Monday, February 8, 2021

Part D

 What's Part D? Is it required?

Part D is drug coverage. Private insurance companies contract with the Federal government I order to offer Part D to the public. Like advantage plans, the premium and benefits are based on a local service area. This might mean a carrier could offer different Part D plans in different counties or states. Also, this is explains why the premiums vary from one service area to the next.

Part D coverage covers prescriptions written by Medicare approved doctors filled at standard pharmacies. This means Cannabis dispensaries, VA, Canadian or international pharmacies, or even maybe the "pharmacy" at your doctors office, which might be a small vending machine safe at the nurse's station, are not covered. Some medicines at the doctors office are covered by Part B, but that will be discussed in a different post.

Part D plans come in HMOs and PPOs. HMOs will have lower premiums and copays, but only certain pharmacies will accept them. This means if you are traveling the country in RV, either bring a 90 day supply or stick with a national chain like CVS or Walgreens. 

All Part D plans offer some kind of mail order and this will almost always be the best deal. Even insulins or other fragile medications are sent my mail. The prescriptions are almost always filled at a regional facility closest to your home and will arrive in 2 days or next day. 

Part D plans vary in monthly premium from $30 to $120. At the end of the day, our-of-pocket drug spend is very similar no matter what plan you get and all plans have to carry the same drug classes so the real difference is how you pay and what brands are covered. For example, a plan with a high premium will have little to no deductible and small to no copays, but you pay in the form of a high premium that might be over $1000/year. On the other hand, a plan with a small monthly premium would have a high deductible and copays, maybe $450 deductible and $10-$50 copay. So the premium is only $360 a year but your out of pocket with deductible could easily be $640, making it no cheaper than the higher premium plan. 

Part D plans have coverage tiers and levels of generic and brand names but I will have to discuss this details another time. Thanks for reading and please follow.

Sunday, February 7, 2021


What are they? Are different acronyms for the same thing?

IRMAA (pronounced Irma) stands for Income Related Monthly Adjustment Amount. This is what can increase the monthly premium of Part B from $148.50 to a max of $504.90.

MAGI (pronounced Maggie) stands for Modified Adjusted Gross Income. This is a reference that even the tax free income that doesn't impact your AGI will be used to calculate whether you have an IRMAA or not.

Think of them as ugly sister tax collectors who will come to crash your party. There are many of them and people affected are said to "have an Irma or a Maggie." If you see Maggie, Irma will follow. Sometimes Irma comes to the party alone. They are the reason a lot of people refuse or can't afford Part B.

Here is the IRMAA table for 2021 from The first column lists MAGI... if you had tax-free income (municipal bond interest, foreign income, IRA contributions, 100% not 85% Social Security Income, etc), you can't count on your AGI to find your place. Make sure to check with a tax advisor and do your research. 

who file 

individual tax returns with income:

Beneficiaries who file

joint tax returns with income:

Income-related monthly adjustment amount

Total monthly premium amount

Less than or equal to $88,000

Less than or equal to $176,000



Greater than $88,000 and less than or equal to $111,000

Greater than $176,000 and less than or equal to $222,000



Greater than $111,000 and less than or equal to $138,000

Greater than $222,000 and less than or equal to $276,000



Greater than  $138,000 and less than or equal to $165,000

Greater than $276,000 and less than or equal to $330,000



Greater than $165,000 and less than $500,000

Greater than $330,000 and less than $750,000



Greater than or equal to $500,000

Greater than or equal to $750,000



Premiums for high-income beneficiaries who are married and lived with their spouse at any time during the taxable year, but file a separate return, are as follows: 

Beneficiaries who are married and lived with their spouses at any time during the year, but who file separate tax returns from their spouses:

Income-related monthly adjustment amount

Total monthly premium amount

Less than or equal to $88,000



Greater than $88,000 and less than $412,000 



Greater than or equal to $412,000



Usually shows up when first retiring and your two previous years of tax returns were higher incomes. If you have an IRMAA because you had usually high income compared to your current tax return (and most of the tax returns in your life), you have a right to appeal IRMAA.

Friday, January 15, 2021

Advantage Plans Deductibles

How can I avoid the Medicare deductibles? What's the MA deductibles? 

