Establishing Your Correct Medicare Premium

Public Benefits | Feb 1, 2010 | Hook Law Center

A recent Wall Street Journal article discussed Medicare Part B premiums for higher-income beneficiaries. Medicare Part B covers doctor visits and outpatient services, and the basic Part B premium is $96.40 per month in 2009.

Higher-income Medicare beneficiaries have had to pay higher monthly Medicare Part B premiums since 2007, based on their “modified adjusted gross income” (MAGI), which is adjusted gross income plus tax-exempt interest income. For individuals with an MAGI over $85,000 per year, or couples with an MAGI over $170,000 per year, the premiums range from $134.90 to $308.30 per month per beneficiary. The Social Security Administration (SSA) has published a list of premiums by income and tax filing status in SSA Publication No. 05-10161.

Unfortunately, the Social Security Administration, which also handles Medicare enrollment, is not able to ask the Internal Revenue Service for the income data required to determine the appropriate Part B premium until an individual is enrolled in Social Security or Medicare. Mark Lassiter, a spokesman for the SSA in Baltimore, recently answered a question from a 67-year-old woman who has been paying the appropriate premium for herself based on her husband’s and her joint MAGI. Her husband recently turned 65, and he was informed that his premium would be the basic $96.40 per month. Mr. Lassiter said that when the “husband first files for Social Security at the point of or shortly before their Medicare eligibility age, there is a lag in our ability to determine the appropriate premium.” Social Security will adjust the premium retroactively after it gets the income information from the IRS; this adjustment may not occur for two to three months. The husband’s premium will eventually be the same as the wife’s premium, and the husband’s Social Security benefits will be adjusted to account for retroactive premiums due. Mr. Lassiter also stated that the husband should have received a letter from SSA advising him of the calculations for higher-income beneficiaries, and that the SSA would contact the IRS for income information.

If a beneficiary’s MAGI falls after the premium is set, SSA may adjust the premium if the income was reduced because the individual married or divorced, if the beneficiary’s spouse died, if either spouse quit working or reduced work hours, if either spouse lost income from property because of a disaster or other event beyond their control, or if either spouse’s benefit from an insured pension plan stopped or was reduced. The SSA has determined that alleged victims of criminal theft or an investment scam (such as alleged victims of Bernard Madoff’s Ponzi fraud) may be able to get their Part B premiums reduced.

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