Medicare eligibility opens a whole new world of healthcare options. Whether you are turning 65 or leaving employer coverage, there are some important things to know before you enroll in Medicare. Here are five things you need to know before enrolling.

1. How To Enroll In Medicare Part A and B

For most people, Medicare eligibility begins on the first day of the month of your 65th birthday. If you are born on the 1st, your Medicare coverage will begin on the first of the month preceding your 65th birthday. However, if you’re leaving your employer’s coverage and already signed up for Part A, you can align your Part B start date with the end of your employer coverage..

The method you use to enroll in the Medicare program depends on a couple of factors:

If you are already receiving Social Security withdrawals, you will automatically be enrolled in Medicare on your eligibility date. About 8-10 weeks before the effective date, you should receive your Medicare coverage card in the mail. They will automatically deduct Medicare Part B premiums from your Social Security payments.

If you are not receiving Social Security withdrawals, you will need to enroll yourself in Medicare. There are three ways you can enroll:

1. Call Social Security at 1-800-772-1213 (open 24 hours a day)
2. Apply online at https://www.ssa.gov/benefits/medicare/. If you are within three months of age 65 or older, you can use this link to enroll with Social Security.
3. Visit your local Social Security office.

SEE OUR ARTICLE ABOUT MEDICARE COSTS AND PREMIUMS (click)

2. Choose Whether To Continue Employer Coverage

If you are already retired or are retiring before your Medicare eligibility, you can move on to the next section.

If you are planning on working beyond age 65, you have some choices to make about whether to enroll in Medicare. Your options will depend on the size of your employer. Here is some helpful information from the Medicare.gov website:

If you aren’t getting benefits from Social Security (or the RRB) at least 4 months before you turn 65, you’ll need to sign up with Social Security to get Parts A and B. However, depending on the size of the employer, you may be able to delay Parts A and B without having to pay a penalty if you enroll later.

The employer has fewer than 20 employees.

You should sign up for Part A and Part B when you’re first eligible. In this case, Medicare pays before your other coverage.

The employer has 20 or more employees.

Ask your benefits manager whether you have group health plan coverage (as defined by the IRS). People with group health coverage based on current employment may be able to delay Part A and Part B and won’t have to pay a lifetime late enrollment penalty if they enroll later. If you want to delay both Part A and Part B coverage, you don’t need to do anything when you turn 65.

If you’re eligible for premium-free Part A, you can enroll in Part A at any time after you’re first eligible for Medicare. Your Part A coverage will go back (retroactively) 6 months from when you sign up (but no earlier than the first month you’re eligible for Medicare).

If you aren’t eligible for premium-free Part A, and you don’t buy it when you’re first eligible, you may have to pay a penalty.

Once the employment (or your employer/union coverage) ends, 3 things happen:

3. Medicare Costs and How They Affect You

The federal Medicare program provides two parts of coverage under Medicare – Part A and Part B. Those two parts of Medicare are listed on your Medicare card. Actually, there are four parts to Medicare in all. Medicare Part C and Part D are coverages that come from private insurance companies.

Cost for Medicare Part A

Medicare Part A for most people is usually free. There is no premium if you have worked 10+years (40 quarters) in the US. Payroll taxes collected from you during those years qualify you to have Part A at no charge. A pro-rated premium is available if you worked less than 40 quarters work experience but more than 30 quarters.

Cost for Medicare Part B is Based on Income

Medicare Part B (and Part D) premiums are based upon your Modified Adjusted Gross Income. Medicare will check your latest IRS tax return and use that to determine what you’ll pay for Parts B & D. Your Modified Adjusted Gross Income (MAGI) includes any money earned through wages, interest, required minimum dividends from investments, capital gains, Social Security benefits, and tax-deferred pensions. Distributions from Roth IRAs and Roth 401(k)s, life insurance, reverse mortgages, and health savings accounts do not count in the MAGI calculation.

Social Security will send you a letter around the end of each year to tell you what your costs are for the upcoming year. Most Americans fall into the standard income bracket.

To see the current year Medicare Part A and Part B premium, as well as the high-income Medicare costs, go to this page – https://integritysenior.com/medicare-costs/

4. Which Medicare Plan Should I Choose?

I mentioned that there are four parts to the Medicare program. They are:

• Part A – Inpatient care
• Part B – Physician services and outpatient care
• Part C – Medicare Advantage plans from private insurance companies
• Part D – Prescription drug coverage from private insurance companies

Medicare Advantage Plans (Medicare Part C)

There are generally two types of plans to choose from. The first option is Medicare Advantage plans. These plans have become very popular over the years. Most have low to zero premiums in exchange for using a limited network of providers and paying co-pays for many services. However, out-of-pocket costs can get very high if you are diagnosed with a serious illness or need chemotherapy and radiation because of a cancer diagnosis. Enrolling in a Medicare Advantage plan replaces Medicare Part A and Part B. I won’t get into the pros and cons of the Medicare Advantage plans here. I have a very detailed article comparing Medicare Advantage plans to original Medicare with a Medicare supplement, or Medigap, plan.

