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    Scarlet Poulet (right), pictured with wife Nadine Kujawa, before Poulet was diagnosed with cancer in 2019.Courtesy: Scarlet Poulet Medicare's rules for signing up have put 68-year-old Scarlet Poulet in an unenviable situation. The New Orleans resident, who is recovering from cancer, has been enrolled in Medicare Part A (hospital coverage) since 2018 when she reached the eligibility age of 65. Yet due to how Medicare interacts with insurance through an employer — coverage she lost in August — Poulet is now not allowed to sign up for Part B (outpatient care) until January. That's when a three-month enrollment window opens for beneficiaries who didn't enroll when they were supposed to. Even then, however, Poulet's Part B coverage would not start until July due to Medicare rules — and she could face life-lasting late-enrollment penalties. More from Personal Finance:How to get a jump-start on upcoming tax seasonMake these investment moves to beat inflationMore than 1 in 3 U.S. adults carry medical debt "The rules surrounding Medicare eligibility, particularly as it relates to employer-based coverage, is unnecessarily complicated, with quite unfair results...
    Phynart Studio | E+ | Getty Images You've got about a week left to make sure your 2022 Medicare coverage suits you. The program's fall open enrollment period, which opened Oct. 15, ends on Dec. 7. While you aren't required to take action — your 2021 plan generally would renew for next year — experts recommend determining whether your current coverage remains your best option. Nevertheless, most beneficiaries do not review their plan: 67% had not as of mid-November, according to a MedicareGuide.com survey. That's similar to the findings of recent research from the Kaiser Family Foundation, which found 71% do not explore their coverage options during open enrollment. More from Personal Finance:How to get a jump-start on upcoming tax seasonMake these investment moves to beat inflationMore than 1 in 3 U.S. adults carry medical debt "It can be a really unpleasant surprise for people who think they're happy with their plan and then in January they have to confront the reality that their plan changed, which has an impact on their care or out-of-pocket costs," said Juliette Cubanski, deputy...
    Audiologist examining a patient's ear.Westend61 | Westend61 | Getty Images Some significant changes to Medicare could be on their way. With the House passage of the $1.7 trillion Build Back Better Act on Friday, provisions that would improve Medicare have moved a step closer to becoming law. The Senate must still pass its version and the possibility exists that any final measure agreed upon by both chambers may look different from what's in play now. If the Medicare provisions remain intact, the federal government would be permitted for the first time to negotiate the price of certain drugs with pharmaceutical companies. That move is intended to bring down the cost of some prescription drugs. More from Personal Finance:How to pick best year-end charitable giving strategyNearly half of all Americans expect to retire in debtHome prices now rising much faster than incomes Additionally, beneficiaries' out-of-pocket spending for Medicare's drug benefit (Part D) would be capped at $2,000 annually beginning in 2024 (with yearly adjustments) and the cost for insulin would be limited to $35 per month.  Hearing services also would be...
    OPEN enrollment for Medicare is going on right now - with the deadline in just over two weeks. Medicare is health insurance for people 65 and older. You're first eligible to sign up for Medicare three months before you turn 65. 1Medicare is available for Americans age 65 or older The initial enrollment period is when you are new to Medicare. It starts three months before you get Medicare and ends three months after you get Medicare. During this time, you can can join any plan, but you need both Part A (hospital insurance) and Part B (medical insurance) to join a Medicare Advantage Plan. Plus, you will need either Part A or Part B to join a Medicare drug plan. Open enrollment is going on right now through Tuesday, December 7. Here are five tips to help you through open enrollment. Most read in moneyCASHING IN Families eligible for ‘surprise’ $8,000 payment after 'Thanksgiving' cash issuedPRETTY PENNY Lincoln pennies from early 1900s sell for $1,175 eachSHOW ME THE MONEY IRS sends out more than 169million stimulus checksCASH BOOST 'Surprise'...
