Updated 2024 Medicare & You Handbook
Available online at: https://www.medicare.gov/index.php/medicare-and-you

Summary: The Medicare & You 2023 handbook is available free of charge. It’s published by the Centers for Medicare & Medicaid Services (CMS). This is the official government guide explaining the Medicare program in detail. You can get Medicare & You in a variety of formats. You can get the handbook in an electronic, PDF form or paper form and in English, Spanish, large print, Braille, or audio.

Medicare & You 2023 Handbook

Medicare & You 2023 is an official government publication. Millions of people receive the Medicare & You handbook at their homes by mail each year. CMS usually mails the Medicare & You handbook in the fall of each year. This is to help prepare people for the Annual Election Period, which occurs October 15th to December 7th each year. During this time, Medicare beneficiaries can review their Medicare coverage and make changes, if they want.

Frequently Asked Questions (FAQ)

I’ve had Medicare for a number of years. Why is the Medicare & You 2023 Handbook important to me?
Each year, the Centers for Medicare & Medicaid Services (CMS) publishes a revised Medicare & You Handbook. The purpose of the Medicare & You Handbook is to provide Medicare beneficiaries with up-to-date information about the Medicare program. If you’ve been enrolled in Medicare for a few years, you may want to use the Medicare & You 2023 as a reference guide to the current features of the Medicare program and your rights as a Medicare beneficiary.

What topics are included in the Medicare & You 2023 Handbook?

The Medicare & You Handbook contains information on

• Medicare Part A (hospital insurance)
• Medicare Part B (outpatient/medical insurance)
• Medicare Supplement (Medigap) insurance
• Medicare Advantage plans
• Medicare Part D prescription drug coverage and the “donut hole”
• Medicare & You 2024 lists many Medicare-covered services. Also, the Medicare & You 2024 handbook has a chart comparing key features of
• Medicare Part A and Part B under the federal Medicare program with Medicare Advantage. Inside Medicare & You 2024 you’ll also find information on such topics as getting help with the cost of Part D prescription drug coverage, and much more.

What topics are not included in the Medicare & You 2024 Handbook?

Medicare & You 2024 doesn’t include plan-specific information – for example, when it comes to Medicare Advantage plans or Medicare prescription drug plans. If you have a Medicare Advantage or Medicare prescription drug plan, you’ll find plan-specific information in your plan’s 2022 Evidence of Coverage and Summary of Benefits. The Annual Notice of Change (ANOC) explains changes in the 2023 plan and benefits.

What if I didn’t get a Medicare & You 2023 handbook in the mail?

You can call Medicare at 1-800-MEDICARE (1-800-633-4227) 24 hours a day, 7 days a week. TTY/TTD users can call 1-877-486-2048. A Medicare representative can check your address on file and get a Medicare & You 2023 handbook mailed to your home.

Can I get the Medicare & You 2024 Handbook in other formats?

Yes. You can get an electronic version of Medicare & You 2024 from the Medicare website. In fact, if you want to “go green” as the kids say these days and inform Medicare you wish to receive communications electronically rather than by postal mail. You can download a PDF to your computer. Keep in mind Medicare & You is about 130 pages long. If you choose to keep it in an electronic format, you can find topics using key word searches and hyperlinks from the table of contents. You can get the Medicare & You 2024 handbook in English or Spanish. You can also download a copy of Medicare & You in large print or Braille. You can listen to audio podcasts of Medicare & You 2024 chapters. Finally, you can order paper or CD versions of Medicare & You by calling Medicare at 1-800-MEDICARE (1-800-633-4227) 24 hours a day, 7 days a week. TTY/TTD users can call 1-877-486-2048. You get Medicare & You free of charge.

Would you like to learn more about your Medicare coverage options?
I can help. Give me a call at 207-370-0143 or email by clicking here.

More information on Plans & Costs in 2024

Learn more about Medicare Supplement (Medigap) and costs

Learn more about the difference between Medicare Advantage and Medigap Plans

Lower income?  Find out how you can reduce your costs in 2024.

How do I get $100 added to my Social Security?

Medicare Part B Premium will be $174.70 in 2024

Medicare Part B covers doctors and specialist visits, outpatient hospital services, certain home health services, durable medical equipment, and certain other medical and health services not covered by Medicare Part A.

Each year, the Medicare Part B premium, deductible, and coinsurance rates are determined according to provisions of the Social Security Act. The standard monthly premium for Medicare Part B enrollees will be $174.70 for 2024, an increase of $9.80 from $164.90 in 2023. The annual deductible for all Medicare Part B beneficiaries will be $240 in 2024, an increase of $14 from the annual deductible of $226 in 2023.