CHECK OUT THIS ARTICLE FOR AN IN-DEPTH COMPARISON OF MEDICARE ADVANTAGE VS MEDICARE SUPPLEMENTS

Original Medicare with Medicare Supplement

Your second option is to stay on original Medicare and enroll in a Medicare supplement plan. Under the Medicare Advantage plans mentioned above, your Medicare Part A and Part B are replaced with coverage from a private insurance company. This makes it fall under Part C of Medicare. However, with a Medicare supplement plan, you stay on Medicare Part A and Part B and choose a Medigap plan from a private insurance company.

There is a difference between the Parts and Plans of Medicare. The Medicare program is divided into Part A through D. Medicare supplements, or Medigap, plans are divided into plans. These are lettered A through N.

Medicare supplement plans offer no drug coverage. Therefore, you will want to also enroll in a Part D prescription drug plan.

Here is a YouTube video that explains the pros and cons of Medicare Advantage plans as well as Medigap plans:

5. An Independent Agent Brings Value

Yes, I know promoting independent agents sounds a little self-serving. But the service of a trustworthy independent insurance agent is free. Also, by shopping all the plans, they can save you money. I know many times people think of insurance agents and immediately picture someone pressuring them and shoving a pen in their face to sign on the line. Although I have seen that happen, it will never happen here. My job is to help you understand how Medicare and the various plans work. Your job is to take that information and make an informed decision.

We would love to earn your business. But we will never pressure you to make a decision. You can take the information here and take your time with it. No one is looking over your shoulder. No one is threatening to not leave your house until you sign up. We can help you enroll in the plan of your choice quickly and easily over the phone. With some companies, online enrollment is an option while still having me as your agent working on your behalf. You can enroll online by following this link -> CLICK HERE

I want you to see the value of our knowledge and how it will help you now and in the future with Medicare changes.

Benefits of Using an Independent Agent:

1. Customer service – A trustworthy independent agent will not treat you like a number. A trustworthy agent is going to take care of you. Their livelihood depends on it.
2. Value – We will find the best deals possible for you. The possibility of losing your business motivates independent agents to find you the best deal. And with rates ranging widely from company to company, we can use our knowledge and resources to find more options than you can on your own. This is what we do every day.
3. Knowledge – Insurance is a complicated subject and having someone that deals with it day in and day out can benefit you. Every day, independent agents help people avoid pitfalls they may not even know to exist. We work with Medicare daily, and we have updated information that could help you avoid choosing the wrong plan or company. People without insurance knowledge often choose what they think is best without realizing there is a better option. Using an independent agent can save you money by avoiding those pitfalls. And best of all, it is FREE.
4. Trust – If you have an independent agent with integrity, you have someone whom you can consult now and into the future.
5. Claims – An independent agent deals directly with the insurance company for you. After all, the independent agent works for you. We have a dedicated claims department to help you deal with any claims that may slip through.
6. Unbiased advice – Working with an independent agent can also provide you with much needed, unbiased advice. When you work with a captive agent who can only represent one company and their subsidiaries, they will want you to believe that they are the best option for you. In reality, they may not even be one of the top three or even top ten choices that you should be looking at. We can help you choose among all the best insurance companies in the market.
7. Education – There is a lot of information on Medicare.gov, but it can be confusing. And there is no information on individual Medigap policies there. You should understand at least in basic terms what your insurance will do for you. Your agent should make sure you understand the differences between different kinds of coverage. We have many YouTube videos that teach you the ins and outs of how Medicare works.

Contact us today a 1-888-228-6119 or fill out the form with your questions to take advantage of our free plan comparison service.

Stanley Keith Murray is an independent agent and the founder of Integrity Senior Solutions Inc. He has been working with Seniors to meet their Medicare insurance and financial needs since 1996.

There a lot of rumors circulating about MACRA this year. Some are true, some are not. MACRA is an acronym for The Medicare Access and CHIP Reauthorization Act of 2015. We will address some of the frequently asked questions about MACRA and how it affects Medigap coverage.

What is MACRA?

The Medicare Access and CHIP Reauthorization Act (MACRA) was passed into law in 2015. The law affects Medigap plans. It goes into effect on January 1, 2020

What Does MACRA Do?