    Marko Geber | DigitalVision | Getty Images As investors flock to municipal bonds, also known as muni bonds, the tax-free interest may trigger a costly surprise for higher-income retirees. There's been record demand for U.S. municipal bond funds in 2021, with an estimated $85.36 billion in net inflows through September, according to Refinitiv Lipper data. While demand slid from August through October, investors poured back into muni bonds in November, despite Democrats' stalled attempts to increase taxes on the wealthy. However, muni bond interest may create a problem for affluent investors: Medicare premium hikes. "There are a lot of moving parts, and you need to have someone look at it holistically," said Matthew Chancey, certified financial planner at Dempsey Lord Smith in Tampa, Florida.Higher taxes and premiumsAlthough tax-exempt muni bond interest may be appealing, those earnings may increase Social Security taxes and Medicare premiums, said Tracy Sherwood, a Williamsville, New York-based CFP at Sherwood Financial Management.  That's because the formulas for Social Security taxes and Medicare Part B and Medicare Part D use so-called modified adjusted gross income or MAGI,...
    (CNN)When the US Food and Drug Administration approved a costly new drug for Alzheimer's disease, Aduhelm, earlier this year, experts warned that all of Medicare's more than 63 million enrollees could wind up paying the price.That's exactly what is happening.Aduhelm, which is priced at $56,000 a year, is one of the key factors driving a major increase in Medicare Part B premiums for 2022, according to the Centers for Medicare and Medicaid Services. The standard monthly payment will soar to $170.10, up from $148.50 this year, the agency announced late Friday.About $10 of the premium spike is due to Aduhelm, a CMS official told CNN. The rest stems from a general increase in health care prices and usage, as well as from congressional action that limited the rise in Part B premiums for 2021 amid the coronavirus pandemic."This does show how just one drug could have a major impact on spending and premiums," said Tricia Neuman, executive director of the Kaiser Family Foundation's Program on Medicare Policy. "Without a change in current law, there's little the administration can do on...
    MEDICARE premiums are set to jump in 2022 by far more than what experts had estimated. The announcement came by the Centers for Medicare & Medicaid Services (CMS) on November 12, 2021 - we explain what you need to know. 1Medicare premiums are on the rise How much are Medicare premiums going up by? Medicare's Part B standard premium is set to jump 14.5% in 2022, meaning those relying on the coverage will face an increase of more than $21 a month. In addition to the standard premium, the deductible for Part B will also increase next year, from $203 to $233. That's a 14.8% increase from 2021 to 2022. The Medicare Part A deductible is also on the rise and will go up by $72 to $1,556. The determining factor for Part B premiums, deductibles, and coinsurance rates is the Social Security Act, according to the CMS. Most read in MoneyPRETTY PENNY Check here to find out real value of your pocket changeIN DESPERATE NEED ‘Secret stimulus check’ sent out as calls grow for more mortgage reliefCASH TO COME...
    Anchiy | E+ | Getty Images Medicare beneficiaries who pay monthly surcharges for premiums may want to take note of how much more they'll be charged next year. With the standard monthly premium for Part B (outpatient care coverage) now set at $170.10 for 2022, the so-called income-related monthly adjustment amounts, or IRMAAs, will result in higher-income beneficiaries paying anywhere from $238.10 to $578.30 each month for that coverage. About 7% of Medicare's 63.3 million beneficiaries with Part B will pay IRMAAs next year, according to the Centers for Medicare & Medicaid Services. The adjustments kick in next year for individuals with modified adjusted gross income — this is your adjusted gross income plus tax-exempt interest — above $91,000. For married couples filing a joint tax return, that amount is $182,000.  For Part D prescription drug coverage, the additional monthly amounts range from $12.40 to $77.90 with the same income thresholds applied. (See chart below.) More from Personal Finance:Handling required withdrawals from retirement accountsRemarrying? Here are key financial considerationsHere’s how to protect your credit from fraudsters Those amounts are in...
    Aimstock | Getty Images Social Security's 5.9% cost-of-living adjustment for 2022 will be the biggest in decades. But those checks likely won't go as far as inflation pushes prices higher on grocery store shelves and at gasoline pumps. Consumer Price Index data for October shows the cost of consumer goods climbed a record 6.2% from one year ago, the biggest increase since 1990. More from Personal Finance:Medicare Part B premiums for 2022 jump by 14.5% from this yearWhy Social Security benefits can't go up more each year Here are the changes that could be coming to your Social Security benefits And that's not the only reason monthly checks will be pinched. Two other items — Medicare Part B premiums and taxes — tend to reduce the value of those increases for many, according to research from the Center for Retirement Research at Boston College.Medicare Part B premiumsWhile the cost-of-living adjustment usually goes up every year, so do Medicare Part B premiums that older Americans pay for physician and outpatient services. In 2022, the standard Medicare Part B premium will increase to $170.10,...