Income-Related Adjustments

Since 2007, some people who make more money may have to pay more for their Medicare coverage. This is called an income-related adjustment amount (IRMAA). These income-related monthly adjustment amounts affect roughly 8 percent of people with Medicare Part B. The 2024 Part B total premiums for high-income beneficiaries with full Part B coverage are shown in the following table:

Full Part B Coverage
Beneficiaries who file individual tax returns with modified adjusted gross income:	Beneficiaries who file joint tax returns with modified adjusted gross income:	Income-Related Monthly Adjustment Amount	Total Monthly Premium Amount
Less than or equal to $103,000	Less than or equal to $206,000	$0.00	$174.70
Greater than $103,000 and less than or equal to $129,000	Greater than $206,000 and less than or equal to $258,000	$69.90	$244.60
Greater than $129,000 and less than or equal to $161,000	Greater than $258,000 and less than or equal to $322,000	$174.70	$349.40
Greater than $161,000 and less than or equal to $193,000	Greater than $322,000 and less than or equal to $386,000	$279.50	$454.20
Greater than $193,000 and less than $500,000	Greater than $386,000 and less than $750,000	$384.30	$559.00
Greater than or equal to $500,000	Greater than or equal to $750,000	$419.30	$594.00

Medicare Part D Income-Related Monthly Adjustment Amounts

Since 2011, a beneficiary’s Part D monthly premium has been based on his or her income. These income-related monthly adjustment amounts affect roughly 8 percent of people with Medicare Part D. These individuals will pay the income-related monthly adjustment amount in addition to their Part D premium. Part D premiums vary by plan and regardless of how a beneficiary pays their Part D premium, the Part D income-related monthly adjustment amounts are deducted from Social Security benefit checks or paid directly to Medicare. The 2024 Part D income-related monthly adjustment amounts for high-income beneficiaries are shown in the following table:

Beneficiaries who file individual tax returns with modified adjusted gross income:	Beneficiaries who file joint tax returns with modified adjusted gross income:	Income-related monthly adjustment amount
Less than or equal to $103,000	Less than or equal to $206,000	$0.00
Greater than $103,000 and less than or equal to $129,000	Greater than $206,000 and less than or equal to $258,000	$12.90
Greater than $129,000 and less than or equal to $161,000	Greater than $258,000 and less than or equal to $322,000	$33.30
Greater than $161,000 and less than or equal to $193,000	Greater than $322,000 and less than or equal to $386,000	$53.80
Greater than $193,000 and less than $500,000	Greater than $386,000 and less than $750,000	$74.20
Greater than or equal to $500,000	Greater than or equal to $750,000	$81.00

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 file separate tax returns from their spouses with modified adjusted gross income:	Income-related monthly adjustment amount
Less than or equal to $103,000	$0.00
Greater than $103,000 and less than $397,000	$74.20
Greater than or equal to $397,000	$81.00

Medicare Part A Premium and Deductible

Medicare Part A covers inpatient hospitals, skilled nursing facilities, hospice, inpatient rehabilitation, and some home health care services. About 99 percent of Medicare beneficiaries do not have a Part A premium since they have at least 40 quarters of Medicare-covered employment, as determined by the Social Security Administration.

Most people have insurance plans to over the Part A deductibles and cost shares listed below. If you have questions about what you will have to pay in 2024 call the member services number on the back of your insurance card or schedule a call with a local agent using the blue button at the bottom of th page.

The Medicare Part A inpatient hospital deductible that beneficiaries pay if admitted to the hospital will be $1,632 in 2024, an increase of $32 from $1,600 in 2023. The Part A inpatient hospital deductible covers beneficiaries’ share of costs for the first 60 days of Medicare-covered inpatient hospital care in a benefit period. In 2024, beneficiaries must pay a coinsurance amount of $408 per day for the 61^st through 90^th day of a hospitalization ($400 in 2023) in a benefit period and $816 per day for lifetime reserve days ($800 in 2023). For beneficiaries in skilled nursing facilities, the daily coinsurance for days 21 through 100 of extended care services in a benefit period will be $204.00 in 2024 ($200.00 in 2023).

Part A Deductible and Coinsurance Amounts for Calendar Years 2023 and 2024 by Type of Cost Sharing
	2023	2024
Inpatient hospital deductible	$1,600	$1,632
Daily hospital coinsurance for 61st-90th day	$400	$408
Daily hospital coinsurance for lifetime reserve days	$800	$816
Skilled nursing facility daily coinsurance (days 21-100)	$200.00	$204.00

Enrollees age 65 and older who have fewer than 40 quarters of coverage and certain persons with disabilities pay a monthly premium in order to voluntarily enroll in Medicare Part A. Individuals who had at least 30 quarters of coverage or were married to someone with at least 30 quarters of coverage may buy into Part A at a reduced monthly premium rate, which will be $278 in 2024, the same amount as 2023. Certain uninsured aged individuals who have less than 30 quarters of coverage and certain individuals with disabilities who have exhausted other entitlement will pay the full premium, which will be $505 a month in 2024, a $1 decrease from 2023.

For more information on the 2024 Medicare Parts A and B premiums and deductibles (CMS-8083-N, CMS-8084-N, CMS-8085-N), please visit https://www.federalregister.gov/public-inspection.