There are two major changes that are coming under the new law:

1. It eliminates so-called “First dollar” coverage. Medigap plans that pay for the Part B deductible cannot be sold to “newly eligible” Medicare beneficiaries. This will eliminate Plans C, F, and High Deductible F for these newly eligible individuals.
2. It changes which plans are eligible for guarantee issue status. For specific scenarios where Guarantee Issue status may apply, see the Medicare.gov website. The available GI plans starting in 2020 are Plan D, Plan G, and a new plan for 2020 – Plan High Deductible G.

Is Plan F Going Away?

No, it is not. If you have a Plan F, you can keep it after January 1, 2020. You can even apply to get a Plan F with a different company. The Plan F will not be available to those “newly eligible” to Medicare after that date. Even though you can keep it, there are several reasons to consider making a change away from Plan F. We recommend you change to a different Medigap lettered plan if you are able to.

SEE OUR ARTICLE ABOUT WHY YOU SHOULD LEAVE PLAN F

What is a “Newly Eligible” Medicare Beneficiary?

Someone who is eligible for Medicare due to turning age 65 or who becomes eligible due to age, disability, or end-stage renal disease on or after January 1, 2020

How Does MACRA Affect Those Currently Enrolled in Plan C, F, or HDF?

Those currently enrolled in one of the discontinued plans will be able to keep their plan. They can also apply for a Plan C, F, or HDF with a different company after January 1, 2020. However, if applying with a new company, you will likely need to go through underwriting to make a change. They can also choose to apply for a Plan High Deductible G.

How Does MACRA Affect High Deductible Medicare Supplements?

You can continue your High Deductible Plan F coverage beyond January 1, 2020 if you so desire. However, there is a new Plan High Deductible G that will be available starting in 2020. Both “newly eligible” Medicare beneficiaries and current beneficiaries will be able to buy the new Plan High Deductible G.

What will happen to Guaranteed Issue requirements?

Plans D and G will become two of the guaranteed issue plans for “newly eligible” Medicare Beneficiaries on or after January 1, 2020. These will replace Plans C, F, and HDF for “newly eligible” beneficiaries going forward.

Because of Plan G taking on the bulk of the Guaranteed Issue enrollees from now on, we expect to see larger rate increases for those on Plan G going forward. This was the case with Plan F for many years. It is one of the main reasons we recommended Plan G over Plan F. There was a large difference in premium for very little difference in coverage between those because of Plan F taking on more people with pre-existing conditions. That will shift to Plan G starting in 2020. Therefore, our recommended going forward is Plan N.

Current enrollees can remain with Plans C, F and High Deductible F. Medicare beneficiaries who are not defined as “newly eligible” will still be able to purchase Plans C, F and High Deductible F from a different company pending underwriting requirements..

For more detailed information, you can review the NAIC implementation guidelines for MACRA.

To see if moving from Plan F is right for you and how the rates for any plans compare in your area, call us at 1-888-228-6119 or use the form to send us a question.

Keith Murray is an independent agent and the founder of Integrity Senior Solutions Inc. He has over 22 years of experience working with Seniors to meet their insurance and financial needs.

The US Food and Drug Administration (USFDA) announced a recall of Losartan over concerns that possible contamination could cause cancer. This is the third such recall of blood pressure medications issued over cancer concerns.

About the Losartan Recall

Sandoz, a pharmaceutical company, says it is recalling a single lot of losartan potassium hydrochlorothiazide tablets because the pills could contain an impurity known as N-nitrosodiethylamine (NDEA).

From the FDA.gov website:

Sandoz Inc. is voluntarily recalling one lot of Losartan Potassium Hydrochlorothiazide Tablets, USP 100mg/25mg to the consumer level. This product is being recalled due to the trace amount of an impurity, N-nitrosodiethylamine (NDEA) contained in the API Losartan, USP manufactured by Zhejiang Huahai Pharmaceutical Co. Ltd. Sandoz Inc. Losartan Potassium Hydrochlorothiazide product is manufactured by Lek Pharmaceuticals dd, Ljubljana, Slovenia. This impurity, which is a substance that occurs naturally in certain foods, drinking water, air pollution, and industrial processes, has been classified as a probable human carcinogen as per International Agency for Research on Cancer (IARC).

The voluntary recall is for 100 milligram/25 milligram tablets with the lot number JB8912. The affected product was distributed nationwide on or after October 8, 2018. The recall affects less than 1% of the national losartandrug products. The FDA report goes on to say that Sandoz has not received any reports of adverse events related to the affected lot.

What You Should Do

Patients who are on losartan should continue taking their medication. They may be more likely to be harmed if the treatment is stopped without an alternative. The risk of not using the prescribed medication could be greater than the possible cancer risk, according to the Nov. 8 recall notice.