    (CNN)The federal government announced a large hike in Medicare premiums Friday night, blaming the pandemic but also what it called uncertainty over how much it may have to be forced to pay for a pricey and controversial new Alzheimer's drug.The 14.5% increase in Part B premiums will take monthly payments for those in the lowest income bracket from $148.50 a month this year to $170.10 in 2022. Medicare Part B covers physician services, outpatient hospital services, certain home health services, medical equipment, and certain other medical and health services not covered by Medicare Part A, including medications given in doctors' offices. "Most people with Medicare will see a 5.9% cost-of-living adjustment (COLA) in their 2022 Social Security benefits—the largest COLA in 30 years. This significant COLA increase will more than cover the increase in the Medicare Part B monthly premium," the Centers for Medicare and Medicaid Services (CMS) said in a statement."Most people with Medicare will see a significant net increase in Social Security benefits. For example, a retired worker who currently receives $1,565 per month from Social Security can...
    Morsa Images | DigitalVision | Getty Images The standard premium for Medicare's outpatient care coverage will jump by 14.5% for 2022, far outpacing an earlier estimate of 6.7%, according to the government. The standard premium for Part B, which covers outpatient care and durable equipment, will be $170.10 next year, up $21.60 from $148.50 this year, said a senior official for the Centers for Medicare & Medicaid Services on Friday. The program's trustees had estimated this summer that the premium would rise to $158.50. The deductible for Part B will be $233, up $30 (14.8%) from this year.VIDEO1:4301:43Social Security COLA in 2022: How much more money you will see in your checkInvest in You: Ready. Set. Grow.The bigger-than-anticipated increase is partly attributed to rising prices and utilization across the health care system and congressional action that limited the increase in the 2021 Part B premium. Additionally, contingency reserves have been increased to account for potential new treatment costs incurred by the program. Meanwhile, the deductible for Medicare Part A (hospital coverage) per benefit period (which generally starts when you are...
    WASHINGTON (AP) — Medicare’s “Part B” outpatient premium will jump by $21.60 next year, one of the largest increases ever. Officials said Friday a new Alzheimer’s drug is responsible for about half of that. The increase guarantees that health care costs will gobble up a big chunk of the recently announced Social Security cost-of-living allowance, a boost that had worked out to $92 a month for the average retired worker. Medicare officials told reporters on Friday that about half the increase is attributable to contingency planning if the program has to cover Aduhelm, a new $56,000-a-year medication for Alzheimer’s disease. The drug would add to program costs because it’s administered in a doctor’s office and paid for under Medicare’s outpatient benefit. The announcement on premiums comes as Congress is considering Democratic legislation that would curb what Medicare pays for medications. The new Part B premium will be $170.10 a month. Copyright © 2021 The Associated Press. All rights reserved. This material may not be published, broadcast, written or redistributed.
    WASHINGTON (AP) — Medicare Part B outpatient monthly premium jumps by $21.60 next year; new Alzheimer’s drug cited in one of largest hikes. Copyright © 2021 The Associated Press. All rights reserved. This material may not be published, broadcast, written or redistributed.
    IF you're a Social Security claimant who has lost income, you may be entitled to lower Medicare payments. This can be helpful as income-related changes may lead to higher monthly premiums for some Medicare beneficiaries. 1Medicare surcharges can cost hundreds extra each month Those who make more money might be subject to surcharges ranging from $59.40 to $356.40, according to the Social Security Administration (SSA). But thanks to income-related adjustment amounts (IRMAA), some may be able to appeal these surcharges. Below we explain how. How to lower Medicare payments Each year, the Social Security Administration determines IRMAA, taking into consideration the most recent tax return available. For some, though, this could be from two years ago when income was significantly higher, especially if they were not yet claiming Social Security benefits. For individuals, IRMAAs go into effect with a gross income of more than $88,000. Most read in MoneyMIXED BAG Shiba Inu coin skyrockets but Bitcoin slumps as Safemoon crypto slide continuesHIDDEN BONUS 'Secret stimulus check' sent as calls for new $2,000 payments EVERY MONTH growCASH TO COME November $3,600...
