This week’s questions from Theresa
I currently have XYZ Medicare Advantage Plan HMO, and my monthly premium is between $35 and $40/month. I was just approved for PACENET. Please explain to me how I can get a refund of Medicare Part B. Do I have to change to a $0 plan or can I stay where I am?
Answer
PACENET
Sorry I had to leave out the name of the company Theresa is on. I’m not allowed to specifically mention them in public forums or advertisements.
That’s great you were approved for PACENET! It can save seniors literally thousands of dollars by eliminating deductibles and high costs of prescriptions in the Donut Hole, as well as ensuring maximum co-pays of $9 for generic and $15 for brands name medications.
Before I start answering the questions specifically, it’s important I mention the income limits for PACENET have been increased. They are now $35,282 for an individual and $45,064 for a married couple. My figures are higher than what’s published on the state’s website because the amount people pay for Part B isn’t included, which makes my numbers accurate. When calculating, add gross Social Security to any other taxable income you receive from pensions, wages, investments, etc. If you fall under the above figures, you qualify. And keep in mind assets are never considered when determining eligibility. If you have property, stocks, bonds, 401K, cash in the bank, etc., only your past year’s income matters. If you want to make it simple, email me a copy of your 1040 with the Social Security number blacked out and I can determine if you qualify or not within a couple minutes and even do the application.
Limited $0 Premium Plans
You can only get a refund of your Medicare Part B premium by enrolling in limited $0 premium plans and would not be eligible if you stayed on your current plan. Another agent or I can help you choose the best $0 plan and those on PACENET can enroll in any Advantage Plan all year round. However, not all plans with $0 premiums that provide a refund are the same. Not even close! We have a client who unfortunately was conned into taking a $0 plan that had 20% coinsurance for an outpatient surgery compared to the $200 on the plan we had advised her to choose. You can imagine her panic when she got a $6,600 bill for a pacemaker replacement procedure instead of the $200 it would have been. She had no choice but to pay it.
For most people, the maximum amount of the Part B premium that can be refunded is $50 per month. There are a couple of plans that offer a few dollars more, but the co-pays on those are so much higher, we would never recommend them to our clients. In addition, those endless TV commercials using washed up athletes or actors as spokespeople are extremely misleading when they claim you can get up to $170 per month back. The goal is to get you to call to see if you can get the refund, which I estimate only 10% of Pennsylvanians over the age of 65 do. The other 90% will be told, “I’m sorry, you don’t qualify for the $170. But tell me what Medicare plan you have now to see if I can save you some money.” It’s a bait and switch, boiler room style of selling which I find abhorrent. These agents are never local, and you will more than likely never talk to them again if they convince you to enroll. This is exactly how our client ended up paying $6,400 more for her surgery and she never even got a copy of her application or the agent’s name! Unfortunately, with the amount of commission on the line for Advantage Plan HMO’s and PPO sales, it’s probable that the person on the other end of the 800-phone number could care less if the plan he or she is attempting to sell is a better value than someone’s current plan.
Contact Us!
If you want to ensure enrollment in the best possible plan occurs now and every year in the future, call us. Even if your currently Advantage, Supplement, Part D, or ACA/Pennie plan is one we recommend and best for you in 2022, you can become a non-commissioned client and receive our recommendation letter every Annual Election Period letting you know if staying on the same plan or moving to another is the best option for the upcoming year. This is especially important with Advantage, Part D, and ACA plans as they can have significant changes in benefits from year to year.
Thank you!
If you have any questions or concerns regarding this column topic, or would like to make an appointment for a no-cost consultation, please feel free to give us a call – we would be happy to help. I’d like to remind everyone that I do a live call-in talk show called Medicare A to Z every 1st and 3rd Monday of the month on WMBS Uniontown, 590AM and 101.1FM, from 1 to 3 PM. You can listen in on their website, wmbs590.com.
Erie County Area
1105 West 12th Street, Suite – A
Erie, PA 16501
Phone: 814-920-5275
Fax: 814-920-5276
Fayette/Westmoreland County Area
121 North Pittsburgh Street
Connellsville, PA. 15425
Phone: 724-603-3403
Fax: 724-603-3402
Pittsburgh Area
21 Yost Blvd., Forest Hills, PA 15221
Mailing Address: 128 Forest Hills Plaza, Pittsburgh, PA 15221
Phone: 412-349-8818
Fax: 878-302-3149
Albuquerque/Santa Fe, New Mexico Area
821 Coors Blvd. NW
Albuquerque, NM 87121
Phone: 505-200-0069
Fax: 505-200-0073
Serving These Areas
We proudly serve the health insurance and Medicare needs of the following Pennsylvania areas: Connellsville, Uniontown, Greensburg, Mt. Pleasant, Scottdale, Irwin, N. Huntingdon, Murrysville, Monroeville, Plum, Lower Burrell, New Kensington, Pittsburgh, Plum, Oakmont, Penn Hills, Forest Hills, Wilkinsburg, East Liberty, Lawrenceville, Bloomfield, Natrona Heights, Leechburg, Washington, Morgantown WV, Latrobe, Monnessen, Jeanette, Erie, Edinboro, Northeast, Girard, Fairview, Union City, Harborcreek, Corey, Meadville, Waterford, Ligonier, Kittaning, Somerset, Waynesburg, Fayette County, Westmoreland County, Armstrong County, Butler County, Somerset County, Erie County, Crawford County, Venango County, Allegheny Valley, Pennsylvania
We proudly serve the following New Mexico areas: Albuquerque, Rio Rancho, Sante Fe, Bernalillo, Belen, Los Lunas, Espanola, Moriarty, Corales, Tijeras, Cedar Crest, Edgewood, Soccoro, Sandoval County, Sante Fe County, Bernalillo County, Rio Arriba County, Valencia County, Soccoro County, New Mexico
Not affiliated with the U. S. government or federal Medicare program.
We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.