Exploring Financial Assistance Options

If you’re worried about the costs of Medicare going up, there are programs that can help. These programs give financial assistance to families who need it. They can help you with the extra costs of Medicare. You can read more about these programs here: https://www.mainemedicareoptions.com/qmb/

Seeking Expert Guidance

This is where I come in!  Understanding changes in Medicare can be a little confusing, but there are people like me who can help you. As someone who knows a lot about Medicare, I can explain things in a way that makes sense and help you understand what you need to know so you can plan for the changes coming in 2024 and 2025.

In 2025, there will be some additional changes to the Medicare program. By learning about these changes and talking to an expert, you can be prepared and understand what it means for you and your family. Remember, there are programs that can help with the costs, and experts who can explain things better. By being informed and planning ahead, you can make sure you have the healthcare you need when the changes come in 2024 and 2025.   

Do you have a Health Savings Account (HSA) & Medicare Part A and/or B?

As you navigate the world of Medicare, it’s crucial to have a clear understanding of how various aspects of your healthcare coverage work together. One component that often raises questions is the interaction between Medicare and Health Savings Accounts (HSAs).  When I meet people who have had High Deductible Health Insurance Plans in the past and have contributed money to a tax-free Health Savings Account (HSA) over the years I often get asked how that works with Medicare.  Here are some of the most common questions I get asked.

Medicare Eligibility and HSAs

Once you enroll in Medicare Part A or Part B, typically at age 65, you are no longer allowed to contribute to your HSA. However, you can continue to withdraw funds from your existing HSA to pay for qualified medical expenses, including Medicare premiums, deductibles, copayments, and certain prescription drugs.

Medicare Part A and HSAs:

Medicare Part A is typically provided at no cost to most individuals. However, if you choose to delay enrolling in Part A while contributing to an HSA, it’s essential to cease contributions six months before your Medicare coverage begins to avoid potential tax penalties.

Approved HSA Expenses Specific To Medicare

You CAN use your HSA for any qualified medical expenses approved by the IRS, including:

• Premiums paid to Medicare (i.e. Part B, Part B IRMAA, Part D IRMAA)
• Premiums paid to an insurance carrier for Stand-Alone Part D Prescription Drug Plans
• Premiums paid to an insurance carrier for a Medicare Advantage Plan (Part C)
• Medical copays, coinsurance, deductibles
• Prescription drug copays
• Dental, vision, hearing costs

You CANNOT use your HSA to pay your:

• Premiums paid to an insurance carrier for a Medicare Supplement (Medigap) plan

Understanding the interaction between Medicare and Health Savings Accounts (HSAs) is crucial for making informed decisions about your healthcare and financial well-being. While Medicare eligibility restricts HSA contributions, HSAs can still be a valuable tool for covering medical expenses during your retirement. Remember to consult with your financial advisor or tax professional to explore the best strategies for optimizing your healthcare expenses and preserving your savings. With this knowledge, you can confidently navigate the complexities of Medicare and HSAs, ensuring your healthcare needs are met while maintaining financial stability.

Certainly this website does not cover everything related to HSAs and Medicare so if you would like to talk about this more of have additional questions about your HSA or another topic, you can reach me at 207-370-0143 or use my simple form on the CONTACT ME page of this site to send an email message.

The best part about working with me is that my help is free.  I do not charge anyone anything to discuss your options or to review the plans that are available.  I am paid by the insurance companies in the form of a commission if you enroll in a plan, just like your car insurance or home owners insurance agent – and I will work just as hard to help you find the best plans to compare!

You will not pay any more than anyone else and you are under no obligation whatsoever to enroll in any plans if you meet with me.  My goal is to help you and I have found great joy in being able to offer my services to people who need my help.

Your Medicare card is proof of your Medicare insurance. If your Medicare card was lost, stolen, or destroyed, you can request a replacement with your personal my Social Security account.

If you don’t already have an account, you can create one online. Go here: https://www.ssa.gov/myaccount

• Once you are logged in to your account, select the “Replacement Documents” tab.
• Then select “Mail my replacement Medicare card.”

Your Medicare card will arrive in the mail in about 30 days at the address on file with Social Security so be sure to make sure your mailing address is correct before completing the request.

If you need to know your new Medicare number now, you have some options. In your personal my Social Security account, you can get your Benefit Verification Letter, which includes your Medicare number. You can also visit Medicare.gov and sign in to see your Medicare number and print an official copy of your card. If you don’t have a Medicare.gov account, go to Medicare.gov and select “Log In/Create Account”. But, you will need your Medicare ID number to create an account.

If you cannot access your My Social Security Account or prefer not to use the online service, you can call 1-800-MEDICARE (1-800-633-4227) to request a replacement card be mailed to you.

Read more:

Need help paying for prescriptions and other Medicare expenses?

How to get Dental coverage if your have Medicare

Are you a Veteran. You can get so much more from Medicare!

Changes for 2023 include premium and deductible increases for Part A, stable rates for Part B, and better Part D coverage due to the Inflation Reduction Act.