    FatCamera | E+ | Getty Images If you're using Medicare and haven't yet reviewed your prescription drug coverage for next year, now's the time to do it. Because plans make changes every year that take effect Jan. 1, evaluating your options during Medicare's fall open enrollment could save you from financial strife. While you aren't required to take any action — your current coverage generally would continue into next year — doing nothing may end up costing you more. "It may be that the drug plan you're on is the best for you," said Kevin Heath, owner and head broker for insurance firm MTD Benefits. "But not to shop it is just not smart because you don't know until you know." More from Personal Finance:How to appeal income-related Medicare chargesNew mortgage refi programs are expandingRemarrying? Here are key financial considerations The window to make changes to your Medicare coverage opened Oct. 15 and will close Dec. 7. During this time, beneficiaries with basic Medicare (Part A hospital coverage and Part B outpatient care) can add or switch standalone Part D...
    Phynart Studio | E+ | Getty Images For military veterans, turning 65 can come with a health-care decision: Whether to sign up for Medicare. Those who use Tricare and plan to enroll in Tricare for Life — an insurance program administered by the Defense Department — generally have no choice: The latter is only available in conjunction with Medicare Part A (hospital coverage) and Part B (outpatient care coverage). Yet for vets who rely on benefits from the Veterans Health Administration, the decision could be less clear. "My dad is a Vietnam-era war veteran and when he was turning 65, he asked me if he should just use the VA and save those premiums for Part B and D [prescription drug coverage]," said Danielle Roberts, co-founder of insurance firm Boomer Benefits.If you have just the VA coverage, and they can't see you until next week, you'll be stuck.Danielle RobertsCo-founder of Boomer Benefits"He didn't want to spend the money but I insisted and … I've been very glad I did," Roberts said. The VA health system provides care for 9 million...
    bymuratdeniz | E+ | Getty Images Some older Americans may be all too familiar with sticker shock when it comes to their Medicare premiums. That is, instead of paying the standard premium for Part B (outpatient care coverage) and Part D (prescription drug coverage), their income is high enough for monthly "income-related adjustment amounts," or IRMAAs, to kick in. However, the surcharge is typically based on their tax return from two years earlier — which may not accurately reflect their current financial situation. "For some clients, their income from two years prior is significantly higher than it is today or will be when they retire," said Elizabeth Gavino, founder of Lewin & Gavino and an independent broker and general agent for Medicare plans.  More from Personal Finance:Remarrying? Here are key financial considerationsYour financial advisor should have a succession planHere are 5 hidden benefits of health savings accounts  The good news for those beneficiaries is that they can appeal the IRMAAs. "Most people don't want to wait two years for their lower income to catch up to them in order to...
    IF you're about to turn the age of 65, you have added health care options to consider. Medicare is health insurance for people 65 and older. You're first eligible to sign up for Medicare three months before you turn 65. 1Medicare is available for Americans age 65 or older Below we round up five things you need to know if you're new to Medicare. 1. Initial enrollment period The initial enrollment period is when you are new to Medicare. It starts three months before you get Medicare and ends three months after you get Medicare. During this time, you can can join any plan, but you need both Part A (hospital insurance) and Part B (medical insurance) to join a Medicare Advantage Plan. Plus, you will need either Part A or Part B to join a Medicare drug plan. Most read in moneyCALI CASH California sends out $1,100 stimulus payments to Golden State residents THIS WEEKNAME GAME Shiba Inu down & Bitcoin up as Elon changes Twitter name to match new crypto coinOPT IN OR MISS OUT Child tax credit...
    peakSTOCK | iStock | Getty Images If Democratic lawmakers get their way, Medicare will start covering hearing services for the first time in the program's history. The coverage, which would take effect in 2023, is included in Democrats' proposed $1.85 trillion spending bill, dubbed the Build Back Better Act and aimed partly at strengthening the social safety net. The legislative package still needs approval in both the House and Senate before it could be signed into law by President Joe Biden. However, hearing is not the only coverage gap. In addition to many new enrollees finding out that Medicare is not free — far from it — they also may be surprised that it doesn't cover a variety of health-care expenses that can hit retirees pretty hard. More from Personal Finance:Remarrying? Here are key financial considerationsYour financial advisor should have a succession planHere are 5 hidden benefits of health savings accounts  About 63.3 million people are enrolled in Medicare. Most of them are age 65 or older (55.1 million) and the rest are generally younger with permanent disabilities. Some people...
