actively covered by an employer health insurance plan.

You drop your employer health plan and enroll in Medicare.  If you are coming off an employer health plan, Medicare will allow you to enroll anytime.

You will not pay a Medicare Part B late enrollment penalty or Part D late enrollment penalty because you had employer health coverage from when you turned 65 until you went on Medicare.

Medicare General Enrollment Period

Suppose you don’t sign up for Part A and/or Part B when you are first eligible and do not qualify for a Special Enrollment Period or have an employer health plan.  In that case, you may have to wait until the Medicare General Enrollment Period, which is from January 1st–March 31st.

When you enroll during this Medicare election period, your Medicare will start on the 1st of the following month.  For example, you enroll in February.  Your Medicare will start on March 1st.

Medicare Enrollment PenaltyWhat is the Medicare Lifetime Late Enrollment Penalty?

In most cases, you will have to pay a late enrollment penalty for the rest of your life if you sign up during the General Enrollment Period.  It means you did not have Medicare Part B and had no employer health insurance plan when you were eligible for Medicare.

The penalty is 10% of the current Part B premium for each full 12-month period you did not have Medicare coverage when you should have.

Yes, if you did not have Part B for five years when you should have and were not an active member of an employer health insurance plan, your late enrollment penalty would result in a 50% surcharge permanently added to your Medicare Part B premium.  Not good.  That is why it is important to understand your Medicare enrollment requirements for 2024.

When Are You Automatically Enrolled in Medicare?

Suppose you are getting your Social Security (or Railroad Retirement Board) benefits.  In that case, you will automatically be enrolled in Medicare Part A and Part B starting the first day of the month you turn 65.  If your birthday is on the first day of the month, Part A and Part B will start on the first day of the prior month.  You should receive your Medicare card three months before the month of your birthday.

You do not need to do anything if you want to keep Part B.  However, if you do not want Part B because you have an employer health plan you prefer, you can cancel Part B by contacting Medicare.  The phone number is on the back of the card (800-633-4227), and Medicare is open 24/7.

If you cancel Part B, a new Medicare card will be issued with only Part A on the card.  You will always have the option to activate Part B at a later date.

You have the option to purchase a Medicare Part D prescription drug plan with Part A only.

However, if you want to purchase a Medicare Supplement or enroll in a Medicare Part C (Medicare Advantage Plan), Medicare enrollment in Part A and Part B for 2024 is required.

Medicare Due to DisabilityMedicare eligibility because of disability

Suppose you are eligible for Medicare because of a disability.  You will automatically get Part A and Part B after receiving disability benefits from Social Security (or RRB) for 24 months.

Sign up for Medicare But Not Social Security

If you are not currently receiving Social Security (or Railroad Retirement Board) benefits, you must sign up for Medicare Part A and/or B to activate them.  You will not automatically receive Medicare benefits like those actively receiving Social Security (or Railroad Board) benefits.

Enrolling In Medicare For the First Time

Social Security is the gatekeeper for Medicare.  Signing up for Medicare has evolved over the past few years.  The Medicare online enrollment iterations were myriad, but the process is slowly improving and becoming more streamlined.

I happily help my clients enroll in Medicare online weekly.

How Do You Apply For Medicare Online? 

Enroll in Medicare at ssa.govYou can call the National Social Security Administration (SSA) at 800-772-1213.  I do not recommend that.  The hold times are maddening.  Do not call Medicare.  Medicare cannot enroll you in Medicare.  Only SSA can enroll you.

If you are considering Medicare enrollment over the phone for 2024, I suggest calling the local SSA office.

Omaha SSA Office                       866-716-8299

Lincoln SSA Office                      866-593-2880

Council Bluffs SSA Office          866-331-9094

The local offices will probably set up an appointment many weeks in the future to perform the actual enrollment.

You can also drop by the local office.  Prepare to wait or be sent away.

Omaha Address:                     Old Mill Center  604 N 109th Ct  Omaha, NE 68154

Lincoln Address:                    100 Centennial Mall N  Room 240  Lincoln, NE 68508

Council Bluffs Address:       Mid-America Center  20 Arena Way  Suite 1  Council Bluffs, IA 51501

The fastest, easiest, and most reliable way to enroll in Medicare is online at the Social Security Administration website (ssa.gov).   In the center of the page, under APPLY, click “Sign Up For Medicare.” Follow the prompts.

You will need immediate access to email and text messages to complete the enrollment process.  You must have a computer and/or phone with internet, email, and text access to enroll online.

How to Enroll in Part B Medicare

Many people delay enrolling completely in Medicare because they have an employer health insurance plan through work or their spouse’sSSA employer information form employer.  Several years may pass before they decide to ultimately go on Medicare and leave their employer’s health insurance plan.  At some point, however, people retire, quit, or stop working and go entirely on Medicare Part A and Part B.

