I think maybe the insurance people in your doctor’s office are doing things wrong. I’ve been on Medicare (with a supplement plan) for over 7 years and have paid zippo for all sorts of tests. I have a hard time believing that if you were diagnosed with a Vitamin D deficiency they wouldn’t pay for a Vitamin D level test. I have Afib, am on a blood thinner, and get my INR checked every six weeks with nary a problem.
I go to a big clinic with lots of good insurance people - though when I was on insurance through work we did have some problems with payments denied from by them, from putting the wrong code in.
I agree. Ask the dr’s office to resubmit the order with the correct coding and then have the lab resubmit the claim. No way should you be paying for those very reasonable labs.
I would speak to the doctor’s office and or/an advocate - but I think that means the only way they will cover a Vitamin D level test is if you were having signs/symptoms of a deficiency now or at least recently, not several years ago
I suspect you are right. The $330 isn’t a hardship for me; my concern is more about what this means for my care going forward.
It is a large (fast-growing and popular practice started by one doctor that we’ve been happy with for 8 years) professional practice who say they have lots of Medicare patients. Since the lab work was done just 2 weeks after I started on Medicare, I’m hoping-or at least willing to believe-the lab PathGroup was possibly behind in switching over their coding/insurance info, and that complicated things. Further, Medicare initially showed my old employer plan as primary, which we resolved quickly over the phone with Medicare, but that may have added further complexity/explanation.
That said, still a bit of mystery why most tests approved but four were not.
I had the same issue. Many months later the echoes are still reverberating thriugh who didn’t get paid for what. Dumb.
I know I’m preaching to the choir but: We need a single payer, nationwide healthcare system that is the same all encompassing care for everyone. Medicare, the way it’s done now, sucks and depends way too much on for profit private insurers. I have been pretty much boxed into an “advantage” plan i.e. privatized medicare. The whole county by county crap has screwed me over and out of a medigap plan. It should not cost so much to have a medigap and plan D and they should cover the medications you take full stop.
I don’t know if this one has been addressed upthread.
I’m reading that the capital gains you realize when you sell a home will be taken into account when Medicare calculates your deductions for Part B, and that is NOT appealable with an IRMAA application for reconsideration. You can appeal when you have a life-changing event, like retirement, that reduces your income. But you can’t appeal capital gains profit from home sales.
Here in California, the gain might be considerable if you’ve owned your home for decades, and Social Security/Medicare will assume you made a buttload of money during the year of sale and your Part B might go through the roof. Yay.
Does this apply if you roll it over to a new house? As far as income taxes are concerned, it’s not a capital gain .
I emailed Ariana with this question, but so far, I don’t think that rolling your profit over into the purchase of a new home will help. I read somewhere that in 1997 this exception was ended for homeowners. But I’ll also ask Schwab to see if this is something they can advise on.
According to this it appears that only the amount of capital gains that exceeds the exclusion ($250K individual, $500K for a married couple) will affect the IRMMA. This exclusion replaced the deferred gain rollover in 1997 - which only deferred taxes if you bought a house that was equally or more expensive.
Yes, that’s my understanding as well. As I said, if you’ve owned a home in California for a long time, your realized capital gain might be well above $500K. And it looks like Social Security will deem that all that gain is income to you in the year of sale and jack up your deduction for Part B accordingly.
And I keep reading articles asking why boomers are staying put in their too-large homes in retirement rather than moving to smaller quarters. This Medicare Part B issue, the capital gains tax on the profit from your home sale, the California homeowners insurance meltdown, the 6% realtor’s fee, and in our case a sewer lateral repair requirement before home sale, might be why!
When I first went on Medicare, right after I retired, they computed the Part B cost based on my work income and it was high. It eventually went down though.
My gain would be a lot more than $500K, not that I’m complaining. The tax on the excess is a lot more of a worry than Part B, not that I’m complaining. On the bright side, the 6% reduces your gain.
We have a lot of geezers like me in our neighborhood for this very reason, and my old boss who has renewed his real estate license confirms that it is an issue.
Since the IRMAA is recalculated every year, IF the home sale capital gains above the exclusionary threshold count THEN your Part D & B would jump for one year then go back down the next year.
So yes, maybe an extra $12K for one year.
