Your Medicare questions answered

Q: Can I get one of those “Medicare commercial plans” like seen on tv?

A: Maybe! Everyone is saying “Show me the money!” They want a plan that adds the $148.50 back to my social security check, free rides to the doctor, home delivered meals and prescriptions, dental, vision, hearing, gym membership and tele-doc appointments.

The truth is you must qualify to get the $148.50 back, because it’s income based. And the meals, dental, vision, hearing, gym membership, over the counter and food cards are offered through Medicare Advantage plans. Limited discounts are offered through some Medicare Supplement plans. Most plans have been offering telehealth visits since the COVID-19 pandemic began.

Q: What are LIS and IRMAA?

A: LIS (Low-Income Subsidy or Extra Help) is for low-income individuals. It helps provide discounts on medications. Depending on your level of LIS, your cost could be $0 for lower tier and up to $9.20 or a percentage up to 15% of the cost for higher tier medications.

IRMAA (Income Related Monthly Adjustment Amount) is an extra fee charged to high income individuals. If you are single and made up to $88,000 (single) or $176,000 ( joint filing), you will pay more on a sliding scale. There is a two-year look back to determine the amount. For example, for 2021, you would look for the Modified Adjusted Gross Income on your 2019 taxes. For 2022, you will look at your 2020 return. There are certain situations where you may file an appeal if you have a life changing event. Visit medicare.gov for more information and to get the form if you have an usual situation and want to appeal.

Q: When do I enroll in Part B? Can I delay Part B?

A: I have seen people pay Part B premiums for years when they did not need to be enrolled in Part B. If you’re getting an individual plan, do not disenroll from Part B or Part D. If you are over 65 and continuing to work (or you are covered under your spouse’s coverage, you can delay enrolling in Part B. If you have any doubts about whether you are required to enroll in Part B, talk with someone in your HR or benefits department. Save your money! Make sure you need to be enrolled in Part B.

Q: What is better — my employer plan or Medicare?

A: This is a good question. It all depends on how generous your company’s plan is and what your out-of-pocket costs are. Use a broker to do a comparative analysis on your employer plan versus an individual Medicare plan. Remember: If you decide to keep your employer coverage, your employer must have 20 or more employees or you’ll have to pay a penalty.

Q: I want to enroll in your best plan. What plan is that?

Most of us are used to a family insurance plan provided by our employers. Whatever the monthly premium and co-pays, the entire family is all on the same plan. But Medicare is different. It’s all about you. There is no one-sizefits-all plan. There are many plans tailored to different individual needs.

Please do not fall for advertising. Your favorite celebrity’s endorsement is no substitute for doing your due diligence.