Don’t overlook Medicare’s low-income support programs

Editor’s Note: Journalist Philip Moeller, who writes widely on health and retirement, is here to provide the Medicare answers you need in “Ask Phil, the Medicare Maven.” Send your questions to Phil.

Brady – Miss.: I am 59 years old. I’ve been on Social Security disability and Medicare since 1996. I enrolled in a Part D drug plan when it became available. I do get Extra Help through my state Medicaid that pays my Medicare and Plan B monthly premiums. But I still have to pay for doctor copays, the annual deductible and the 20 percent of covered expenses my Part B does not pay. I want to now enroll in an HMO [Health Maintenance Organization] or PPO [Preferred Provider Organization] or get a Medigap plan to help with these growing expenses. Whatever help you can give me on this would be greatly appreciated.

Phil Moeller: There are other Medicare support programs that might help here. I’d suggest you call a Medicare counselor, either with the State Health Insurance Assistance Program or the Medicare Rights Center, and see if you qualify for any additional help with your health care bills. Odds are this would be a less expensive solution for you than buying an additional health policy. Such a policy usually would charge you premiums beyond those you already pay for your basic Part B Medicare premium. There are Medicare Advantage plans that might be less costly but they also usually have their own copays and other charges. Ask a counselor to help you explore plans available where you live to see if there’s a clearly better choice for you. As for Medigap, these plans do not cover drugs at all. They do plug some of the holes in basic Medicare, but they also have their own premiums, and it can be very hard in some states for a disabled Medicare beneficiary to even find a Medigap plan, let alone one they can afford.

Alice – N.Y.: Beginning March 1, my husband’s company is paying in full for COBRA for both of us for one year (benefits include dental.) I will be 65 in April. Can I choose to stay on COBRA for the year?

Valli – Colo.: My husband had to take early retirement at age 64 in January. His company is paying our insurance premiums a full year with a COBRA policy. I am 65 years old and Medicare told me I have to get Plan B in eight months or pay a penalty when I do. Why can’t I continue on my husband’s insurance?

Phil Moeller: Unfortunately, having COBRA does not count as active employer health insurance when it comes to meeting Medicare enrollment rules. If you delay Medicare you will not have a special enrollment period for Medicare and might thus be without health insurance while waiting for your Medicare to take effect. Secondly, if there is a gap between the end of your active employer coverage and the starting date of your Medicare, you face possible late-enrollment premium penalties for Part B. Talk to your husbands’ employee benefits departments to make sure you get the timing right and avoid this penalty, which can last the rest of your life.

Newell – Maine: I am 63 and have group medical insurance. My wife has not worked enough hours to qualify for Medicare on her own, so when she turned 65 last November she did not sign up for Part A, because she is fully covered by my plan. Am I correct that this will not cause her to pay a penalty when she does sign up when I retire and start taking it?

Phil Moeller: Yes, that’s correct. However, under Medicare rules, if you are eligible for Social Security benefits (and I assume you are), your wife is eligible for free Part A coverage even if she’s never earned a penny of wage income in her life. Unless you have a high deductible health plan with a health savings account, she should get her free Part A now. It can provide secondary coverage to her and may help pay some hospital expenses not paid by your group plan.

Anne – Ariz.: I am doing my sister’s taxes, and this year her annual income is very high due to capital gains from the sale of her home (over $250,000 adjusted gross income).  Her normal income is about $70,000. I know that the Medicare Part B premiums and the Part D premiums are tied to income. Her income for 2015 could be used to raise those premiums to the maximum in 2017, assuming no legislative changes. If her income then is only $70,000, can she do anything about those premiums?

Phil Moeller: Anne’s question is about the income-related surcharges for Medicare under the Income-Related Monthly Adjustment Amount program, called IRMAA for short. As her note implies, there is a two-year lag in the program’s impact, with 2015 tax returns being used to determine any 2017 IRMAA surcharges. Unfortunately, one-time increases to income, such as the sale of a home, usually do not qualify as grounds for appealing an IRMAA surcharge. Social Security runs this program for Medicare and has an appeals process that Anne can check out. Perhaps her sister is also experiencing some of the hardship factors that can be the basis for an appeal.

Phil Moeller: Medicare eligibility does not begin until you turn 65 unless you are disabled, regardless of when you start claiming Social Security. You can get both VA and Medicare coverage. While many veterans receive excellent coverage through the VA system, not everyone does, and many people also get Medicare so that they can be covered for care outside the VA network. Because this decision is still several years away, I urge you to carefully explore what each covers and whether the extra Medicare premiums are a good idea for you. As for mental health care, yes, Medicare certainly does cover this. However, “counseling” is a very broad term, so I’d again urge you to make sure that the care you seek is a covered service.