To enroll in Medicare Part B in this situation, you must complete two CMS (Center for Medicare & Medicaid Services) forms.  You will find these forms on the CMS.gov website under forms.  The forms are Application for Enrollment in Part B CMS 40B & Request for Employment Information CMS-L564.  You can also use the search tool on the CMS.gov website and type “enrollment.”

If you have not enrolled in Medicare Part A by this point, you must also enroll in Part A on the SSA website.  Enrolling online for Part A is the preferred method.  Calling the SSA office or visiting is usually exceptionally time-consuming.  If you already have Medicare Part A, simply complete the two required forms.

Then, fax the two forms to the local Social Security Administration Office.

SSA Omaha Fax:                   833-515-0443

SSA Lincoln Fax:                   833-641-3167

SSA Council Bluffs Fax:        833-950-2936

Refrain from faxing the forms to the National SSA fax number.  I would also mail the forms to the local SSA office.  Then, call the local SSA office to confirm the forms were received and processed.  If you do all three, you significantly increase the chances of a timely and successful enrollment.

We help our clients do this every day.  Our success rate is high when you complete all three steps.  Success goes down exponentially when you leave out a step.

Medicare and HSAHealth Savings Account Contributions & Medicare

Once you enroll in Medicare, even if you only enroll in Medicare Part A, you can no longer contribute to an employer’s Health Savings Account (HSA).  If you or your employer contributes any amount to your HSA after you enroll in Medicare Part A and/or Part B, you will pay a sizeable tax penalty, and you will need to pay back the unpaid taxes when you withdraw the money from your account.

You must ensure you and your employer stop contributing to your HSA at least six months before your Medicare takes effect if you enroll in Medicare past age 65.  Medicare Part A is always back-dated six months (or to your 65th month of birth, whichever is shorter).

Again, do not enroll in either Medicare Part A OR Part B if you wish to continue contributing to an employer HSA. 

What is the Medicare HSA Penalty?

The amount of your pre-tax contribution to your HSA during the time you were prohibited will be added back into your past taxable income.  You will then be responsible for those past taxes.  You will not have the HSA deduction for that period.

An additional 6% amount will also be charged as an IRS penalty accessed on the amount contributed.

VA benefits and MedicareHow Do Veteran Benefits Affect Medicare?

 Many veterans have access to veteran benefits.  Veteran benefits are separate from Medicare benefits.  The Veteran Administration (VA) administers Veteran benefits.  VA benefits are based on the person’s service, time and place of service, disabilities, and even income.  Consult the Veteran Administration for your benefits.  VA benefits do not affect your Medicare Benefits, though they may work with them.  They are two completely separate entities.

Medicare has unique Medicare insurance plans that give additional benefits to veterans who have and use VA benefits.  Contact us at 402-614-3389 to speak with a licensed insurance agent professional about these unique plans.Medicare and VA benefits

How Does ACA or Marketplace Health Insurance Affect Medicare? 

The Health Insurance Marketplace is generally for people who need to buy individual or family health insurance or those offered employer coverage through the Marketplace.

Medicare is not part of the Marketplace.  Once you are Medicare eligible and not on an employer health plan, health insurance companies cannot sell you a plan through the Marketplace.

Medicare Vs. Employer Insurance: Which is Better? 

Many people continue to work past 65 for various reasons.  You can stay on your employer’s health plan or go completely onto Medicare.  Medicare is usually better health coverage for the money, but you need to compare.

Four Basic Questions to Ask

To compare Medicare insurance to an employer’s health insurance plan, you need the answer to four questions.

Premium

1.) What is your monthly premium?

If you are on your spouse’s health insurance, your premium may be higher than that of the non-employee.

Deductible

2.)  What is the deductible per individual?  The deductible is the amount you pay upfront for medical expenses before the plan’s coinsurance pays.

Coinsurance

3.)  What is coinsurance?  Coinsurance is often a percentage split, like 80% / 20% or 70% / 30%.

Coinsurance is a percentage you pay of the actual cost after you meet the deductible.

For instance, you have a $10,000 medical bill.  The deductible is $2,000.  After you pay the first $2,000, you then pay 20% on the next $8,000, which is $1,600 of coinsurance.  The total between deductible and coinsurance equals $3,600.

Maximum Out-Of-Pocket

4.)  The final number is the maximum out-of-pocket (MOOP).  The MOOP is the total amount you pay out of your pocket, independent of the insurance company’s payment.  You stop paying once you reach your MOOP, and the insurance company pays 100% of the bills from that point on.  Your MOOP could be $5,000, $10,000, $15,000, or even higher.

In the above example, if your MOOP is $3,500, you stopped paying at $3,500.  If your MOOP were $4,000, you would pay $3,600.

When you have the answers to these four questions, you can compare your employer’s health insurance plan with Medicare and any Medicare plan.

Before Medicare enrollment for 2024, call us at Omaha Insurance Solutions for a free consultation at 402-614-3389 to speak with a licensed insurance agent professional about Medigap, Medicare Advantage, and prescription drug plans and pricing.