    andresr | E+ | Getty Images For retirees, unplanned medical expenses can upend their budget. Indeed, while about 33% of Americans age 65 or older have at least $6,000 set aside for medical bills, 27% have less than $500 in savings for that purpose, according to a survey from MedicareGuide.com. Nearly half (46%) in that age group — who generally rely on Medicare for coverage — are very or somewhat concerned that a major health situation in their household could lead to medical debt or bankruptcy. So how would they pay for the treatment cost of severe illness? More than 1 in 5 (22%) would turn to credit cards. Another 15% would tap retirement savings and 13% would draw on other savings. The survey was conducted in mid-September among a national sample of 1,176 U.S. adults ages 65 and older. More from Personal Finance:Joining the ‘Great Resignation’? How to handle your 401(k)Here are five hidden benefits of health savings accounts Does your advisor have a succession plan? Why it matters If you're among those older Americans who struggle to pay...
    U.S. President Joe Biden speaks about the status of coronavirus disease (COVID-19) vaccinations and his administration's ongoing pandemic response in the State Dining Room at the White House in Washington, May 4, 2021.Jonathan Ernst | Reuters The White House on Thursday unveiled a new plan to expand several federal health-insurance programs to lower costs to consumers as part of President Joe Biden's broader $1.75 trillion domestic spending package. Biden plans to expand Medicare, Medicaid – the federal health insurance programs for the elderly and poor – as well as the Affordable Care Act, more commonly known as Obamacare, according to a factsheet released by the White House. Under the expanded benefits, Medicare would provide hearing benefits. His plan would also provide tax credits to up to 4 million uninsured Americans in states that have not expanded Medicaid under the ACA. He also plans to reduce premiums for some 9 million people who get coverage through the ACA by an average of $600 per person. Notably, there was no mention of prescription drug pricing reform, a policy Democrats and some Republicans...
    XiFotos | E+ | Getty Images After the Social Security Administration announced a record-high cost-of-living adjustment for 2022, many beneficiaries are asking, "How much bigger will my monthly checks be?" People who receive Social Security or Supplemental Security Income, or SSI, benefits will get a 5.9% boost to their payments next year. That is that highest increase since 1982. The last time the COLA came close was in 2009, when it was 5.8%. More than 64 million Social Security beneficiaries are slated to see bigger checks in January. The same also goes for about 8 million SSI recipients.More from Life Changes:Here's a look at other stories offering a financial angle on important lifetime milestones. This could be the worst market for a first-time homebuyer, experts say Here are some smart financial moves for new parents Student loan forgiven? Here’s what experts say you should do next The annual adjustments are based on inflation. So bigger monthly checks mean that consumer prices have also gone up. Consequently, the extra cash may not go as far. The average monthly retirement...
    fizkes | iStock | Getty Images For Medicare beneficiaries who want to join an Advantage Plan, now is the time to do it. Just be sure you know what the plan covers and what your potential costs will be — and how long you have to change your mind. During the annual fall open enrollment period, which is now underway and runs through Dec. 7, one of the things you can do is sign up for an Advantage Plan, as long as you have original Medicare (Part A hospital coverage and Part B outpatient care). More from Personal Finance: The best and worst states for older workersThis is where to invest your money in 2022Here’s how many people pay the estate tax While these plans continue growing in popularity and availability, there are some things to know. "Not all will have the same benefits," said Elizabeth Gavino, founder of Lewin & Gavino and an independent broker and general agent for Medicare plans. "You have to see what's important to you." Roughly 63.3 million individuals get their health coverage through Medicare....