This latest recall follows several others announced since July when the FDA announced the recall of five separate valsartan blood pressure drugs over possible NDEA and NDMA contamination. Many more were announced in August as the recall spread to Canada and the European Union. Earlier this month, a blood pressure drug known as irbesartan was recalled.

Patients with questions about the recall can contact Sandoz Inc. at 800-525-8747 or email usdrugsafety.operations@novartis.com. Additionally, you can contact the pharmacy that filled the prescription to see if they received tablets from the affected lot.

If you are currently taking this medication, you are advised to speak with your doctor before stopping use. If your doctor recommends a change of medications, you can contact Keith Murray at ExpertMedicare.com or call 1-888-228-6119 to find a Medicare Part D plan that covers your new prescription.

Medicare fraud can cause you a lot of headaches. It is costly to individuals and to taxpayers – we all pay for this fraudulent activity. Medicare fraud is very lucrative for scammers, otherwise, they would not waste their time on it.

A stolen Medicare card can be a valuable asset in the wrong hands. Scammers can use your Medicare number to bill Medicare for supplies and services in your name. The more funds that are paid out in false claims, the less money there could be available to pay for legitimate benefits for those who need it. This can cause premiums to rise for everyone.

Until April 2018, Medicare would print your Social Security Number (or your spouse’s, depending on your Medicare eligibility) with an extra letter on the Medicare card. However, new legislation changed the law so that Medicare is now issuing random letters and numbers as your new Medicare Beneficiary Identifier (MBI) to replace the old Medicare number. It is 11 characters long.

Five Ways You Can Fight Medicare Fraud

Fraudulent activity increases during the Annual Election Period (AEP), which some call Open Enrollment (Oct. 15 – Dec. 7). But Medicare fraud can hit at any time. Here are five ways you can keep your guard up:

1. Protect Your Medicare Card

Even though your SSN is no longer on your Medicare card, it is still a valuable number that needs to be protected. There are only three situations that require you to give out your MBI from your Medicare card:

• When applying for Medicare insurance plans, such as Medigap or a Medicare Advantage. In this case, your independent agent and insurance company needs your MBI to ensure correct billing and claims payments.
• Your doctor or medical provider.
• Your Medicare supplies provider

2. Do Not Entertain Door-to-Door Salespeople

Unfortunately, we live in a different world than we did 20 to 30 years ago. If someone shows up at your door unannounced offering medical supplies or Medicare plans, you should sense red flags going up. The medical supply or Medicare plan salesman could be after your valuable MBI from your Medicare card. Neither Medicare nor Medicaid send their representatives to your home to solicit plans. An agent selling Medicare Advantage plans can never legally show up to your house unannounced to sell a plan, either. If one does, they should be reported to your state insurance commissioner’s office. This restriction does not apply to those who sell Medigap, or Medicare Supplement plans.

With today’s available technology, you do not have to let a stranger into your house to get Medicare insurance coverage. Independent agencies like Integrity Senior Solutions can help you enroll online or over the phone. Today’s electronic insurance applications are far safer than the paper applications of yesteryear. The applications are completed by your independent agent directly on the carrier’s website through a secure socket connection. So there is no paper to shred or destroy and no chance that important papers get into the wrong hands.

3. Check Your Explanation of Medicare Benefits (EOMB)

Whenever you receive a Medicare service, the Center for Medicare and Medicaid Services sends you an Explanation of Medicare Benefits, or EOMB. Your insurance company may send one, as well. This EOMB statement gives a detailed account of when and how much your providers are paid for services rendered. It’s important to be sure that the information is accurate. If you see something that is incorrect, be sure to report it to Medicare or your insurance provider.

4. Be Wary of Healthcare Freebies

If someone offers a free medical product or service, but then requires your MBI from your Medicare card, just say no! If it were really free, they would have no need to get your Medicare Beneficiary Identifier. This could be an attempt to grab your MBI for Medicare fraud. As we mentioned earlier, your insurance agent or insurance coverage will need your MBI if you are applying for Medicare coverage. Just be sure you a dealing with a legitimate, licensed insurance agent. You can look up the agent’s information on your state insurance commissioner’s website. Just do a Google search for “[your state] insurance commissioner,” replacing [your state] with the state you live in.

5. Watch For Fake Medicare Plans

Scammers may use the Annual Election Period in the fall of each year to try to have you enroll in their phony plans, services, or products. The goal here is to get their hands on your MBI and use it for Medicare fraud. Use the Plan Finder at Medicare.gov to verify any plan that is being offered to you. If it’s not listed, it may be illegitimate.

How to Report Fraud

First, check with your provider. It may be a simple misunderstanding or oversight. An incorrect billing code or filing under the wrong patient can happen.

Your independent agent works for you, so get them involved. Agents are trained to spot fraud.

