Our resident expert answers readers' toughest
questions
by Phil Moeller | December 3, 2018
Figuring out what
Medicare coverage you need—not to mention what you’re paying for your
plans—never gets easier. That’s something every senior is reminded of during
the annual fall open
enrollment period, which runs through December 7.
In his latest answers
to reader questions, columnist Phil Moeller, the author of Get What’s Yours for Medicare: Maximize Your Coverage,
Minimize Your Costs and the co-author of the updated edition
of The New York Times bestseller How to Get
What’s Yours: The Revised Secrets to Maxing Out Your Social Security,
explains when you do and don’t need additional prescription drug coverage, as
well as how Medicare funding works in the first place.
Got a question of
your own about Medicare or Social Security? Send it to askphil@considerable.com.
Are Medicare Parts A
& B enough coverage?
Judy, Virginia: I am fairly healthy
and am not on any medications. I rarely get sick enough to go to the doctor and
have no ongoing conditions. Is there any reason I should have other Medicare
except Parts A and B?
Phil Moeller: I think Judy has
lots of company among healthy seniors. No one likes to pay for insurance if
they can avoid it.
In Judy’s case, she
will face late-enrollment penalties for Part D drug
coverage if she later needs it. These are permanent penalties and
equal about 30¢ a month tacked on to the Part D premium for each month she is
eligible for Part D but does not have coverage.
Otherwise, the big
risk health seniors face is a surprise and expensive medical need—think cancer,
a bad accident, etc. Part B covers only 80% of outpatient and doctors’
expenses, so people with only Original Medicare are on the hook for 20% of a
potentially large number.
If it was me, I’d get
a cheap Medicare
Advantage plan. It won’t cost much beyond Part B and will include
protection against catastrophic medical expenses.
Why am I being charged for a drug plan when I don’t need one?
James, Maryland: I have been retired
for nearly three years and enrolled in Social Security and Medicare when I
turned 65. With Medicare, I opted in to Parts A and B. I did not get a Part D drug plan
because I was able to stay on the prescription drug plan offered through my
former employer.
Upon receiving my
first benefit statement from Social Security, I noticed a deduction for
prescription drugs that represents a high-income surcharge. Together with what
I am paying through my former employer program, my monthly cost for
prescription drugs has nearly doubled!
I understand the
rationale for high-income Medicare surcharges and am more than willing to pay
my fair share. What I don’t understand is why I am making payments for
something I don’t have and from which I am deriving no benefit? I also can’t
understand why no one informed me of these surcharges in the first place. Could
you help me understand this?
Phil Moeller: If you have credible
drug coverage from an employer retiree plan, your former employer should be
able to provide you a statement to that effect. Credibility means that the
retiree plan is comparable to a typical Medicare Part D plan.
Armed with this
statement—which employers are legally required to provide you upon request—you
should appeal to Social Security to stop deducting Part D payments. In a truly
fair world, you’d be able to get refunds of past payments, and I certainly
would request this. However, I wouldn’t hold my breath.
In
a truly fair world, you’d be able to get refunds of past payments. However, I
wouldn’t hold my breath.
Here is Social
Security’s general appeals page.
There also is a separate page
for appeals of Medicare’s high-income surcharges. I have never seen an online
form that allows people to challenge Part D payment withdrawals or Part D IRMAA
charges. Given that your withdrawal results in you receiving a
smaller Social Security benefit than you deserve, perhaps you can use this as
the basis for an appeal.
As for the lack of
notice about surcharges, this is just one more area where Medicare and Social
Security fail miserably in transparency and communications. Trying to get
Social Security to do the right thing can be time-consuming and exhausting, but
I urge you not to give up.
Am I paying for
Medicare twice?
Marilyn, Georgia: Why do they take Medicare out of my payroll check and out of my Social Security check? It’s like I’m being charged twice!
Phil Moeller: The money taken from
your payroll check is used to fund Medicare Part A, which covers hospital and
nursing home expenses. People who have worked long enough to qualify for Social
Security benefits are entitled to Part A without having to pay a premium.
While the Part B premiums may seem
expensive, they actually cover only a fourth of Part B expenses.
Once you’re on
Medicare, the premiums for Medicare Part B are deducted from your Social
Security payments, assuming you’ve already claimed Social Security.
It may appear as if
you’re paying twice for the same thing, but you’re really not. And while the
Part B premiums may seem expensive, they actually cover only a fourth of Part B
expenses. The rest come out of general federal revenues every year, to the tune
of about $400 billion.
These questions
previously appeared on the PBS NewsHour Making Sen$e
website.
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