Medicare Advantage plans may or may not have a deductible. The ones that do not have a deductible are usually HMOs and the plan starts paying from day one (as long as you go "in-network). That means you have co-pays or co-insurance straight-away. This is one of MA's advantages.

Some Advantage plans have high deductibles, similar to what many people get from thru their employer. The deductibles can range from $500 to $4000 and typically there is some Part B Premium Rebate the higher the deductible. The other perk is the money you spend on healthcare will be exempt when you deposit money into and spend from a Medicare Spending Account (MSA). This is similar to Health Spending Account or Flexible Spending Account. There are contribution limits.

Medicare Spending Accounts (MSA) can be the best option for some people and those details with be in a future post.

Most Medicare Advantage Plans have a prescription coverage, and prescription coverage has its own deductibles. The deductibles will be based on medication tiers and most tier 1 will not have a deductible.

Thank you for reading. Please leave comments or follow.

Original Medicare Deductibles

What's that? How much? Isn't there usually only one deductible?

A deductible is the amount you pay for covered healthcare services and treatments before the insurance starts to pay. Private health plans will usually have only 1 deductible. More working Americans get to choose some version of a High Deductible Plan before the plan picks up the costs. The deductibles are often $1500 - $4000. Sometimes there are deductible tiers (or multiple deductibles) related to specific conditions, such as having a baby. 

Medicare has 2 deductibles. One for Part A and one for Part B. 

Part A (2021) - $1484
Part B (2021) - $203

After the deductible is met, Medicare picks up 80% of assignment or contracted payment. Medicare-approved doctors can charge up to 15% over assignment, which means Medicare isn't pay 80% anymore but only 73.5% and the consumer pays the rest, called co-insurance.


Part A-Hospital, hospice, skilled nursing facility and home health.
Part B-Out-patient, labs, medical equipment, limited medications, and mental health.

An individual on Medicare or a private health insurance is still covered by the terms of the plan. This means a few things. 1) Only money paid towards covered healthcare services and treatments will count towards the deductible. 2) The doctors and medical professionals need to be Medicare approved, or "take" the private insurance, and 3) the doctors will charge prices based on agreements with Medicare or the hypothetical  insurance company.

Medicaid plans don't have deductibles. They are designed to be zero-cost to super-low cost for needy individuals. If someone isn't "needy enough," but their Medicaid starts to pay after they pay a certain amount for covered healthcare, that's called spend-down. This may sound like a deductible, but because folks with spend down aren't restricted to the terms of Medicaid, doctor networks, etc, it's not a deductible. This means the doctors will charge patients with spend-down more than they would normally get paid by Medicaid. If the person with spend down is also on Medicare or a private insurance, the doctors have to charge based on the terms of the primary plan. Usually, only state-approved treatments and spending counts towards the spend-down, but not always. Medicaid can get really tricky, so it's best to get confirmation of coverage from the doctor's office and Medicaid office.

On Medicare, the doctors must treat you if you haven't met your deductible. On private insurance, or with a Medicaid spend down, the doctors might (but not always) refuse to treat you until they receive payment. 

There is a lot to cover with deductibles. In a future post I will talk about ways to eliminate the Part A and Part B deductibles. There are supplements, cost plans and MAs available that eliminate these for the consumers. Thank you for reading. Take care.

Wednesday, January 13, 2021

Medicare vs. Medicaid

What's the difference? Is Medicaid the worst and Medicare the 2nd worst?

MediCARE vs. MedicAID

Pronunciation and spelling are the first major differences. They are both government health insurance administered by the federal agency known as the Centers for Medicare and Medicaid Services (CMS).

Medicare is funded by payroll and self-employment taxes. Medicaid is funded by state and federal taxes.

Medicare is based on federal laws passed by Congress. The terms of how patients get care and doctors get paid is the same in all states. Private Medicare plans have to cover at least the same illnesses, treatments and services as Original Medicare.

Medicaid is legislated at the state level so every state Medicaid program is unique. This also means the terms of patient care vary among the different state plans. Also, you can only be in one state plan at a time. No doubling-up the benefits.

Now, many people can have both Medicare and Medicaid. In the insurance industry, this is referred to as Dual Eligible. When Medicaid coordinates with Medicare, the state picks up a lot of the costs that Original Medicare doesn't cover, like the Part B premium or the deductibles. 

