An Introduction to Medicare Part B Premiums

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Published: January 28, 2019

Everyone knows (or should know) they can sign up for Medicare at age 65. In fact, given the uncertainties regarding health insurance over the past year or so, many are chomping at the bit to get there faster.

What many don’t know, though, is that there are several parts to Medicare. Part A is the more commonly known feature of Medicare. That’s the part most people are thinking about when they refer to Medicare. But there are also parts B, C and D. Here are some common questions about Medicare Part B.

What is the difference between Medicare Part A and Medicare Part B?

For the vast majority, there are no premiums for Medicare Part A. There are premiums for Medicare Part B.

Medicare Part A covers inpatient care, including care received while in a hospital. If you meet certain conditions (such as having a qualified hospital stay), it may cover time in a skilled nursing facility for a limited number of days, and, in limited circumstances, care at home. It does not, as the majority of Americans believe, cover long-term care assistance defined as needing help at home to handle the activities of daily living.

Medicare Part B covers services and supplies that are medically necessary to treat a health condition. These can include outpatient care, preventive services, mental health services, screenings, ambulance services, and some forms of medical equipment. It also covers some home and rehabilitative services, such as physical therapy (if authorized by a doctor).

When do you sign up for Medicare Parts A & B?

First, let’s review sign up rules for Part A. If you have retired, you must sign up for Part A when you turn 65. There is an open enrollment period that starts three months before the month you reach age 65 and extends three months past the month you turn 65, a total of seven months. Make sure you enroll on time; hefty penalties apply if you sign up late. Most people sign up for Part B at the same time they sign up for Part A – but there are exceptions if you are still working and covered by certain types of employer plans.

Individuals who don’t sign up for Part B when they are first eligible may pay a 10 percent penalty on the annual premium for each year that they delay enrollment. Based on your circumstances, that penalty can be harsh or not so harsh depending on your total income and savings. The question is, do you have to sign up for Part B at 65? Maybe not if you are still working.

Do I need to enroll in Medicare Part B if I’m still working?

If you are still working at 65 and your employer has 20 or more employees, you do not need to sign up for Part B right away because your employer’s group health plan will be the primary insurer. When you retire, you will have a special enrollment period of up to eight months to sign up for Part B, without penalty.

But if your company has fewer than 20 employees you should enroll in Medicare Part B when you are first eligible at age 65 because Medicare will be the primary insurer, which means it pays before your employer’s insurance pays. If you don’t enroll, your employer’s plan can refuse to cover you for services that Medicare would have covered. That means that you may have to pay for those services out of your pocket.

And when you do retire, you’ll need to add Part B within eight months of the earliest of either the end of your employment or end of your group health coverage. This enrollment option falls under one of the designated Special Enrollment Period offerings.

How much does Medicare Part B cost?

Costs of Medicare Part B depend on your total income as filed on your tax return two years prior. The higher your income, the larger your premium. This process is called “means testing.” If your income shows you have the means to pay more, a higher premium applies. The technical term is IRMAA or the Income-Related-Monthly-Adjustment-Amount.  The table below shows you 2019 premiums.

2019 Medicare Part B Premium Schedule

  • $135.50 per month, applies to singles with MAGI less than $85,001 and marrieds with AGI less than $170,001)
  • $189.60 per month, applies to singles with MAGI between $85,001 and $107,000, and marrieds with AGI between $170,001 and $214,000)
  • $270.90 per month, applies to singles with MAGI between $107,001 and $133,500, and marrieds with AGI between $214,001 and $267,000)
  • $352.20 per month, applies to singles with MAGI between $133,501 and $160,000, and marrieds with AGI between $267,001 and $320,000)
  • $433.40 per month, applies to singles with MAGI between $160,001 and $500,000, and marrieds with AGI between $320,001 and $750,000)
  • $460.50 per month, applies to singles with MAGI greater than $500,000, and marrieds with AGI greater than $750,000)

How it works: The IRS supplies your tax filing status, your adjusted gross income, and your tax-exempt interest income to the Social Security Administration for the purpose of calculating what your premiums will be.

If 2019 will be your first year on Medicare, your premiums will be calculated based on your 2017 modified adjusted gross income (MAGI).

When the Social Security Administration reviews your benefits application, it will add your adjusted gross income (AGI) together with your tax-exempt interest income to get an amount called the modified adjusted gross income (MAGI). This number is used to determine your Medicare Part B premium. If you are collecting Social Security the premium is deducted from your benefits. If you have not started Social Security you will receive a quarterly invoice for the premiums.

If you sold a home or business or had a large bonus, it may have boosted your income in a prior tax year, and that can result in increased Medicare Part B premiums a few years later. Fortunately, you may be able to appeal this increase (see below).

As you near retirement, sometimes there are ways to manage your MAGI to keep it from crossing into the next threshold. Managing MAGI means planning a few years ahead as to how much you will take out of an IRA or 401(k), and managing capital gains or losses as well as other types of investment income in a way that reduces the amount of total income that shows on your tax return.

Can I appeal a Part B premium?

Your premium amount is determined by your MAGI from your tax return two years prior. But what if your income is a lot lower the year you apply for Medicare Part B? There is a way to appeal the IRMAA premium and ask for a reduction. The seven valid reasons for having the premium reduced include death of a spouse, marriage, divorce or annulment, work reduction, work stoppage, loss of income from income-producing property, and loss or reduction of certain kinds of pension income. Work stoppage and work reduction are the most common reason for appeals by our clients.

Each year, the Social Security Administration sends out a notice regarding your upcoming Medicare Part B premiums, even if you haven’t yet claimed Social Security. If you think you are eligible for a premium reduction, you must appeal right away.

To learn more about health care costs in retirement check out our free recorded YouTube Class Planning for Health Care Costs in Retirement.

As with all topics related to health insurance and Social Security, and every other retirement planning related issue, it behooves you to become as knowledgeable about the rules as possible. Knowing the rules helps save you money. Here at Sensible Money, we know the rules. If you want to see how working with an experienced retirement planner can help, give us a call to set up a complimentary consultation.