    Choreograph | iStock | Getty Images This is one of those times you may not want to follow the herd. Most Medicare beneficiaries — 71% — do not explore their coverage options during open enrollment, according to a new Kaiser Family Foundation study. Because the specifics of health plans change from one year to the next, experts say this is a mistake. "It can be a really unpleasant surprise for people who think they're happy with their plan and then in January they have to confront the reality that their plan changed, which has an impact on their care or out-of-pocket costs," said Juliette Cubanski, deputy director for the foundation's program on Medicare policy. More from Personal Finance:Here's how you can update your budget for the fallDrop in birth rates may have lasting economic impactGood financial habits used the most by ‘super savers’ Medicare's fall open enrollment period starts Friday and runs through Dec. 7. In simple terms, this annual window is for adding or changing coverage related to an Advantage Plan (Medicare Part C) and/or prescription drugs (Part D)....
    Female doctor working with senior patient in a modern office clinic / hospitalmomcilog | E+ | Getty Images Sure, there are probably more entertaining things to do than review your Medicare coverage. Nevertheless, it's about that time of year. Open enrollment, which starts Oct. 15 and runs through Dec. 7, is when you can make changes that take effect Jan. 1. While you aren't required to do anything — your 2021 coverage generally would continue into 2022 — it's worth at least checking to see if your current plan remains your best option, experts say. "Providers may opt in or out of a network plan, or the cost of a prescription drug may be higher or lower, or may no longer be covered," said Elizabeth Gavino, founder of Lewin & Gavino and an independent broker and general agent for Medicare plans.  More from Personal Finance:Here’s how many people pay the estate taxHow to get tax-free income in retirementThese tips can help rein in impulse spending In simple terms, this annual fall open enrollment period is for adding or changing coverage...
    SOCIAL Security claimants expecting a boost to their payments in 2022 may find the raise wiped out by Medicare premiums. The cost-of-living adjustment (COLA) of Social Security is expected to rise by 6% or 6.1% next year, which would mark the biggest hike since 1982. 1Social Security claimants may find their COLA boost next year wiped out by Medicare costsCredit: Getty Based on the current average benefit of $1,543, an increase of this size would mean a hike of between $92.58 and $94.123. Meanwhile, those receiving the maximum payout of $3,895 each month can expect a monthly boost of between $233.70 and $237.595. However, the COLA could be eroded by a hike in Medicare Part B premiums, which typically rise even more each year. In fact, between 2000 and 2020, COLAs averaged 2.2%, while Medicare Part B premiums rose by 5.9%. Medicare Part A, which covers hospital care, is generally free for seniors who paid Medicare taxes for a certain amount of time while working. Meanwhile, Part B premiums cover outpatient and diagnostic services and enrolled senior are instead charged...
    FatCamera | E+ | Getty Images It's a situation that appears incongruous: Congressional Democrats want to expand Medicare's benefits while a trust fund that supports the program is facing insolvency. Indeed, some Republican lawmakers have seized on that looming problem as a reason to oppose a proposal to add dental, vision and hearing coverage to Medicare. The provision is included in Democrats' 10-year, $3.5 trillion spending plan that would expand the social safety net and battle climate change, among other policy goals. "Democrats are ramming through a reckless new expansion of Medicare – just as it's a few years from bankruptcy," said Rep. Kevin Brady, R-Texas, in prepared remarks at a House Ways and Means Committee session on Thursday as debate began on portions of Democrats' massive legislative package.VIDEO5:3205:32Ways and Means Committee members debate $3.5 trillion spending billSquawk BoxBecause of how Medicare is structured, adding dental, vision and hearing coverage would have little impact on the trust fund that's forecast to be insolvent beginning in 2026. "In short, we're largely talking about different pots of money," said David Lipschutz, associate...
    Washington (CNN)Social Security will have to cut benefits by 2034 if Congress does nothing to address the program's long-term funding shortfall, according to an annual report released Tuesday by the Social Security and Medicare trustees.That's one year earlier than reported last year. By that time, the combined trust funds for Social Security will be depleted and will be able to pay only 78% in promised benefits to retirees and disabled beneficiaries. The Covid-19 pandemic and economic recession are to blame for moving up the depletion rate by a year, driven by the big drop in employment and resulting decline in revenue from payroll taxes. But it remains unclear what the long-term effects of the pandemic will be on the funds and the trustees will continue to monitor developments. The projections for Medicare are roughly on par with last year's report. The trust fund for Medicare Part A, which covers hospital and nursing home costs for seniors, will be depleted by 2026, the same year as reported last year. At that point the program would only be able to pay out...