The standard Part B premium will be $164.90 for 2023. This is a $5.20 decrease from the 2022 premium of $170.10.

Part A deductible will increase by $44 in calendar year 2023, to $1,600.

The Part A daily coinsurance amounts will be $400 for days 61-90 of hospitalization in a benefit period; $800 for lifetime reserve days; and $200 for days 21-100 of extended care services in a skilled nursing facility in a benefit period. The monthly Part A premium, paid by beneficiaries who have fewer than 40 quarters of Medicare-covered employment and certain people with disabilities, will increase by $7 in CY 2023 to $506, CMS announced. Certain voluntary enrollees eligible for a 45% reduction in the monthly premium will pay $278 in CY 2023.

The Part B deductible will decrease by $7 in 2023 to $226.

Most people will pay the standard Part B premium amount. But 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 premium amount PLUS an Income Related Monthly Adjustment Amount (IRMAA). IRMAA is an extra charge added to your premium.

Income Related Monthly Adjustment Amount (IRMAA) for 2023

The income brackets for high-income premium adjustments for Medicare Part B and D start at $91,000 for a single person, but this threshold is expected to increase to $97,000 or $98,000 in 2023.

If your yearly income in 2021 was	If your yearly income in 2021 was
File individual tax return	File joint tax return	File married & separate tax return
$97,000 or less	$194,000 or less	$91,000 or less	$164.90
above $97,000 up to $123,000	above $194,000 up to $246,000	Not applicable	$230.80
above $123,000 up to $153,000	above $246,000 up to $306,000	Not applicable	$329.70
above $153,000 up to $183,000	above $306,000 up to $366,000	Not applicable	$428.60
above $183,000 and less than $500,000	above $366,000 and less than $750,000	above $91,000 and less than $409,000	$527.50
$500,000 or above	$750,000 and above	$409,000 and above	$560.50

More information on Plans & Costs in 2023

Learn more about Medicare Supplement (Medigap) and costs

Learn more about the difference between Medicare Advantage and Medigap Plans

Lower income?  Find out how you can reduce your costs in 2023.

How do I get $100 added to my Social Security?

Summary:  The Medicare & You 2023 handbook is available free of charge. It’s published by the Centers for Medicare & Medicaid Services (CMS). This is the official government guide explaining the Medicare program in detail. You can get Medicare & You in a variety of formats.  You can get the handbook in an electronic, PDF form or paper form and in English, Spanish, large print, Braille, or audio.

Medicare & You 2023 Handbook

Medicare & You 2023 is an official government publication. Millions of people receive the Medicare & You handbook at their homes by mail each year. CMS usually mails the Medicare & You handbook in the fall of each year. This is to help prepare people for the Annual Election Period, which occurs October 15^th to December 7^th each year. During this time, Medicare beneficiaries can review their Medicare coverage and make changes, if they want.

Frequently Asked Questions (FAQ)

I’ve had Medicare for a number of years. Why is the Medicare & You 2023 Handbook important to me?

Each year, the Centers for Medicare & Medicaid Services (CMS) publishes a revised Medicare & You Handbook. The purpose of the Medicare & You Handbook is to provide Medicare beneficiaries with up-to-date information about the Medicare program. If you’ve been enrolled in Medicare for a few years, you may want to use the Medicare & You 2023 as a reference guide to the current features of the Medicare program and your rights as a Medicare beneficiary.

What topics are included in the Medicare & You 2023 Handbook?  

The Medicare & You Handbook contains information on

• Medicare Part A (hospital insurance)
• Medicare Part B (outpatient/medical insurance)
• Medicare Supplement (Medigap) insurance
• Medicare Advantage plans
• Medicare Part D prescription drug coverage and the “donut hole”

Medicare & You 2021 lists many Medicare-covered services. Also, the Medicare & You 2021 handbook has a chart comparing key features of Medicare Part A and Part B under the federal Medicare program with Medicare Advantage. Inside Medicare & You 2021 you’ll also find information on such topics as getting help with the cost of Part D prescription drug coverage, and much more.

What topics are not included in the Medicare & You 2023 Handbook?

Medicare & You 2023 doesn’t include plan-specific information – for example, when it comes to Medicare Advantage plans or Medicare prescription drug plans. If you have a Medicare Advantage or Medicare prescription drug plan, you’ll find plan-specific information in your plan’s 2022 Evidence of Coverage and Summary of Benefits. The Annual Notice of Change (ANOC) explains changes in the 2022 plan and benefits.

What if I didn’t get a Medicare & You 2023 handbook in the mail?

You can call Medicare at 1-800-MEDICARE (1-800-633-4227) 24 hours a day, 7 days a week. TTY/TTD users can call 1-877-486-2048. A Medicare representative can check your address on file and get a Medicare & You 2023 handbook mailed to your home.

Can I get the Medicare & You 2023 Handbook in other formats?