If you still believe that you or Medicare has been billed for a service or supply you did not receive, call the Medicare helpline to report it (1-800-MEDICARE or 1-800-633-4227, TTY 1-877-486-2048, 24 hours a day, seven days a week).

Another great resource is the Senior Medicare Patrol (SMP) office in your state. SMP workers and volunteers can help determine if there has been any fraudulent activity. They have direct communication with governmental Medicare investigators who will look into it for you.

Conclusion

Although Medicare fraud can happen at any time, it seems to be more rampant during the AEP from October 15 through December 7 of each year. Do your part to be diligent to stop this behavior. It will help strengthen Medicare for all of us.

There is a giant Medicare card changeover that the Centers for Medicare and Medicaid Services (CMS) program is preparing. It all comes about starting in April 2018 when the new Medicare card begins to be mailed out.

Medicare will begin sending new Medicare cards to more than 55 million Medicare beneficiaries. The new cards are being sent out in response to new legislation that requires Social Security Numbers no longer be used as part of the Medicare ID.

The legislation is called the Medicare Access and CHIP Reauthorization Act of 2015, or MACRA. Section 501 of that legislation requires CMS to replace Social Security numbers with a randomly-generated number. This will be the Medicare Beneficiary Identifier, or MBI.

Implementing Change

CMS plans to have all Medicare cards that use SSI numbers replaced within 12 months. You should receive your new Medicare card with the MBI on it by April 2019, if all goes as planned.

Here is a short video CMS released that talks about the change and how it prevents fraud:

CMS has also set up a website with more information about the coming changes to your Medicare card. There is already a lot of confusion about Medicare. This change – although necessary because of identity theft protection – can make an already confusing topic even more confusing. We are here to try to help explain the new system and help you navigate it.

Potential Problems With New Medicare Cards

The new Medicare cards should not have a negative effect on enrollees in Medicare “Advantage” plans. MA enrollees no longer need to use their Medicare ID card since they have chosen to go with a Medicare replacement plan. MA enrollees are not required to show their Medicare card to health providers as all of their care is controlled by their plan provider and not Medicare itself.

One issue we can see right away is for people who wish to enroll in a Medigap plan but have not received their new Medicare card yet. There is no way to notify the insurance company of what that randomly-generated ID number is going to be until the card arrives. We have not heard from the insurance companies how they are going to deal with this issue going forward as of the publication of this article.

There is also the issue of cards that never arrive. This could cause a big problem for those who are waiting for healthcare services. It could possibly delay their ability to enroll in a plan to cover the gaps in Medicare until the new card arrives.

Keith Murray is an independent agent and the founder of Integrity SeniorSolutions Inc. Keith has over 24 years of experience working with Seniors on their Medicare insurance needs. He can be reached at 1-888-228-6119 or through the form to the right side of the page.

This page is for informational purposes only. Please consult the Social Security Administration for help completing this form or for answers to your questions. We cannot assist you with IRMAA questions or concerns.

If you are a Medicare beneficiary that had a high income within the last couple of years, you may be penalized with a higher premium by Medicare. This penalty can affect your Part B premium and your prescription drug (Part D) premium. There is a process to appeal a Part B premium penalty.

The technical name for this penalty is the Income-Related Monthly Adjustment Amount, or IRMAA. A Request for Reconsideration is a petition that you can file with Social Security if you feel your premium amount is unwarranted or based on inaccurate information (more on that below).

Once you retire, your income is likely to drop. Yet, the IRMAA can cause you to pay may more even though at retirement your income is lower. The Request for Reconsideration could help lower your premium.

How Your Part B and Part D Premium is Calculated

Your Modified Adjusted Gross Income (MAGI) is calculated by adding your adjusted gross income plus any tax-exempt income. This could include items such as dividends, interest, capital gains, wages, rental income, or non-taxable Social Security benefits.

In order to determine this amount, Social Security will use the information from your most recent federal tax return. So the amount that they are basing your premium on could be your MAGI from 18-24 months ago.

Part B Monthly Premium

Most people pay the standard Part B premium amount ($185 in 2025). Social Security will tell you the exact amount you’ll pay for Part B in 2025. You pay the standard premium amount if you:

■ Enroll in Part B for the first time in 2025.
■ Do not receive Social Security benefits.
■ Directly billed for your Part B premiums.
■ Have Medicare and Medicaid, and Medicaid pays your premiums.

If your modified adjusted gross income as reported on your IRS tax return from 2 years ago is above a certain amount, you’ll pay the standard Part B premium and an income-related monthly adjustment amount.

Part D monthly premium

The chart above also shows your estimated drug plan monthly premium based on your income. If your income is above a certain limit, you’ll pay an income-related monthly adjustment amount (IRMAA) in addition to your plan premium.

