What Makes Medicare Different for Everyone?

One of the ways that Medicare can be different for some is with the cost of the Medicare Part B premium. The Part B premium has a standard rate. If you have a higher income, you will pay an Income Related Monthly Adjusted Amount, also known as an IRMAA. Most people will pay the standard rate. However, if your modified adjusted gross income that was reported on your tax return from two years ago is above a certain amount, you will pay the standard rate plus the IRMAA. If you do not pay your IRMAA you could lose your Medicare coverage.

This amount generally changes every year. You can find the current IRMAA amounts on the Social Security website.

Medicare Part D and IRMAA

Medicare Part D is also subject to the IRMAA depending on your income, again from your reported income from two years ago. You will pay the IRMAA in addition to your Medicare Part D premium, whether you have a stand-alone Part D or a Medicare Advantage Plan with Part D.

The Part D IRMAA is paid directly to Medicare and not to your plan or employer. If you do not pay the Part D IRMAA, you will lose your Part D prescription coverage.

If your income has gone down, depending on specific circumstances, you may be able to get a new decision about your IRMAA.

If you are subject to an IRMAA, you will receive a notice from Social Security.

Medicare Late Enrollment Penalty (LEP)

Another way Medicare can be different for some is if they have a Late Enrollment Penalty (LEP) on their Medicare Part B premium. In most cases, this penalty will be for the rest of the time that you have Medicare. This is not a one-time penalty. If you have Medicare due to disability, your penalty will go away when you turn 65.

How is the Part B penalty calculated? For each 12-month period that you delay Part B enrollment you will have to pay a 10% premium penalty unless you are eligible for the Medicare Savings Program (MSP) or you have active job-based insurance through yourself or your spouse with more than 20 employees.

There is also a penalty for a late enrollment in a Medicare Part D plan. If you delay enrollment, you will pay a LEP of 1%, of the national base premium, in addition to your Part D plan premium. The national base premium changes every year and currently for 2021, it is $33.06. This penalty is assessed for every month that you went without a Medicare Part D or creditable coverage. Creditable coverage is coverage that is as good as or better than the Medicare Part D coverage. If you receive assistance through Social Security’s Extra Help Program, also known as LIS (Low Income Subsidy), have creditable drug coverage or prove that you received inadequate information about your drug coverage being creditable, you may not have to pay the LEP.

Like the Part B LEP, this is not a one-time penalty. The LEP for Part D, is also a penalty that you will have for as long as you have Medicare. If you are under 65 and have Medicare due to disability your LEP will go away when you turn 65.

Medicare for Those Under 65 with Disability

How does Medicare coverage for those under 65 with a disability work? Like the Initial Enrollment for a person eligible due to turning 65, there is a seven-month period to enroll in Medicare. The difference is that the enrollment period for those on disability surrounds the 25th month of disability. You will automatically receive your Medicare card and packet three months before your 25th month of disability. Your effective date will be the 1st of the month, that is your 25th month of disability. Generally, you should not delay Medicare Part B unless you have job-based insurance that pays secondary to Medicare (employer insurance with more than 20 employees). If you delay without job-based insurance as previously mentioned, you may incur a penalty. If you do not receive your card and packet, contact Social Security.

Railroad Retirement

Another scenario where Medicare will be different for some is those with Railroad Retirement.When a person who is receiving Railroad Retirement benefits becomes eligible for Medicare, instead of enrolling in Medicare through Social Security their enrollment will be processed through the Railroad Retirement Board (RRB). They would be automatically enrolled in Medicare Parts A & B.

If the person is not collecting Railroad Retirement benefits when turning 65, they should contact the Railroad Retirement Board to enroll. The RRB will collect the Medicare premiums and the Medicare Part B premium should be automatically deducted from their monthly check. Additionally, the doctor’s and providers will send claims to the Railroad Medicare Part B Claims Contractor selected by the RRB. It is important to make providers aware that the Medicare is Railroad Medicare. The Medicare card will look different. It will have RAILROAD RETIRMENT BOARD labeled at the bottom of the card and an insignia at the top left, for the RRB. Finally, if you are under 65 and disabled, you will have different eligibility criteria depending on how the RRB classifies your disability.

For additional information go to www.rrb.gov.