Yes. You can get an electronic version of Medicare & You 2021 from the Medicare website. In fact, if you want to “go green” as the kids say these days and inform Medicare you wish to receive communications electronically rather than by postal mail. You can download a PDF to your computer. Keep in mind Medicare & You is about 130 pages long. If you choose to keep it in an electronic format, you can find topics using key word searches and hyperlinks from the table of contents. You can get the Medicare & You 2021 handbook in English or Spanish. You can also download a copy of Medicare & You in large print or Braille. You can listen to audio podcasts of Medicare & You 2021 chapters. Finally, you can order paper or CD versions of Medicare & You by calling Medicare at 1-800-MEDICARE (1-800-633-4227) 24 hours a day, 7 days a week. TTY/TTD users can call 1-877-486-2048. You get Medicare & You free of charge.

Would you like to learn more about your Medicare coverage options? 

I can help. Give me a call at 207-370-0143 or email by clicking here.

In 2022 many plans will offer Insulin for $25-$35 copay!

Do you use one of the insulins listed below?

Admelog® 10mL Vial

Admelog® 3 mL Vial

Afrezza® – 180 count: 60 x 4 units + 60 x 8 units + 60 x 12 units Inhalation Powder

Afrezza® – 180 count: 90 x 4 units + 90 x 8 units Inhalation Powder

Afrezza® – 180 count: 90 x 8 units + 90 x 12 units Inhalation Powder

Afrezza® – 90 count: 90 x 12 units Inhalation Powder

Afrezza® – 90 count: 90 x 4 units Inhalation Powder

Afrezza® – 90 count: 90 x 8 units Inhalation Powder

Apidra® Vial

Apidra® SoloStar® Pen

Fiasp® Vial

Fiasp® FlexTouch® Pen

Fiasp® PenFill® cartridge Pen

Humalog® 10 mL Vial

Humalog® 3 mL Vial

Humalog® Cartridge Pen

Humalog® Junior KwikPen® Pen

Humalog® KwikPen® U-100 Pen

Insulin Aspart Vial

Insulin Aspart FlexPen® Pen

Insulin Aspart PenFill® Cartridge Pen

Insulin Lispro Vial

Insulin Lispro Vial

Insulin Lispro Junior KwikPen® Pen

Insulin Lispro KwikPen® Pen

Insulin Lispro KwikPen® Pen

Lyumjev™ Vial

Lyumjev™ Kwikpen® U-100 Pen

NovoLog® Vial

NovoLog® FlexPen® Pen

NovoLog® PenFill® Pen

Humulin® R 10 mL Vial

Humulin® R 3 mL Vial

Novolin® R Vial

Novolin® R FlexPen® Pen

Humulin® N 10 mL Vial

Humulin® N 3 mL Vial

Humulin® N KwikPen® Pen

Novolin® N Vial

Novolin® N FlexPen® Pen

Basaglar® KwikPen® Pen

Lantus® Vial

Lantus® Novaplus® Vial

Lantus® SoloStar® Pen

Lantus® SoloStar® Novaplus® Pen

Levemir® Vial

Levemir® FlexTouch® Pen

Semglee™ Pen

Semglee™ Vial

Tresiba® Vial

Tresiba® FlexTouch® U-100 Pen

Humalog® Mix 50-50 Vial

Humalog® Mix 50-50 KwikPen® Pen

Humalog® Mix 75-25 Vial

Humalog® Mix 75-25 KwikPen® Pen

Humulin® 70/30 KwikPen® Pen

Humulin® 70-30 10 mL Vial

Humulin® 70-30 3 mL Vial

Insulin Aspart Mix 70/30 Vial

Insulin Aspart Mix 70/30 FlexPen® Pen

Novolin® 70/30 Pen

Novolin® 70/30 Vial

NovoLog® Mix 70/30 Vial

NovoLog® Mix 70/30 FlexPen® Pen

Humalog® KwikPen® U-200 Pen

Humulin® R U-500 Vial

Humulin® R U-500 KwikPen® Pen

Lyumjev™ Kwikpen® U-200 Pen

Toujeo® Max SoloStar® Pen

Toujeo® SoloStar® Pen

Tresiba® FlexTouch® U-200 Pen

Soliqua™ 100/33 Pen

Xultophy®

If you use of the insulins listed above then there may be a plan that offers a $25-$35 copay this year!

Say “Good Bye” to the Donut Hole!

The opportunity to get insulin for $25 or $35 a month is a very good deal. However, this isn’t automatic and you may be stuck paying much higher copays in 2022 if you don’t have a plan that is participating in this new program.

That’s right. Not all Part D prescription drug plans will offer the $25-$35 copay.

It is important to understand that of the 14 insurance companies that offer Medicare plans in Maine and New Hampshire, only about half are participating in this lower copay scheme. And some companies only offer it on select plans.

How to get these new Medicare savings?

This is the important part. Getting these savings is not automatic, you have to have a plan that participates.