Medicare versus employer health plan How Do You Weight the Options of Employer Health Insurance Vs. Medicare?

People will often look at the monthly premium to determine which is a better plan.  The lower the premium, the better the plan.  Premium is undoubtedly a factor among the four, but the deductible is the first consideration when thinking about Medicare enrollment for 2024.

You are eligible for Medicare at age 65.  That number is not arbitrary.  Even though your health may have been excellent before age 65, health significantly declines in the remaining 18 years, which is the average life expectancy once you reach 65.

Chronic conditions, such as diabetes, arthritis, and heart disease, disproportionally affect those above 65.  Eighty percent of Medicare beneficiaries have at least one chronic condition, and nearly 70% have two or more.  These conditions worsen with age.

National Poll on Health & Aging

What is the chance you will have outpatient surgery?  Elective surgery is more common among adults age 65-80 than adults age 50-64 (36% vs.health studies 25%).

The five most common elective surgeries Medicare beneficiaries consider are joint surgery (18%), eye surgery (12%), abdominal surgery (10%), cosmetic surgery (9%), and foot or leg surgery (7%).

Those 65-80 were more likely than those age 50-64 to have elective surgery (73% vs. 57%), as were those who were retired or not working compared with those employed (71% vs. 55%).  The University of Michigan National Poll on Health & Aging

The Deductible Is Upfront Money

You pay the deductible immediately before the employer’s health insurance begins to cover the surgery.  You pay the first $1,000, $2,500, or $5,000 of the $20,000 knee replacement upfront.  Then, you pay the coinsurance of 20% for the remaining amount to the maximum out-of-pocket.

The chance that an unforeseen health issue will occur after 65 is significantly higher.  The deductible, which is your upfront expense, can instantly wipe out any momentary savings you may have had with a smaller employer health plan premium.

MOOP Is Your Total Risk

The second most important number to consider is the maximum out-of-pocket (MOOP).  The MOOP is the most you pay out of your pocket in a year.  It is the maximum risk.  After reaching that number, the health insurance company will cover your medical expenses 100%.  MOOPs are generally large numbers.  Paying the MOOP would significantly affect most families’ bottom line.

What is your employer’s health insurance MOOP compared to a Medicare Advantage Plan, Medicare Supplement, and Medicare Part D prescription drug plan?  These numbers are usually figured differently, so be careful to make sure you are comparing apples to apples.

When you accurately compare your Medicare options to your current employer’s health insurance plan, you have the essential information to decide.

Will you stay on your employer’s health plan or drop the plan and go completely on Medicare?

Medicare and familiesSpouse & Children Are Part of the Equation

Other considerations are spouses and perhaps even children.  If your spouse, who may be younger, cannot find health insurance from an employer or Marketplace at a reasonable price, and you plan to continue working anyway, remaining on your employer’s health insurance for both of you is likely the better choice.  The same is especially true when children are involved.

Where do you find yourself in the Medicare journey?  Are you just beginning?  Are you still working with only Part A?  Is it time to hop on Medicare completely and retire?

A Real Comparison Needs Real Numbers

To make an accurate comparison, you need actual numbers.  You need the numbers from your employer’s health insurance plan and the numbers from Medicare, the many Medigap policies, the Part D prescription drug plans, and the Medicare Advantage plans.

omaha Nebraska medicare insurance agent

Christopher J. Grimmond

We help clients lay out these many plans and numbers in a way that makes sense so you can consider your options and make thoughtful plans and informed choices.

We cost you nothing.  The insurance companies and Medicare cover the cost.  Our services are FREE Free means free.

Talk with someone who can interpret the data, explain the information, and evaluate the pricing at Omaha Insurance Solutions.  Call us at 402-614-3389 to speak with a licensed insurance agent professional about your Medicare enrollment in 2024.

What Our Clients Are Saying About Omaha Insurance Solutions

Joe & Myra R.

What an adventure! We started getting ourselves educated about Medicare insurance coverage several years ago – a bit too early, given how things change every year! While we had a foundational knowledge of the basics, it was helpful to work with Chris to fine tune all the nuances and make sure we were enrolling in the plan that best met our needs. Fingers crossed that our retirement and future insurance needs do not present any unwelcomed “surprises”. If that’s the case, we’ll be setting up time with Chris to help us through it!

Lisa G

Thank you Christopher!
You made the whole process of choosing a Medicare supplement easy and less confusing.
I appreciate your knowledge and professionalism. You are a great asset to all of us “young at heart” clients!
I will give your name and number to my eligible Medicare friends.
Thanks again,

Cheryl A.

After I acknowledged that I was nearing Medicare age, I realized I knew nothing about it so I reached out to two very informed friends. They both recommended Chris Grimmond. They praised his knowledge and helpfulness so I gave him a call. After meeting with Chris, I was 100% convinced that we would be working together. He answered all my questions and helped me understand the Medicare system. I feel confident I made the right decision to work with Chris and his team at Omaha Insurance Solutions.