Seems kind of stupid to live in the wrong house paying more for HVAC, property taxes, insurance, etc., year after year after year to avoid that one-time expense.
It’s even stupider if you could reinvest the house sales proceeds at a better rate of return than the current rate of local real estate appreciation.
IRMAA is also calculated 2 years in arrears, so a 2024 house sale would affect your 2026 IRMAA. Giving you plenty of time to budget accordingly. Or have the investment results cover the IRMAA.
The extra that you play for medical pales in comparison to the capital gains tax which is the real reason people are holding onto the homes.
A couple of articles in the local birdcage liner shine a spotlight on a “feature” of Medicare Advantage. There’s a compensation dispute between the area’s largest health provider organization and a major insurer, and if it’s not resolved by 1 March the provider will be dropped from the insurer’s network. Which means that thousands* of subscribers (including Medicare Advantage subscribers) will need to:
- Find another provider in a shrunken network, many of whose members are not taking new patients and/or have long lead times, or
- Find other insurance, or
- Pay higher(!) out-of-network fees.
It should be noted that the insurer did throw a bit of a bone:
“Some Medicare Advantage members may be eligible to receive in-network treatment at [the provider] for a limited time after March 1. These may include members being treated for some chronic conditions, undergoing inpatient care, being scheduled for non-elective surgery or who are terminally ill. Please call us to see if you are eligible.”
Gee, thanks.
One quote from an MA subscriber had me shaking my head:
"I finally spoke with a person at Medicare.gov who had absolutely no idea of what I was calling about,” she said. “The lack of customer service, communication and understanding of the crisis is shocking.”
Umm, your plan — you did read its documentation, didn’t you? — basically says you told Medicare to take a hike as far as your primary insurance is concerned. So the “lack of … understanding of the crisis” is itself kinda understandable since they’re not a party to price negotiations.
Oh, and a (perhaps inadvertent) knife twist: the insurer specifically said that their Medicare Supplement subscribers would not be affected. Probably because the term “network” means something completely different when it comes to MS plans.
I’m fairly confident that the compensation issue will be resolved before the deadline (the statements from the provider and insurer strike me as 99-44/100% PR), but the subscribers — and the state SHIP reps to whom they’re flocking in search of a safety net — don’t need this kind of stress. As for me, they’ll get my Part B when they pry it from my cold, dead hands.
* The insurer says “hundreds of thousands,” which I regard as hyperbole.
We went through a very similar flail a few years ago when my employer’s insurance plan locked horns with the hospital system that was providing all the care for my then-wife’s galloping advanced stage IV cancer.
Suddenly all of our eye-wateringly expensive treatments and meds were out-of-network. Which meant the normally quite tolerable patient share of those multiple-6-figure annual costs was suddenly a LOT bigger. We had the money to cover that, but lots of people did not.
About 4 months later they came to terms and suddenly the hospital & related providers were in-network again. Of course that meant that all the money we had already spent did not count towards our in-network deductible, since that was spent on out-of-network deductible. So that year we got to fill both deductibles.
Gee thanks, a$$holes.
It’s simply a game if chicken between two forces both used to getting their way.
As it applies to the specific situation with Medicare, it’s not obvious to me that Medicare supplements are necessarily immune to this same risk.
My understanding is that for Medicare Part A and Part B, the only criterion for providers being “in network” is that they accept the fee schedule. So the in/out determination is made by Medicare; the supplement just picks up the costs that Medicare doesn’t (for Part B, generally 20% after deductible). The supplement makes no determination on its own.
Of course, there could be problems if, for instance, a surgeon is “in” but the anesthesiologist is “out” — but that can occur in MA plans as well.
Disclaimer: the closest I got to being an “expert” was a couple of years spent supporting claims processing for a company that self-insured. Perhaps @JohnT could confirm or correct.
I think that is correct.
I mentioned it upthread, but just in case I am wrong… I’m no longer in the business.
So I mentioned that I chose an “advantage” plan ’ cause that was the only plan that covered my maintenance inhaler, according to Medicare.gov? Well, I get a letter from the plan the other day after filling my meds the first time, it said that medication is not on their formulary. Weird, I went to said formulary and it shows it there clearly. It also says they will fill it one more time, but I’m supposed to find a different med from the formulary. Tricky that since who knows if it’s really on the formulary or not? Grrr
Call “customer service” and ask.