If Social Security determines that you are in a bracket that will trigger a Part B or Part D premium penalty, you will receive a letter from them informing you of what your premium will be. They will also include an explanation of your Medicare Part B premium penalty. If you disagree with their assessment, you can then file a Request for Reconsideration.

Situations That May Qualify You For a Lower Part B Premium

You can call the SSA to request the reconsideration. The number is 1-800-772-1213.

Here are the situations that may cause a Part B premium penalty to be reversed:

1. Tax return inaccurate or out of date

• A beneficiary filed an amended tax return for the year SSA is using to make an IRMAA decision
• There was an error in the IRS data
• The IRS provided SSA with older data and the beneficiary wants to use newer information
• You had a major life-changing event that significantly reduced your income

2. A life-changing event that affects the beneficiary’s modified adjusted gross income:

• Death of spouse
• Marriage
• Divorce or annulment
• Work reduction
• Work stoppage
• Loss of income from income-producing property
• Loss or reduction of certain kinds of pension income

The most common of these is work reduction or work stoppage. If you were making $100,000 when you retired two years ago and your retirement income is now $40,000, you have a pretty good case for having your premium reduced.

How To Appeal a Part B Premium Penalty

When following the steps below, be sure to keep a record of all your correspondence. This is your Medicare Part B premium penalty you are trying to lower, so it puts money back in your pocket if you are successful. So, make sure you keep a copy of everything. The IRMAA also can affect your Part D premiums. If you are entitled to having your premium adjusted it is in your best interest to do so.

1. 1. Complete a request to SSA for reconsideration. Contact SSA to learn how to file this request. Here is a direct link to the form you will need (CLICK).
   2. Your premium amounts will be corrected if your reconsideration is successful. If your reconsideration is denied, you can appeal to the Administrative Law Judge (ALJ) within 60 days of the date on the reconsideration denial. Follow the directions on the denial to file an appeal with the ALJ. If you decide to appeal to the ALJ, you may want to contact a legal services organization or lawyer to help you with this or any further levels of appeal—but this is not required. You must submit any new evidence within 10 days of filing your appeal to the ALJ. Contact the ALJ to learn how to submit this. You can ask the ALJ for an extension if you are unable to submit new evidence within 10 days.
   3. If your ALJ appeal is successful, your premium amount will be corrected. If your appeal is denied, you can choose to appeal to the Medicare Appeals Council (MAC) within 60 days of the date on the ALJ denial.
   4. The Part B premium amount will be corrected if the MAC appeal is successful. If the MAC denies your appeal, you can choose to appeal to the federal judicial district has at least one courthouse, and most districts have more than one. Each state has at least one judicial district.

This page is for informational purposes only. Please consult the Social Security Administration for help completing this form or for answers to your questions. We cannot assist you with IRMAA questions or concerns.

For many years, it was easy to know when retirement, Social Security, and Medicare were going to be a reality in our lives. Age 65 was the defining marker for all of those, including Medicare enrollment. That one birthday used to mean that retirement (and hopefully a pension), better healthcare options through Medicare, and the beginning of Social Security benefits were available. That is no longer the case.

The Social Security Amendments of 1983 (H.R. 1900, Public Law 98-21) contained two provisions which may have an impact on when an individual decides to retire. For those born from 1943 through 1954, the age you can begin full SSI benefits in age 66. This means that turning 65 is no longer an automatic trigger for Medicare enrollment. Because of this change in retirement age, many seniors are unaware that they still need to enroll in Medicare at age 65, not 66. Not enrolling when you are first eligible could lead to lifelong penalties on your Medicare premium.

Seniors who are already receiving SSI payments when they turn 65 are not affected by enrollment issues. You will be automatically enrolled is you are receiving SSI benefits. If you postpone your Social Security benefits either because you are still working or want a higher payout by waiting to start, you will need to enroll yourself in Medicare at age 65.

Medicare Enrollment Period

If you are still covered by group coverage from a retiree plan, or your or your spouse’s plan, you might want to wait to enroll in Part B. However, you can sign up for free Part A (if you’re eligible) anytime during or after your Initial Enrollment Period starts. Your coverage start date will depend on when you sign up. If you have to buy Part A and/or Part B, you can only sign up during a valid enrollment period. The General Enrollment Period (GEP) runs from January 1 through March 31 of each year. Coverage for enrollments during GEP will begin July 1 of that year.

If you are not covered by a group or retiree plan, you must enroll in Medicare during your Initial Enrollment Period (IEP). That period is a seven-month period that begins three months before the month of your 65th birthday. It includes your birth month and ends three months after your birth month. You can enroll in Part A and Part B of Medicare at that time. Part A is free as long as you worked 40 quarter hours (or 10 years) during your lifetime. It covers hospital and most other inpatient services.

