Kevin Knauss: Health, History, Travel, Insurance
Posts focusing on Medicare Parts A, B, C and D, Medicare Advantage, Supplements, changes in benefits, enrollment.
You may have to pay an Income Related Monthly Adjustment Amount (IRMAA) if your income is greater than $109,000 for a single adult or $218,000 for joint tax filers. The income is the Modified Adjusted Gross Income which is comprised of your AGI plus tax exempt interest. The income year is 2 years prior. For 2026, Social Security uses the 2024 tax return to determine if you are subject to the IRMAA.
There are many different rules to determine if assets and personal property are exempt or counted. It quickly gets complicated if the applicant is married, but their spouse is not applying for the Medi-Cal extra help.
Medicare allows alternate cost structure designs. These designs must be as good as the standard cost structure. One alternate structure only has drugs in tiers 3, 4, 5 subject to the pharmacy deductible. Generic drugs, tiers 1 and 2, are not subject to any deductible. The plan member goes straight into a set copayment or coinsurance for the prescriptions.
When we extrapolate the savings to an annual basis, Plan N rates are $214 lower than Plan G by age 68. This means that at age 68, an individual could incur ten $20 office visit copayments during the year and still pay less than Plan G (annual premiums plus copayments.) The individual could also have two emergency visits at $50 and five office visits at $20 and still pay less money.
Under the leadership of Dr. Oz, Medicare is rushing to implement Artificial Intelligence (AI) to review, authorize, or deny health care services received by Original Medicare beneficiaries. The primary goal is to save money not necessarily improve patient outcomes. CMS calls the new AI health care initiative “Wasteful and Inappropriate Service Reduction (WISeR) Model.
The monthly insurance premium for Part B of Medicare is $185 for individuals who had earned less than $106,000 or $212,000 for a married couple filing a joint federal income tax return. As the household income increases, the insurance premium for Part B increases. For individuals who earned over $500,000, the Part B premium is $628.90 per month for 2025. Remember that the monthly premiums are per person. If a married coupled earned over $750,000 and are eligible for Medicare, each person will pay $628.90 for Part B.
Regardless of the error, Medi-Cal updates the Covered California income section denying the non-Medicare spouse their private health insurance with the subsidy. The spouse is determined Medi-Cal eligible and their health plan is terminated.
Social Security recipients who have a Part D drug plan need to review their 2025 monthly premium rate. The changes to the Part D drug plans with a lower maximum out-of-pocket amount has forced many Part D plan sponsors to raise their monthly premiums. Rate increases of $30 to $50 per month is not uncommon.
The impacts of so many Medicare plans not paying an agent commission will suppress the number agents who are willing to assist enrollments for no compensation. In other words, some Medicare beneficiaries may have a tough time finding local agent help to evaluate their Medicare plan options.
Other plans may have an out-of-network deductible of $500 to $750+. The out-of-network deductible must be satisfied before the plan begins to share in the cost of the health care services or out-of-network services.