In a future post, I will cover Medicare deductibles. Rest assured, there are options that make them non-issues. Thank you again for reading. Please follow.

Tuesday, January 12, 2021

Part B Rebate

Where do you sign up? How much can you get back?

The standard premium for Part B in 2021 is $148.50. There are 3 ways to pay less:

  • Qualify for Medicaid and the state will pay all or some of your premium
  • Get a Medicare Advantage (MA) plan that includes a rebate
  • Cancel your Part B enrollment.

If you want to try to get your state to pay your Part B premium, you will have to be approved for medicaid. This is a state benefit that is usually for the low-income, but not always. Some states accept anyone over 65. Some states will never pay the Part B premium. It's worth exploring if are living check-to-check. If order to apply, search your state's websites. In a later post, I will detail some of the general differences between Medicare and medicaid.

If you need to keep major medical insurance and Medicare is your best option, then there *might* be a Medicare Advantage (MA) plan in your area that offers a Part B "premium reduction" or "rebate." Most of the premium reduction or rebates are $15-$40. The plan may or may not include prescription drug coverage. If you have VA benefits, look for MA-only plans. Most areas have them, but not all. You can continue to get your prescriptions thru the VA pharmacies and still get the Part B reduction from the MA plan. Most of the MA-only plans have a Part B premium reduction or rebate upwards to $40. These plans are marketed towards Veterans and have names like Patriot or Honor. The reduction will usually come thru your monthly Social Security check.

For those who need creditable prescription drug coverage, there are MA (MAPD) plans with prescription coverage that offer a monthly rebate or Part B reduction. They will be based on where you live so not everyone, who see this, will be able to enroll in one.

Yes. Unfortunately, Medicare plans are designed for local markets and plans change if you move counties/major cities. These are called service areas. Sometimes nearby service areas have such similar plans no one know the difference. 

There is a link below that will take you to where you can search for local plans without logging in. 

From there, you will be asked other questions and eventually get a list of potential plans. There is no easy way to filter for plans that pay towards the Part B premium, but most of them are high deductible plans. Also, the MAPD plans tend to send a "rebate check," and the $148.50 (or more) will still get deducted from your Social Security check.

The Link:
You will be redirected.
Select Medicare Advantage Plan.
Enter your zip code.
Select "Plan Details" box for potential plan.
For for "Overview."
Look to see Row 5 "Part B premium reduction" Yes or No
Now you will have to search elsewhere or call the carrier for the exact amount.

The last option to save on the Part B premium is to cancel Part B. I only recommend this if you or your spouse currently have coverage thru a group employer plan.

This has been a longer post. Future posts will unwrap some of the generalities like some differences between Medicare and medicaid, or even - What's an Advantage Plan? Thanks for reading this far and please comment or subscribe.

Original Medicare - Part A and B

What is it? How much does it cost?

...Let's jump in.

Part A- Inpatient hospital stays, hospice care, and provides limited "skilled nursing" facility and home health benefits.

Part B- Professional services such as those provided by a doctor, and standard supplies that are needed to diagnose or treat medical conditions. It also covers ambulance, durable medical equipment like wheelchairs, limited out-patient drugs, and psych treatments.

Beneficiaries are said to be "entitled to Part A" and "Enrolled in Part B." This is because generally, most people get Part A at no cost and have to pay a monthly premium for part Part B. The standard premium in 2021 is $148.50.

Don't freak out. 

The money is drafted before you get your cut of Social Security. It's the almost the same premium for most retirees and disabled people, and a good majority will never realize or care that they "paid" a premium for Part B.

Now maybe you heard you get can get a reduction or a refund of your Part B premium. There are ways to pay less for Part B, and I will cover that in future posts.

I will eventually post a deep dive into Part A premium and why it's "usually no cost" but sometimes a cost, and the deductibles and co-insurance for Original Medicare, as well as some of the most common limits like the ones for nursing homes and out-patient drugs.

Thank you again for reading. Please leave any comments and come back often.

Part D

 What's Part D? Is it required? Part D is drug coverage. Private insurance companies contract with the Federal government I order to off...