Part B requires a premium. It covers physician and outpatient services. Part C is the Medicare replacement plan known as Medicare Advantage. Part D is the prescription drug program, which you will also need to look into when you first enroll in Medicare. You can also get a Medicare supplement plan to cover the gaps in Medicare. These are also known as Medigap plans. If you are confused about the Parts and Plans of Medicare, be sure to check out our article and video that fully explains both by clicking here.

The Late Enrollment Penalty For Medicare Part B

If you do not enroll in Part B when first eligible, and you are not enrolled in a qualifying group or retiree plan, you will be penalized. For every year that you delay Medicare enrollment in Part B, you have a 10% surcharge added to your Part B premiums. The surcharge is permanent – you will pay it the rest of your life. So if you delay enrollment in Part B for two years, that would mean a 20% surcharge added to your Part B premium going forward.

As mentioned previously, you can delay Part B enrollment. You must be covered by an employer plan (yours or your spouse’s) or a retiree group plan. Once that coverage ends, you will be eligible for a Special Enrollment Period (SEP) to enroll in Part B. That SEP gives you up to eight months to sign up for Medicare without a penalty.

One important note about ending group coverage. If you opt for COBRA, you will not be exempted from needing to enroll in Part B. The 8-month SEP runs concurrently with COBRA. It is based on termination of group coverage, not termination of COBRA. So you need to enroll in Part B when your group coverage ends, not when COBRA ends. Otherwise, you will have the late enrollment surcharge applied to all future Part B premiums. That penalty applies ONLY to your Part B premium and does not affect Medicare supplement premiums.

To enroll in Medicare past age 65, you will need to call Medicare. Their number is 1-800-MEDICARE (1-800-633-4227). TIP: call them late at night or really early in the morning. Their service is available 24 hours a day. You can also visit the website at http://medicare.gov.

Beneficiary Enrollment Notification and Eligibility Simplification (BENES) Act (H.R. 5772 and S. 3236)

As of the writing of this article, there is legislation in both houses of Congress to address this confusing enrollment process. In late August 2016, 73 state and national organizations that represent seniors, health insurers, unions, people with disabilities, and health care providers sent a letter to the lead sponsors of the legislation in both the House and Senate expressing their support for these bills.

“The basic rules underpinning the Part B enrollment system were developed more than 50 years ago, when Medicare was first established. Through bipartisan, low-cost reforms, the BENES Act shields people with Medicare from steep premium penalties, fills needless gaps in coverage and expands avenues for relief among those who mistakenly delay or decline Part B.”   -From the coalition

The coalition also pointed out that over 750,000 Medicare beneficiaries were paying a lifetime penalty in 2014. These penalties were a result of not enrolling in Part B within the Initial Enrollment Period. The coalition also pointed out that the average penalty being paid was 30%.

In addition to this, Congressional leaders also received comments from eight past administrators of the Centers for Medicare & Medicaid Services (CMS) expressing their support. CMS is the agency that administers the Medicare program. These administrators were from both Republican and Democrat administrations. Their letter stated:

“The decoupling of eligibility ages for Medicare and full Social Security benefits, revisions to Medicare Secondary Payor law, and the growing number of Americans working past the age of 65 have, together, substantially complicated the decision-making process for eligible individuals and couples in deciding when and how to enroll in Medicare.”

Because of a shortened Congressional session and the fact that this is a Presidential election year, some believe the standalone bill has little chance of passage. However, once new Medicare premiums and Social Security benefits are announced for next year, this bill could attach itself to legislation addressing those issues. In 2015, Congress passed legislation addressing a very large Part B premium increase. If they were to do so again this year, this new bill could be lumped in with it.  This would give it a much better chance of passage.

If you are still confused about Medicare enrollment periods and how this can affect you, please give us a call or write to us. The phone number is 888-228-6119. It is at the top of the page. You can use the request form on the right side of the page to send your questions, as well.

The advice on this website is informational. Please consult with us before making a purchasing decision to determine what is best for your individual situation. You can contact Keith Murray at 888-228-6119 or keith@expertmedicare.com.

Keith Murray is an independent agent and the owner of Integrity Senior Solutions Inc. He has over 25 years of experience working with Seniors to meet their insurance and financial needs.

The Senior Medicare Patrol (SMP) consists of volunteers who donate their time and energy to teach others about fraud in Medicare and Medicaid. These volunteers are well-versed on how to detect, prevent, and report fraud. The Senior Medicare Patrol believes that this will help to protect our citizens’ health and health benefits, as well as strengthen the Medicare and Medicaid programs.

