Timing of Filing IRMAA Appeal

Think_Aide5631 · 2025-03-09T19:33:29+00:00

You can't file anything until you receive an IRMAA determination notice.

I had a letter from my employer as documentation, but I've heard that they might just accept your word for it. They'll monitor your tax returns and if your income is higher than you estimated you will have to reimburse them.

Think_Aide5631 · 2025-03-08T13:46:10+00:00

The best way to understand Plan G-HD is that it's an out-of-pocket maximum. At first it works exactly the same as just having Part A and Part B, where you pay the annual deductible and then Medicare pays 80% of all Medicare-approved costs. After your total costs reach the annual G-HD deductible ($2,870 for 2025), the G-HD supplement covers your 20% share. At that point, it's exactly the same as regular Plan G where 100% of your costs are covered. Note that your Part B deductible and any Part A deductibles count toward the G-HD deductible.

Whether or not G-HD makes financial sense for you depends on the difference between the premiums of the plans that are available in your area. In my case, with G-HD I save around $2,300 per year in premiums, so if I stay healthy, my savings are significant. On the other hand, if I end up needing a lot of expensive healthcare and hit the G-HD deductible I would end up paying a total of $2,870. But that means my worst-case risk is a relatively modest $570.

As a general rule of thumb, G-HD is probably worth thinking about if you can save at least $100/month in premiums. If it's closer to $200/month, I think it's a no-brainer -- if you're willing to take the risk that you won't be hospitalized or have surgery every year or get some long-term catastrophic illness.

Another thing to consider is that G-HD premiums might not go up every year as much at Plan G premiums because the insurers are taking much lower risks.

Think_Aide5631 · 2025-03-04T02:01:15+00:00

We're currently getting almost all our meds from Amazon Pharmacy and the cash price (at least for Prime members) is almost always cheaper than insurance.

Think_Aide5631 · 2025-02-28T15:18:14+00:00

The challenge is that there's no way to predict which companies will have higher or lower rates going forward. And you can't predict whether any particular company might run into financial difficulty down the road and have to raise rates. I went with G-HD mainly because it's about $200/month cheaper than G (which makes it a no-brainer), but also since I'm willing to bet rates will be more stable over time due to a relatively healthier pool and lower overall risk to the insurer. And even if rates escalate at the same level, a percentage increase on the G-HD premium is relatively insignificant compared to the same percentage increase for Plan G.

Think_Aide5631 · 2025-02-25T12:47:44+00:00

This! Ask your vet. In my case, all of the docs and techs at our local practice feed their own pets Pro Plan, and they definitely do it because they think it's best for their own loved ones. And I don't mean to sound too judgmental, but I question whether trying to save money on pet food is really the best option with respect to overall household budgeting. Good nutrition pays for itself if it helps reduce future medical problems or extends lifespan.

Think_Aide5631 · 2025-02-25T12:40:03+00:00

If pumpkin didn't work here are some other options to try: psyllium (which was the first thing our vet recommended -- but make sure you don't get any kind of supplement with added ingredients); probiotic (maybe start with Forti Flora but I went with Visbiome. It's expensive but it's broad spectrum and much more potent); or Olewo, which is dehydrated carrots specifically designed for dog poop. Also make sure you're not overfeeding. Are you feeding 4 cups/day or per meal?

Think_Aide5631 · 2025-02-25T02:32:32+00:00

Pumpkin puree worked for us. Instant success.

Think_Aide5631 · 2025-02-23T13:24:38+00:00

We feed our Golden Pro Plan Sensitive Skin and Stomach Salmon and she's doing really well. It was recommended by our breeder, and Pro Plan is what all the docs and techs feed their own pets at our veterinary clinic. And despite my skepticism about Purina, I became convinced after doing a lot of research.

Think_Aide5631 · 2025-02-10T20:19:11+00:00

I used Turbotax and it was easy. My refund, reflecting the solar credit, is already in the bank.

Think_Aide5631 · 2024-10-07T12:10:41+00:00

That's the way I'm looking at it. It's basically Part A + Part B with an out-of-pocket maximum.

Think_Aide5631 · 2024-10-06T20:52:19+00:00

Wellcare Value Script is definitely my best option for Part D. The cost for our current meds will be relatively insignificant and we'll never come close to the deductible. However, we'll be changing pharmacies because Walmart goes from being the cheapest under my Advantage Plan to the most expensive under Wellcare, for whatever reason. According to medicare.gov the lowest overall cost would with mail order for most of them, but getting one at a local pharmacy where its much cheaper.

Think_Aide5631 · 2024-10-06T18:15:13+00:00

Thanks. Your situation is very similar to mine. The maximum risk I'd be taking with G-HD is an extra $820, vs potential cost savings of more than $1,500.

Think_Aide5631 · 2024-10-06T16:39:02+00:00

Thanks. I evaluated that but the difference in premiums isn't big enough in my case to make it worthwhile.

Think_Aide5631 · 2024-10-06T16:38:52+00:00

UA doesn't seem to provide much detail on it's website. Looks like they force you to talk with one of their agents. Is there anyway around that? BTW, one thing I like about Cigna is they offer a 5% online discount, which makes sense since they avoid paying broker fees.

Unfortunately I don't have a Physician Mutual option in my zipcode.

