Ask The Medicare Specialist

QUESTION:

Question from Connie: I read your latest column about people who are eligible for HOP and wanted to ask you a question. My Medicare A and B become effective 12-1-22. 1) I’m retired, but my husband is still working. We each have our own insurance. 2) I’m sure as you know my Part B and D monthly premiums will be based on both of our incomes. If I’m understanding this correctly, I will be paying for Parts B and D plus adjustments for IRMAA. 3) I chose the HOP Medical Plan, The Basic Rx for prescriptions, and added their dental/ vision option. Are you recommending that I change that (if I can), drop the dental/vision, and Basic prescription, then purchase a prescription plan through you?

ANSWER:

I wanted to break this question down into three parts, so the column is easier to follow.

First, I’d like to let all HOP recipients know that the deadline to enroll or make changes has been extended until December 15th. I think they did this because many people have been opting out of HOP altogether to enroll in Medicare Advantage Plans. For those who get the $ 100 premium assistance, this is a mistake that may be irreversible. I don’t recommend doing it.

1) Connie, check and see if you can go on your husband’s employer plan. You can opt out of Part B and enroll anytime in the future because you would have had continuous coverage from his plan. This may be by far the best option if indeed you’re going to pay extra for your Parts B and D. You’ll want to find out what it would cost to add you to his plan. If it’s significantly less than what Medicare and your HOP plans cost, and if the deductible and the MOOP are reasonable, it’s a no brainer.

2) Single people who have an adjusted gross income of more than $ 97,000 and married couples over $194,000 are subject to the Income Related Monthly Adjustment Amount (IRMAA), which is what those above these income thresholds must pay in addition to the Standard Part B premium of $164.90. It also adds to the cost of Part D prescription coverage. There are five levels of IRMAA, with the additional costs ranging from $66 to $395 per month for Part B, and $12 to $74 for D. There are a couple important nuances that most people aren’t aware of. IRMAA is determined by one’s income from two years ago. For example, 2021 income is used to calculate the charges in 2023. Secondly, if your income is going to be lower in 2023 than it was in 2021, an appeal can be filed to eliminate or lower IRMAA. Let’s say Connie was retiring this December and because she was no longer going to be collecting a paycheck, her and her husband’s income in 2023 will be less than $194,000. Even though it was $240,000 in 2021, she can file an appeal to get IRMAA waived by submitting form SSA-44 to Social Security.

3) Every single HOP recipient who talks to any agent of The Health Insurance Store receives the same advice: Retirees who get the $100 premium credit should choose the HOP Medical Standard Plan, which is a Supplement and secondary to Medicare. It supplies access to any doctor and hospital in the country who accept Medicare Assignment. And more importantly, there’s never any need for prior authorizations for certain medical services like there are with the HOP HMO and PPO options that actually cost more. The spouse of a retiree who doesn’t get the $100 premium assistance and is 75 years old or younger should purchase a Supplement or Advantage Plan outside of HOP. Supplement Plan N, which is a very close equivalent to the HOP Medical plan is $91 to $123 per month less for the retiree’s spouse. As for prescriptions, I estimate that 85 to 90 per cent of HOP recipients are better off on a Medicare Part D Plan, the most popular for 2023 are $11 and $12 per month compared to $66 for the Basic Rx Plan through HOP. Co-pays are generally less as well! Tier 3 medications with the HOP plan cost 25% of the retail price. Eliquis, the most common brand name medication taken in the United States, retails at $600 for a 30day supply. Those on the HOP Basic Rx plan would have to pay $150 per month all year long versus $40 to $47 after the deductible with the most popular Medicare Part D plans. The Health Insurance Store can help analyze which plan is best and let you know exactly how much savings there are by changing. I approximate that to be $800 per person just on Part D alone. This week I recommended that a married couple take Medicare Part D and for the husband to go on Supplement Plan N. Their total savings for 2023 will be over $2,700! Lastly, YOU DON’T NEED DENTAL INSURANCE! I’ve said it over and over. Almost no one will ever get more back in paid claims than what they shelled out in premiums to a dental insurance company! Crowns and root canals are only covered at 50% and the limit on benefits is between $1,000 and $2,000 per year. We don’t buy insurance to get oil changes and tire rotations, which are now about the same cost as a teeth cleaning. We don’t buy insurance for replacement tires which can be more expensive than the cost of a root canal. And remember that all medical conditions of the eyes, mouth, and ears are covered by your health or Medicare insurance: cataract, macular degeneration, glaucoma, an ear or eye infection, a broken jaw that required surgery to repair, etc.

If you’re interested in us analyzing your HOP plans or aren’t eligible for HOP and would like to make sure you’re on the best possible plan(s) for 2023, there’s still time to have that done prior to the Annual Election deadline of December 7th. Consultations in office, over the phone, or via the internet are always provided at no cost.