Joanne: One of the most frustrating things people encounter when it comes to Medicare is finding clear answers to their most common questions. To help solve this, in today’s episode, we’re going to answer several questions recently asked by our podcast and TikTok audience. We hope this helps you find answers to some of the Medicare questions you might have.

Cameron: Before we dive in, my name is Cameron Giardini, and together with my co-host, Joanne Giardini-Russell, we operate Giardini Medicare, an independent insurance agency based in Southeast Michigan. Although we're based in Michigan, we work virtually, helping consumers in about 15 states find the right Medicare coverage for them.

If we don’t work in your state, we’ll connect you with another trusted independent agent who can help you find the coverage you need. As a brief overview of today’s episode, we’ve gathered questions directly from you, our audience, that we’ll be answering today. These questions include: What happens if you enroll in Medicare but decide to go back to work? What changes are in store for Medicare Advantage in 2025? And more. If you have specific questions you want to ask, the best way to do so is by emailing us at info@gmedicareteam.com. Your question might even be featured in a future episode to help others.

Joanne: Let’s dive into the first question. What happens if I enroll in Medicare and Medigap, but later get access to employer coverage and want to drop Part B?

Let’s imagine you’re not working when you turn 65, so you decide to enroll in Medicare Part A and Part B, along with a Medigap plan and a Part D prescription drug plan. Then, at age 66, you get an amazing job offer that includes employer health insurance. Now, you have a decision to make.

Option 1: You could choose not to enroll in your employer’s health plan and continue with your Medicare and Medigap coverage. 
Option 2: You could cancel your Medicare Part B and switch to your employer’s health insurance.

However, remember that dropping Part B would also mean canceling your Medigap plan.

To cancel Part B, you’ll need to complete CMS Form 1763, indicating that you want your Part B to end. You can submit this form to your local Social Security office by fax or in person, but be aware that the Social Security Administration may ask for a brief phone interview to ensure you understand the consequences of canceling Part B.

Now, what happens when you want to re-enroll later? Suppose a few years down the road you retire again and want to restart Medicare Part B. Because you had active employer coverage, you can re-enroll using a Special Enrollment Period. You’ll need to provide proof of employer coverage using Form CMS-L564, which we’ve discussed in detail in other episodes. When you re-enroll, you’ll likely get a new Medicare Part B effective date, even though you had it before. That can be confusing for some.

Cameron: At that point, if you’re planning to re-enroll in Medigap coverage when your Medicare Part B is reactivated, it’s essential to understand the Medigap Open Enrollment Period. According to Medicare, this is a one-time enrollment period that doesn’t repeat annually. Your six-month Medigap Open Enrollment Period starts the first month you have Medicare Part B and are 65 or older.

This Medigap OEP is critical because, for most people, it’s the only chance to enroll in a Medigap plan without answering health questions or facing potential denials or higher premiums due to pre-existing conditions. However, since this would be your second time enrolling in Medicare Part B, Medigap companies may not provide another Medigap Open Enrollment Period. While some companies still do, it’s not guaranteed.

If you can’t find a company that offers open enrollment, you may still qualify for a guaranteed issue right when leaving employer coverage, though this doesn’t apply to all Medigap plans like Plan N. You can always apply for any Medigap plan using medical underwriting, but your approval will depend on your health.

So, if you’re considering dropping Part B coverage along with Medigap or Medicare Advantage, it’s crucial to consult with an independent broker to determine your next steps and assess whether it makes sense for your situation.

Joanne: And remember, rules can change. We’re talking about this in 2024, but companies' policies may evolve. So, if you retire again in five years, it’s tough to guarantee what your options will be.

Cameron: The key point is that the Medigap Open Enrollment Period is a one-time opportunity. If a company says “no” to open enrollment later, it’s within their rights.

Joanne: Let’s move on to question number two. Do I need to enroll in a Medicare Supplement or Medicare Advantage plan at the same time I apply for Medicare?

The short answer is no, but let’s dive into the details. We’ll focus on someone enrolling at age 65 who is not yet collecting Social Security benefits.

Original Medicare consists of Part A and Part B. When you turn 65, you have a seven-month Initial Enrollment Period to sign up for Medicare Part A and Part B. This period starts three months before your 65th birthday, includes the month you turn 65, and extends three months after your birth month. For example, if you turn 65 in February 2025, you can enroll as early as November 1, 2024, and your Initial Enrollment Period will end in May 2025.

If you want your Medicare coverage to start on February 1, you should enroll between November and January. Keep in mind that if you’re born on the first day of any month, your Initial Enrollment Period starts a month earlier. If you’re already collecting Social Security benefits, you’ll be automatically enrolled in Part A and Part B about three months before your 65th birthday.

Cameron: Medicare Advantage plans follow the same Initial Enrollment Period timeline as Original Medicare, but you’ll need your Medicare ID number to enroll. Since you can only get this number after applying for Medicare Part A and Part B, you shouldn’t try to apply for both things simultaneously.

For example, you could apply for Original Medicare in November, and once you receive your Medicare ID card, you can enroll in a Medicare Advantage plan in the following weeks. Both would be effective on February 1.