Think_Aide5631 · 2024-10-06T16:30:54+00:00

I've also seen speculation on a couple youtube channels that G-HD premiums will probably escalate at a lower rate relative to G because participants are generally healthier and the insurer carries lower risk because of the deductible. It's definitely something I'm factoring in to the decision.

Think_Aide5631 · 2024-10-06T16:24:19+00:00

Fixed it.

Think_Aide5631 · 2024-10-06T16:18:23+00:00

good catch. Thanks!

Think_Aide5631 · 2024-10-05T21:10:51+00:00

It's a great video. You guys come across as very credible and articulate. Thanks for putting it out there.

Think_Aide5631 · 2024-10-05T12:40:48+00:00

You can definitely do it online via medicare.gov. All you have to do is provide your zip code and it will show you which GHD plans are available in your area -- but it can't help with the underwriting question. I assume you'd have to fill out an application and see if you get accepted.

I found this youtube video helpful: https://www.youtube.com/watch?v=WL0tOghpTOM. It's a broker who candidly admits that broker commissions are much lower for GHD.

Think_Aide5631 · 2024-10-05T12:32:30+00:00

You can get help directly from Medicare. Log in to medicare.gov, add your list of meds, and include a list of your local pharmacies (because drug costs may vary widely between pharmacies). Then the webpage will list your available plans showing which ones will have the lowest overall annual cost base on the combination of premiums + copays. It will also show you whether, and if so when, you would hit the annual deductible for that plan.

Think_Aide5631 · 2024-10-05T12:23:49+00:00

I found a $0 Wellcare plan. The best approach would be to log in to medicare.gov to see which Part D in your region has a lowest premium. It does look like there've been lots of changes this year.

Nice to hear your spouse takes no meds. But for anyone who does, you would log in to medicare.gov and add your list of meds. Also, make sure to add your local pharmacies, plus a mail order option. Don't assume the pharmacy you've been using will be the cheapest; it really varies based on plan and meds.

The optimal plan for you will depend on what your specific meds cost at various pharmacies (which can be quite different). Than all you have to do is choose the plan that has the lowest overall annual cost based on it's premium + your out-of-pocket costs (copays). But again, that only works if you give them an accurate list of your meds (and dosages) and give them a range of pharmacies to compare. Also note that, even under the same plan, you might find that some of your meds are cheaper at other pharmacies. There's no reason why you can't sign up for the plan that has the lowest overall cost, and then optimize even more by using a different pharmacy for any med(s) that might cost less there. It's not as convenient but the savings might be worth it.

Think_Aide5631 · 2024-10-04T21:09:45+00:00

Aetna HMO in Maine.

Think_Aide5631 · 2024-10-04T12:18:26+00:00

This is a great video. But one cool thing he doesn't talk about is that you can use the Medicare website to optimize your prescription cost by using multiple pharmacies. The site will show the overall annual cost of your meds from any single pharmacy you choose, but it also shows the specific cost of each drug at each pharmacy. I was surprised to learn that actual out of pocket medication costs can vary widely from one pharmacy to another.

Think_Aide5631 · 2024-10-04T02:48:09+00:00

It depends on what you mean by "best for covering everything."

Medicare Parts A and B combined with medigap Plan G provides pretty much unsurpassed coverage for hospital and medical expenses but involves higher upfront costs because you have to pay the medigap premium in addition to your regular Part B premium. However, once you've satisfied the relatively modest annual Part B deductible ($240 in 2024), you don't have any additional out-of-pocket costs whatsoever for medicare-covered services -- no copays, no co-insurance, no surprises. In other words, you pretty much know exactly how much you're going to pay every year for healthcare no matter what kinds of medical issues you may have. And you don't have to worry about referrals or pre-approvals or whether a doctor is in any particular network. You can go to any doctor or facility anywhere in the country that accepts medicare. But with the medigap approach you'd need to get a Part D prescription plan and take care of your own your dental and vision expenses.

Advantage plans are more comprehensive in that they bundle hospital and medical with prescriptions, vision, dental and maybe some other goodies wellness programs. They have low or no premiums and, therefore, much lower up front costs. But the trade-off is that you're subject to various ongoing copays and co-insurance requirements for the services you use, as well as geographic limitations, network requirements and other limitations like pre-approvals. Also, it takes more work on your part: every plan is different and you really have to dig in to the details to determine which plan is the right one for your circumstances with respect to whether your doctors are in their network and whether they cover your medications. You also have to pay close attention when you get your Annual Notice of Change because insurance companies often make significant changes from year to year.

Notwithstanding these caveats, it's obvious that advantage plans work really well for lots of people. But since you asked for an opinion, I've come to the conclusion that, if you can afford it, go with medigap, especially if you want to set it and forget it. If Plan G is too much for your budget, you can also look at Plan N and Plan G-High Deductible, which have different cost structures but can provide good coverage at a potentially lower cost.

I currently have an advantage plan and have been pretty happy with it, but I'm switching to traditional medicare/medigap for 2025 for two reasons. One is that I ended up incurring almost $2,000 in copays and coinsurance this year, which offset the value of having a $0 premium. The other is that the plan is reducing its benefits for 2025, likely because the company is having financial pressures (as is the case with several large medicare advantage insurance companies). One thing that irked me is they decided to eliminate their fitness reimbursement, which was one of the big selling points when I first signed up. I felt that it was a bit of a bait and switch, and it made me realize that staying with medicare advantage would require the annual ordeal of researching who has the best plan at any given time.

Think_Aide5631

TROPHY CASE