You will need to research all the plans to find which standalone Part D prescription drug plans or Medicare Advantage plans will offer the lower costs. Start by calling your current plan and asking what your costs will be next year. If they do not say $25 or $35 then you may want to shop around for a better plan.

When can I change my plan?

Generally, the only time you can switch to another Medicare prescription drug plan is during the Annual Medicare Open Enrollment Period that begins October 15th and ends December 7th.

However, there are other times of the year you can change, depending on where you live and what plan you have. To find out if you qualify to change plans outside of the Open Enrollment window, give me a call. I am happy to help!

If you’re only paying $35 every month, who’s helping to pay the rest?

Currently, the insurance companies that offer Part D prescription drug coverage on their plans have the option to offer prescription drugs at lower copays during the donut hole coverage gap.

But the insurance companies have to pick up the costs that would normally be paid by the pharmaceutical companies. Often, they choose to pass these costs on to you, the Medicare beneficiaries in the form of much higher premiums.

This new program makes two significant changes:

1. Pharma companies (specifically, Eli Lilly, Novo Nordisk, and Sanofi as the participating insulin makers) can continue paying their full coverage gap discount for products, even if a Part D plan offers lower cost-sharing.
2. Participating Part C and Part D plans will be required to cap insulin costs at $35 for a month’s supply, by applying the manufacturer rebates. This will happen year-round, even if you enter the “donut hole.“

How long will this program last?

This is a pilot program, in a sense. Medicare says it will watch how this works starting in 2021 and determine whether any changes are needed as time goes on. Expectations are from 3 to 5 years.

Medicare Administrator Seema Verma also said during the announcement: “If it goes well, we’ll extend this to other drugs. We’re starting with insulin, but depending on the progress, we will consider offering this flexibility to manufacturers and plans with other drugs, depending on the results. We think this creates a foundation and a platform to fix some of the problems that we have in Medicare Part D.”

The good news is that if Medicare does decide to continue with this low-cost insulin, other insurance companies may sign on in 2022 or later.

Would you like more info?

If you would like to talk about this program or schedule a meeting, you can reach me at 207-370-0143 or use my simple form on the CONTACT ME page of this site to send an email message.

The best part about working with me is that it w not cost you anything to discuss your options or to review the plans that are available.  I am paid by the insurance companies in the form of a commission if you enroll in a plan, just like your car insurance agent.

You will not pay any more than anyone else and you are under no obligation whatsoever to enroll in any plans if you meet with me.  My goal is to help you and I have found great joy in being able to offer my services to people who need my help.

If you are diabetic and using insulin,
you may be able to save a lot of money.

Call me today and I will be happy to explain all your options and help you compare plans so you can choose the coverage you need for a price you can afford.

Schedule a quick phone call today.

I can answer all your questions over the phone and I can help you with everything you need to know. I have all the forms and applications you need and I can also help you complete them.

Medicare Part B premiums will increase by about $4 per month next year and high-income surcharges will also rise modestly in 2021,

The standard Medicare Part B premium, which covers doctor’s visits and other outpatient services, will increase to $148.50 per month in 2021, up $3.90 from this year’s monthly premium of $144.60.

Medicare imposes surcharges on higher-income beneficiaries. The theory is that higher-income beneficiaries can afford to pay more for their healthcare. Instead of doing a 25/75 split with the government, you must pay a higher share of the program costs.

The surcharge is called IRMAA, which stands for Income-Related Monthly Adjustment Amount.

The income used to determine IRMAA is your AGI plus municipal bond interest from two years ago. Your 2019 income determines your IRMAA in 2021. Your 2020 income will determine your IRMAA in 2022 and so on.

As if it’s not complicated enough for not moving the needle much, IRMAA is divided into five income brackets. Depending on your income, higher-income beneficiaries pay 35%, 50%, 65%, 80%, or 85% of the program costs instead of 25%.

The lines drawn for each bracket can cause a sudden jump in the premiums you pay. If your income crosses over to the next bracket by $1, all of a sudden your Medicare premiums can jump by over $1,000/year. If you are married and both of you are on Medicare, $1 more in income can make the Medicare premiums jump by over $1,000/year for each of you.

So if your income is near a bracket cutoff, see if you can manage to keep it down and make it stay in a lower bracket. Using the income from two years ago makes a little harder. Now in 2020, you don’t know where exactly the brackets will be for 2022. Still, you can make reasonable estimates and give yourself some margin to stay clear of the cutoff points.

IRMAA Brackets

The IRMAA income brackets (except the very last one) started adjusting for inflation in 2020. Below are the IRMAA income brackets for 2020 coverage and the new brackets for 2021 coverage.

Before the government publishes the official numbers, I’m able to make projections based on the inflation numbers to date. Rounding rules make it such that the inflation numbers for the upcoming months are unlikely to affect the final results. For example, when a number is rounded to the nearest $1,000, it doesn’t matter whether the number is really $87,600 or $87,800 before rounding. Remember the income on your 2019 tax return (AGI plus muni interest) determines the IRMAA you pay in 2021. The income on your 2020 tax return (to be filed in 2021) determines the IRMAA you pay in 2022.