According to the Senior Medicare Patrol website, they focus their work in three areas:

1. Conduct Outreach and Education. SMPs give presentations to groups, exhibit at events, and work one-on-one with Medicare beneficiaries. Since 1997 more than 30 million people have been reached during community education events, more than 6.5 million beneficiaries have been educated and served, and more than 46,000 volunteers have been active.
2. Engage Volunteers. Protecting older persons’ health, finances, and medical identity while saving precious Medicare dollars is a cause that attracts civic-minded Americans. The SMP program engages over 5,200 volunteers nationally who collectively contribute more than 155,000 hours each year.
3. Receive Beneficiary Complaints. When Medicare beneficiaries, caregivers, and family members bring their complaints to the SMP, the SMP makes a determination about whether or not fraud, errors, or abuse is suspected. When fraud or abuse is suspected, they make referrals to the appropriate state and federal agencies for further investigation.

The Senior Medicare Patrol volunteers are seniors and professionals such as doctors, nurses, investigators, independent insurance agents, law enforcement personnel, attorneys, and teachers.

In 2011, there were more than 5,600 active volunteers in the Senior Medicare Patrol. Some of their accomplishments include:

• Referring more than 800 complaints for investigation
• Educating and empowering over 11,000 groups and more than 4.3 million Medicare recipients
• Holding more than 66,000 one-on-one consultations

Since 1997, Senior Medicare Patrol projects have trained more than 30,000 volunteers and received more than 300,000 complaints for investigation. From those efforts, they have amassed more than $106 million in funds recovered by Medicare and Medicaid, as well as individuals receiving benefits.

Medical Identity Theft

One of the most impacted areas of fraud is identity. Over 250,000 Medicare beneficiaries have had their Medicare claim number stolen or misused. This is known as Medical Identity Theft. Medicare numbers are linked to a Social Security number of someone of either themselves or a spouse who qualified for benefits. They cannot be changed. Once someone’s Medicare ID number has been compromised, their future benefits could be at risk.

Impact On Your Health

Receiving care from someone posing as a healthcare provider could be dangerous at best. These fraudulent providers will not provide quality care and their care could actually be harmful. If receive legitimate care from a physician after receiving care from a fraudulent provider, your new physician may treat you based on previous medical records that are inaccurate.

Additionally, since Medicare has limitations on some of their benefits, you could actually be denied the care that you need. They may think you have already received care that you did not and therefore limit your benefits based on false information.

Impact on Personal Finances

Fraud in Medicare and Medicaid costs all of us. They cost taxpayers unnecessary extra expenses. Fraud also causes higher co-pays and deductibles because Medicare bases those numbers on how much it pays out each year. If it is paying for fraudulent claims, that affects everyone using their services.

You could also find yourself stuck with bills that you don’t really owe. If a provider that should have billed Medicare instead bills the patient for the full cost, that causes an issue.

Lastly, as mentioned above, your Medicare claim number is tied to your or your spouse’s Social Security Number. Once a thief has that they can open credit and bank accounts in your name. Those numbers are of great value to thieves.

The Cost of Fraud

The Medicare program loses billions of dollars each year due to fraud, errors, and abuse. These are our tax dollars. In 2014, the National Health Care Anti-Fraud Association estimated these losses at $60 billion annually, though the exact figure is impossible to know. The most commonly cited range for all health care fraud estimates is 3 to 10 percent of annual health care expenditures. 2012 Medicare expenditures were nearly $600 billion and are expected to rise as the baby boomer population ages.

What Can You Do?

Make sure that you read over any notices you receive from Medicare. A Medicare Summary Notice is sent to those on original Medicare with a Medicare Supplement plan. Those on Medicare Advantage plans and Part D drug plans will receive an Explanation of Benefits (EOB). Check them carefully. If you don’t understand the information on there, have your Medicare agent help you.

These two types of notices will tell you:

• What the health care provider billed for
• The amount approved by Medicare for payment
• How much Medicare paid
• What the beneficiary may be billed for

Detect Potential Fraud, Errors, or Abuse

• Review your Medicare statements when you receive them. Be sure you actually received all of the services listed on the statement.
• Keep a written record of your healthcare visits including what services and tests were provided.
• Compare your written record to what is on the statement. If they don’t match up, contact your provider or insurance company to discuss discrepancies.
• You can see your most recent statements at the MyMedicare.gov website. You can also track your claims for up to three years and see if your provider has been paid on their site. Registration and use of this feature is free.

Conclusion

So you can see that the work of Senior Medicare Patrol is very important. We all owe those volunteers a huge pat on the back for their patriotic service to all of us in helping attack fraud and waste. If you would like to volunteer for this service, you can click here to contact your local office.