D E PA R TM E NT S PA R TN E R
I N
M E D I C I N E
S P OTLI G HT
Heading toward 65 WHAT PHYSICIANS NEED TO KNOW ABOUT MEDICARE ENROLLMENT By Mary Jo Heins, independent Medicare insurance agent and former medical practice manager Physicians are Medicare insiders when it comes to the workings of Medicare billing, coding and coverages. All practice staff want to become well-versed in Medicare idiosyncrasies via education and research, not billing denials.
1 Size of the employer group If an individual is on an employer group health insurance plan with 19 or fewer employees on the plan, Medicare is primary and the employer plan is secondary.
Likewise, being educated regarding Medicare enrollment will save us from denials of coverage. As I’ve guided hundreds of people on their Medicare journey, I’ve found several recurring Medicare idiosyncrasies to be central to the conversation with physicians and other high-income individuals, as well as billing departments.
Relevant link: https://tinyurl.com/2v4etbhr Let’s flesh this out. A 65-year-old sole practitioner (only six people on the health insurance plan) could have their health insurance carrier say “Due to the size of your practice, we are secondary. Medicare is primary. Oh, you don’t have Medicare? Well then, we are secondary to you as a self-pay.” This is the letter of the law, though I do not know of specific instances where insurance carriers have taken this hard line. In any case, why risk the possibility? Also, Medicare could impose a 10 percent late enrollment penalty.
TIME IS FLYING
DON’T WAIT UNTIL THE LAST MINUTE TO WORRY ABOUT YOUR HIPAA PROGRAM Not sure if your current compliance program meets annual HIPAA requirements? What are you waiting for! Schedule a 20-minute consultation with one of our HIPAA experts today to see what key elements you might be missing and how Abyde can help get you up to speed in no time! VISIT ABYDE.COM/HIPAACONSULTATION TO SCHEDULE
800.594.0883 info@abyde.com
2 0 C O LO R A D O M E D I C I N E
PROUD PARTNER OF
2 RMAA (income-related monthly adjustment amount) – Medicare premiums vary by income Medicare Part B and Part D premiums are tied to your adjusted gross income (AGI). It is a two-year look back on AGI, which is line 11 of your 1040 income tax return. AGI includes wages, capital gains and rental income and is significantly higher than taxable income. Every November, Social Security sends notification of the new year’s premium based on the AGI from your income tax return two years prior. Relevant links: https://tinyurl.com/yxr76tbs https://tinyurl.com/yuwzuf5z What does this look for high-income individuals? If your AGI for 2019 was more than $500,000 on an individual return or more than $750,000 on a joint return, your Part B premium would be $504.90 per month. This may be lower than what you are paying for the health insurance premium through your practice if your expenses are allocated against your draw from the practice. The kicker is Part D, Rx coverage. The Part D IRMAA for the individual referenced above is $77.10 per month. So, in addition to the Part D insurance premium, which may be only $15-$20 per month, you pay Medicare $77.10, bringing your total Part D “premium” payment to roughly $100 per month. For individuals on no chronic medications or a few generics, this premium price tag is disconcerting and calls for discussion of alternative strategies.