2021 Parts B and D Income-Related Premiums

Beneficiaries who file an individual tax return with income:	Beneficiaries who file a joint tax return with income:	Beneficiaries who are married, but file a separate tax return with income:	2021 Total monthly Part B premium amount	2021 Part D income-related monthly adjusted amount paid to Medicare (in addition to plan premiums)
Less than or equal to $88,000	Less than or equal to $176,000	Less than or equal to $88,000	$148.50	your plan premium
Greater than $88,000 and less than or equal to $111,000	Greater than $176,000 and less than or equal to $222,000		$207.90	$12.30 + your plan premium
Greater than $111,000 and less than or equal to $138,000	Greater than $222,000 and less than or equal to $276,000		$297.00	$31.80 + your plan premium
Greater than $138,000 and less than or equal to $165,000	Greater than $276,000 and less than or equal to $330,000		$386.10	$51.20 + your plan premium
Greater than $165,000 and less than $500,000	Greater than $330,000 and less than $750,000	Greater than $88,000 and less than $412,000	$475.20	$70.70 + your plan premium
Greater than or equal to $500,000	Greater than or equal to $750,000	Greater than or equal to $412,000	$504.90	$77.10 + your plan premium

Higher-income Medicare beneficiaries also pay a surcharge for Part D. The income brackets are the same. The surcharges are relatively smaller in dollars.

It’s too early to project the income brackets for 2022 coverage. Right now we only have one data point out of 12 to calculate the brackets for 2022. We’ll have three data points out of 12 by mid-December. If I must guess, the range for the first tier will be between $88,000/$176,000 (no change from 2021) and $90,000/$180,000, with the most likely scenario in the middle, i.e. $89,000/$178,000.

The standard Medicare Part B premium is $148.50/month in 2021. A 40% surcharge on the Medicare Part B premium is about $700/year per person or about $1,400/year for a married couple both on Medicare. In the grand scheme, when a couple on Medicare have over $174k in income, they are probably already paying a large amount in taxes. Does making them pay another $1,400/year make that much difference? Nickel-and-diming just annoys people. People caught by surprise when their income crosses over to a higher bracket by just a small amount get mad at the government. Rolling it all into the income tax would be much more effective.

Oh well, if you are on Medicare, watch your income and don’t accidentally cross a line for IRMAA.

HOW TO APPEAL AN IRMAA SURCHARGE

If your income two years ago was higher because you were working at that time and now your income is significantly lower because you retired (“work reduction” or “work stoppage”), you can appeal the IRMAA assessment. The “life-changing events” that make you eligible for an appeal include:

• 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

You file an appeal by filling out form SSA-44 to show that although your income was higher two years ago, you had a reduction in income now due to one of the life-changing events above.

For more information on the appeal, see Medicare Part B Premium Appeals.

You will not be penalized for life

If your income two years ago was higher and you don’t have a life-changing event that makes you qualify for an appeal, you will pay the higher Medicare premiums for one year. IRMAA is re-evaluated every year as your income changes.

If your higher income two years ago was due to a one-time event, such as realizing capital gains or taking a large withdrawal from your IRA, when your income comes down in the following year, your IRMAA will also come down. The change will take plans every year in January.

If you have any questions about this or anything related to Medicare, give me a call. I help people every day understand the complexities of Medicare. I’m happy to help.

Special Needs Plans (SNPs) are a type of Medicare Advantage plan that are specifically designed for people who meet certain eligibility criteria. These plans cater their benefits to serve the unique needs of its members.

There are three types of Special Needs Plans available in Maine:

Dual-Eligible Special Needs Plans (D-SNP)

D-SNP plans are for individuals who are entitled to Medicare and who are also eligible for some level of assistance from a state Medicaid program or MaineCare.

Chronic-Condition Special Needs Plans (C-SNP)

C-SNP plans are for individuals with one or more of the following conditions: diabetes, cardiovascular disorders, chronic heart failure and chronic lung disorders such as COPD.

Institutional Special Needs Plans (I-SNP)

These plans serve those living in an institution (such as a nursing home) or who need nursing care at home.

If you fall into any of the categories above, you may have unique health-care needs that a Special Needs Plan may be better equipped to address.

For example, some Special Needs Plans offer a larger network of providers that specialize in treating your condition or lower costs for the prescription drugs typically prescribed for your particular illness.

Special Needs Plans benefits

Like other Medicare Advantage plans, Special Needs Plans are available through private insurance companies that are approved by Medicare. All Medicare Advantage plans are required to offer at least the same level of coverage as Original Medicare, Part A and Part B. Some Medicare Advantage plans may also cover benefits beyond what Original Medicare covers, and your Medicare plan options and benefits can vary, depending on where you live. You can read more about Medicare Advantage plans here

If you’re enrolled in a Special Needs Plan for dual eligibles, there may be certain social services available to help you coordinate your Medicare and Medicaid benefits along with additional benefits like dental and vision coverage, help with over-the-counter items such as vitamins and toothpaste or allowances to purchase healthy foods.

