I know, but I wanted to fume about it. I was so careful researching this stuff to get blindsided less than a month in. Grumble…
Take a screenshot, a download if it’s a document, whatever you need to do to document that the medication is in the formulary. If they deny it, go straight to the insurance regulator in your state with the documentation and file a complaint. I’m not an expert, but that sounds like a clear case of bad faith on the part of the insurer.
Never attribute to bad faith that which can be explained by incompetence and bad faith
When you say you “went to said formulary”, are you talking online or a dead-tree book they sent you?
All insurers reserve the right to alter their formulary at will. IOW, at any time for any reason convenient to them and your only choice is to suck it up.
So a dead tree book or pamphlet is obsolete by the time it gets to your mailbox. Online should be better. Should.
Good luck. Seriously, not snarkily.
N/M. I posted a long gripe about Medicare not paying a legitimate bill, then I called the billing lab and found that someone had just entered in Medicare ID wrong and it goofed up the process. So I deleted my gripe. Phew.
Not correct, actually.
That USED to be how a house sale worked. You pay taxes on the gain, unless you roll it over into a new house. But 20+ years back, the law was changed, giving everyone a 250,000 exclusion on capital gains (500,000 for a couple). It has to have been your primary residence for 2 out of the previous 5 years. There are some more nuances to that, but for most people that’s the rule to worry about.
I imagine the IRMAA rules will only kick in if there is a reportable gain - e.g. if you and the spouse sell the house for a 400K gain, they won’t hear about it. If you sell it for a 600K gain, that’s a 100K taxable gain.
Don’t quote me on that last part - I have not looked at the tax paperwork for such a sale. The form likely says “sold for 800K, basis is 500K, gain is 300K, your taxable gain is 0”, If IRMAA just looks at the “gain is 300K” part, might it kick in anyway?
Doesn’t California also have some limits on how much their property insurance can be jacked up while they remain in the home? Seems like they could actually wind up with a BIGGER tax bill if they move to a smaller place.
Aside from that: while I can see all those arguments, all those fees (including IRMAA and capital gains) are surely going to be less than the profit. E.g. if your gain is 600K, 100K is taxable. That jacks up your Medicare a couple thousand for a year, and you pay 15K in capital gains taxes. You’ve still got an extra 80K in your pocket (plus that 500K).
Property tax (I think that’s what you meant). You get to keep your low Prop 13 basis if you’re over 55 and the new house is of equal or lesser value than the original one and you stay within the same county. There are a few counties that have some sort of reciprocity with each other and you can move from one of those to a different one of those and keep the basis.
The idea is to get oldsters out of homes meant for families with kids to a smaller home without getting killed on taxes. The capitol gains thing that you corrected me on earlier is a killer though from a tax perspective. May as well close one of the wings and keep the mansion.
Prop 13 is something else.
I live in a neighborhood of tract homes that are effectively of equal value. The guy next door is an original owner (bought in 1961) and pays $800/year. I bought in 1993 and pay $4200/year. The family down the block who bought a year ago pays over $20k.
IRMAA runs off your AGI. So a reduced or fully excluded gain only impacts your AGI that much.
D’oh! Yeah, I meant property TAX, LOL.
I did not know about the ability to stay at your lower rate under those circumstances. I’m on the other coast, and we don’t truck with such newfangled foolishness.
There appears to a be a looming crisis in property insurance because of the increasing number of disasters due to climate change, so you may be righter than you think. (And not just in California.)
My block is the same as hajario’s block. But Prop 13 applies to everyone. Even businesses, some of whom have longer life spans and less movement than people.
Hah - until 10 months ago, we owned a condo in Florida, so you’re right about not just in California!! I’d initially called the company we’ve insured with (in Virginia) for decades… they did not even return my calls. Another Doper actually helped out (his parents had a condo near where we were buying, and he steered us to their agent). We were lucky in that the place we bought was NOT in a high-risk flood area - though looking at real estate listings for near there, when we were selling, it was about the only area that did not have “high risk and expected to get worse” on the listings.
Florida does not have Prop 13, but they do (at least in that county) have homesteading exemptions (significant discounts) on property tax if you are elderly. Since we were not the residents of the condo (and were not 65 anyway), the taxes were higher on the 900 square foot unit than the in-laws had been paying on their nicer, larger place before that. There are absolutely sound economic reasons for people to retire down there versus staying up north.
I was thinking about Florida. Bad hurricanes happen more frequently than damaging earthquakes.
Lots of states have breaks on property taxes for seniors. New Jersey did, for one. But people have been moving from the North to Florida as long as I’ve been alive, which is quite a while, more for weather than money. Not that I disagree money is a reason to these days.
It was a total Howard Jarvis scam. He was a big property owner and wanted his property taxes lowered. I was a renter at the time, and did I get a cut on my rent when Prop 13 passed??? Heck, no.
Please. You got a $60 renter credit (which still exists), you ingrate. /s
Yeah, and I spent it all in one place!
That avocado toast isn’t going to buy itself!
Yep. Our next-door neighbors moved south when they retired, 55ish years ago.
My in-laws moved south for a combination of the weather and the cost of living - they were in NJ, and the cold was really getting to them, plus they’d had an inheritance that was enough to buy an inexpensive condo there.
When we were down there last spring to sell ours, it was a bit of a shock to realize that if we stayed there, we could have afforded to retire right then (paid-for condo, so housing would just have been the HOA fees plus taxes). Plus enforced downsizing. But… Florida. And some other expenses would be higher (I once priced similar Medigap policies and it would be roughly 2x as much there). Plus, as my SIL put it, the whole area seems like God’s Waiting Room.
The Medigap, and medical care down there in general, are among the many reasons not to move there in my opinion. MIL ADORED their primary care doctor (hearing some things that went on later on with them, I’m not as impressed). But she said it was hard to find anyone good.
As for weather? I keep talking about moving NORTH when we retire 
Huh - this thread has been dormant for a while now!!
My latest question relates to taking part D/B some time after age 65.
I hit that milestone in less than a month (which is baffling, as I’ve been claiming I’m still 29 for, well, decades now). My husband and I both plan to continue working for a while - he is targeting late 2026, though I think he may give up sooner than that; we’ve both decided that our current projects / clients will be our last, so if one of us gets rolled off, that person will just retire right then.
In any case, it’s likely we’ll be signing up “late” - which will incur a surcharge unless we have had acceptable coverage in the interim. Which employer coverage should do. What kind of documentation will we need to get to prevent the surcharge, and have people had any issues obtaining that documentation?