Joanne: Medigap, also known as Medicare Supplement Insurance, works a bit differently. Many Medigap companies allow you to enroll in a plan up to six months before you turn 65, even without your Medicare number. If your coverage needs to start on February 1, you could apply for Medigap as early as August. You would then enroll in Medicare Part A and Part B during your Initial Enrollment Period, which starts in November.

As for Part D prescription drug coverage, the enrollment timeline aligns with that of Medicare Advantage plans. You would apply for a Part D plan after receiving your Medicare ID number during your Initial Enrollment Period.

It may seem complicated, but it’s really about taking it step by step.

Cameron: Exactly. Don’t get overwhelmed thinking you need to have Medicare Part A, Part B, and your Medigap or Medicare Advantage plan figured out at the same time. Focus on enrolling in Medicare first, then take the next step to determine the right coverage for you. And, of course, using a broker helps simplify the process.

Joanne: Many people also worry that they need to inform Medicare (meaning the government) about which Medigap or Medicare Advantage plan they want. But Medicare doesn’t care! They’re two separate transactions.

Cameron: Yeah, if you tell Social Security, “Hey, I want this Medicare Advantage plan,” they’ll probably just look at you funny and say, “Okay, whatever.”

Joanne: Moving on to question three: Is there a maximum out-of-pocket limit for Medicare Supplement Plan N?

The answer is no. While Medicare Advantage plans have a maximum out-of-pocket (MOOP) limit, Medigap plans like Plan N do not. However, Medigap Plan N does require you to pay up to $20 for doctor office visits and up to $50 for emergency room visits, though the ER copay is waived if you’re admitted to the hospital. Additionally, Plan N doesn’t cover Part B excess charges.

There’s no limit on how many copays or excess charges you can incur in a year with Plan N. If you visit the doctor 100 times, you could pay a $20 copay each time, leading to substantial out-of-pocket costs.

However, some Medigap plans, like Plan K and Plan L, do have maximum out-of-pocket limits. For example, in 2024, Plan K has a maximum out-of-pocket limit of $7,060, and Plan L has a limit of $3,530.

Cameron: When considering a Medigap plan, if you’re looking for a limit on your out-of-pocket spending, it doesn’t have to be through Medicare Advantage. Plan G, for instance, effectively functions like a maximum out-of-pocket plan because, after you pay the Part B deductible (currently $240 in 2024), you have no additional out-of-pocket costs for Medicare-covered services.

Joanne: Question number four: Will Medicare Advantage plans be required to send a list of unused benefits to enrollees in 2025?

Yes, starting in 2025, Medicare Advantage plans will be required to notify enrollees about any unused supplemental benefits. Insurance companies must send a notice listing any supplemental benefits that haven’t been used during the first six months of the year (from January 1 to June 30). These notices will be sent between June 30 and July 31 each year.

This rule ensures that enrollees are aware of the benefits they’re entitled to and that those benefits are being used.

Cameron: A lot of people don’t even realize they have these benefits, like dental coverage, gym memberships, or over-the-counter allowances. That’s why it’s important to make sure you’re fully utilizing your plan's offerings.

Joanne: Finally, question number five: Is your income re-evaluated annually for an IRMA surcharge?

Yes, your income is re-evaluated annually to determine if you’ll need to pay an Income Related Monthly Adjustment Amount (IRMA) surcharge. IRMA is based on your income from two years ago. For example, your 2024 IRMA surcharge is determined using your 2022 income. If your income exceeds the thresholds, you’ll have to pay a higher premium for Medicare Part B and Part D.

However, you can appeal the IRMA surcharge if your income has decreased due to life-changing events like retirement. You may need to appeal more than once if your income fluctuates over time.

Cameron: Let me give an example. In 2022, let’s say your income was $200,000 as an individual, and in 2023, your income remained the same. Then, in 2024, you retire, and your income drops to $70,000. When you apply for Medicare in 2024, your IRMA determination will be based on your 2022 income, so you would face an additional surcharge because your income exceeded the $103,000 limit for individuals.

However, since your income has dropped due to retirement, you can appeal this surcharge, and your Part B premium could be adjusted down to the standard rate of $174.70 per month. But when 2025 comes around, the Social Security Administration will again look at your income from two years earlier, which would be your 2023 income of $200,000. In this case, you might receive another determination that requires you to pay an IRMA surcharge in 2025.

Once again, you can appeal the surcharge due to your lower income from retirement, but keep in mind that this re-evaluation process happens every year. Hopefully, once your income is consistently lower, you won’t have to deal with the IRMA surcharge in future years.

Joanne: So, to summarize: Yes, your income is re-evaluated annually, and yes, you can appeal the IRMA surcharge if your income has decreased. This process might repeat over several years, especially if your income fluctuates. As always, if you’re dealing with this situation, be sure to reach out to us or another expert for help navigating the appeal process.

Cameron: At the end of the day, everyone’s Medicare situation is unique. If you have any specific questions related to your Medicare, don’t hesitate to send us an email at info@gmedicareteam.com or listen to more of our podcast episodes to learn even more. And as always, please leave us a review on your podcast app and subscribe so you can listen to future episodes.

You can find even more Medicare content from us by searching “Giardini Medicare” on YouTube and TikTok. Lastly, if you need personalized help, feel free to give us a call at (248) 871-7756. Thank you, and have a great day!