It’s important to note that you still get all the coverage that is otherwise included with Original Medicare, Part A and Part B, and Medicare Part D.

A Special Needs Plan simply offers extra coverage to help you better manage your particular situation, whether that’s living in a nursing home; coordinating your Medicare and Medicaid benefits; or treating a serious chronic illness.

Getting help with costs

If you have both Medicare and Medicaid or if you have limited income, Medicaid may be able to cover some or all of your Medicare Advantage Special Needs Plan’s premiums and/or out-of-pocket costs. Depending on your income levels, you may qualify for a Medicare Savings Program, which can help pay for costs like premiums, copayments, coinsurance, or you deductible.

Medicare Advantage Special Needs Plans costs

Depending on the Special Needs Plan, you will typically have help paying for the following:

• Medicare Part B premium
• Monthly premium for your Special Needs Plan (Up to a certain amount)
• Cost-sharing expenses, such as copayments, coinsurance, and deductibles

Keep in mind that your specific costs may vary, depending on if you qualify for full or partial financial assistance or get both Medicare and MaineCare benefits.

Your out-of-pocket costs will also depend on the type of health-care services you need and how often you need them. Each Special Needs Plan is different so you should review the specific plan materials for the plan you’re considering to see exactly how much you’ll have to pay.

Make sure you pay particular attention to the differences in your cost sharing when you use the plan’s in-network doctors versus out-of-network doctors (if the plan allows you to go outside it’s network).

Enrolling in a Medicare Advantage Special Needs Plan

You can enroll in a Special Needs Plan once you’re first eligible for Medicare if there is a Special Needs Plan in your service area and you meet the eligibility requirements of that plan.

Most people are first eligible for Medicare during their Initial Enrollment Period, the seven-month period that starts three months before your 65th birthday, includes your birthday month, and ends three months later. If you qualify for Medicare because of disability, your Initial Enrollment Period starts three months before the 25th month that you are receiving Social Security or Railroad Retirement Board disability benefits and lasts seven months.

You can also enroll in a Special Needs Plan during the Annual Open Enrollment Period from October 15 to December 7 of every year. During this period, you can enroll in a Special Needs Plan for the first time, switch plans, or disenroll from your plan to choose another plan.

Outside of these periods, you may be able to join a Special Needs Plan with a Special Election Period in certain situations. Some situations that may qualify you for a Special Election Period to enroll in a Special Needs Plan or make coverage changes include:

• You are diagnosed with a severe or disabling condition: You can enroll in a Chronic-Condition Special Needs Plan for beneficiaries with your illness at any time, and your Special Election Period ends once you enroll in the plan.
• You move into, currently live in, or leave a nursing home: You can enroll in a Special Needs Plan or switch plans at any time.
• You qualify for Medicaid: If you have Medicaid or are newly eligible for Medicaid, you can enroll in a Medicare Special Needs Plan at any time.
• You move outside of your Special Needs Plan’s service area: You can use a Special Election Period to switch to a new plan, or you’ll be automatically returned to Original Medicare.
• Your Special Needs Plan leaves the Medicare program: You can use a Special Election Period to switch to a different Special Needs Plan.

Still have more questions?

If you need help comparing the different health insurance plans or understanding which plans will cover your doctors and prescriptions, I can help you.

There is no obligation to you and no cost to talk with someone.

Medicare Savings Programs, also known as the Medicare Buy-In or “Quimby” is a way to help reduce your costs with the Medicare Part B premium, copays and costs for prescription medications under Part D.

Depending on your income and assets, you may get help paying for Medicare co-pays, coinsurance, deductibles, premiums, and “extra help” with your Part D costs. There are two levels of MSP or Medicare Savings Program help that you may qualify for.

Level 1—The Qualified Medicare Beneficiary (QMB) level:

QMB pays ALL Medicare premiums, coinsurances, and deductibles, and lowers generic drug co-pays and eliminates the “donut hole.” There are also special plans with additional benefits like dental, vision, hearing and transportation that you will also qualify for. Click here to learn more.

Here are the income and asset guidelines for Maine:

Level 2—The SLMB or QI level with Maine Rx or DEL:

SLMB or QI pays Medicare Part B premium and Part D premium within a certain limit, pays your deductible, and lowers copays & eliminates the “donut hole.” It also lowers generic drug copays.

Here are the income and asset guidelines for Maine:

What Is Estate Recovery?

If you only have one of the MSP levels, QMB, SLMB or QI, the state cannot recover the cost of helping you from your estate when you die.

But if your income and assets are low enough and you get MaineCare plus an MSP, the state MAY try to recover some costs when you die if you are over 54 and have no surviving spouse or dependent child.

How Do I Apply?

1. Call toll Free: (866) 976-9038 for help or to find someone in your area to help you apply.
2. Or use My Maine Connection to apply online: www.Maine.gov/MyMaineConnection