    SAN FRANCISCO — A civil settlement Monday resolves a lawsuit that had alleged a health care provider knowingly gave incorrect information about Medicare beneficiaries’ health status, the U.S. Justice Department said. The lawsuit, brought under whistleblower provisions of the False Claims Act against Sacramento-based Sutter Health and several affiliated medical foundations, alleged the company violated the act while handling information about Medicare beneficiaries, who would enroll in managed health-care insurance plans. After Sutter provided services to enrollees in certain plans, it received part of the payments for treating them, with those payments based on beneficiaries’ demographic information and health status, as well as generally increasing based on severity of diagnoses. “The government alleged that Sutter Health knowingly submitted unsupported diagnosis codes for certain patient encounters for beneficiaries under its care. These unsupported diagnosis codes caused inflated payments to be made to the [p]lans and to Sutter Health,” a Justice Department statement said in part. “The lawsuit further alleged that, once Sutter Health became aware of these unsupported diagnosis codes, it failed to take sufficient corrective action to identify and delete additional...
    Prostock-Studio | iStock | Getty Images If you get your health insurance through the public marketplace and are nearing age 65, don't forget about Medicare. The general rule is that you must enroll when you reach that age unless you have qualifying coverage elsewhere — and plans through the exchanges (whether federal or state) do not count.  "You need to be prepared to make that change," said Karen Pollitz, a senior fellow with the Kaiser Family Foundation. "Otherwise you can face [costs] for being late to enroll in Medicare and for being late getting out of the marketplace."More from The New Road to Retirement:Here's a look at more retirement news. Biden tax plan may lead to more Roth retirement accounts How to handle Covid-related withdrawals from retirement accounts 3% of near-retirees can answer all these Social Security questions Of the 12 million or so people who have health insurance coverage through the marketplace, roughly 3.4 million are ages 55 to 64 — meaning some of them are approaching Medicare eligibility and will need to sign up. "If you...
    Choreograph | iStock | Getty Images Signing up for Medicare sometimes means deciding that a supplement plan — aka Medigap — suits your situation. That is, you want extra insurance to at least partially cover the cost-sharing aspects of Medicare — deductibles, copays and coinsurance. However, Medigap plans do have limitations to be aware of. For instance, they don't cover costs associated with prescription drug coverage ( unless, perhaps, the policy was issued prior to 2006.) Nor do they help you pay for services that are excluded from Medicare's coverage, generally speaking, such as dental or vision. More from Personal Finance:Comparing lump-sum investing to dollar-cost averagingHow to handle Medicare when you're living overseasCrypto takes off as a way to pay for vacation getaways And, while the coverage offered by these policies is generally standardized regardless of which insurance company sells them and where you live — available plans are A, B, C, D, F, G, K, L, M and N — each of those options offers different levels of coverage. Also, the premiums for same-named plans can vary significantly from...
    Klaus Vedfelt | Getty Images The Social Security cost-of-living adjustment for 2022 potentially will be the biggest in 40 years. Estimates indicate the annual boost could be 6.2%, prompted by rising inflation. But rising prices on grocery store shelves and at gasoline pumps aren't the only reasons why those bigger monthly benefit checks will likely not go as far. Social Security's cost-of-living adjustment is calculated each year using the Consumer Price Index for Urban Wage Earners and Clerical Workers, also known as the CPI-W. The calculation for 2022 will be based on data through the third quarter.VIDEO1:2501:25Social Security benefits in 2022: How much more money you can expectInvest in You: Ready. Set. Grow.While people may think an approximate 6% benefit increase is good news, it's important to remember it's not necessarily additional income, said Patrick Hubbard, research associate at the Center for Retirement Research at Boston College. "Everything is 6% more expensive these days and is only the minimum needed to maintain the purchasing power that you've had all along," Hubbard said. Moreover, two other items — Medicare Part B...
    dusanpetkovic | iStock | Getty Images A push to rein in the cost of prescription drugs for Medicare beneficiaries could emerge on Capitol Hill in the coming months. President Joe Biden called on Congress last week to reduce those costs through several means: letting Medicare negotiate with drug manufacturers, generally limiting price increases to the inflation rate and capping beneficiaries' annual out-of-pocket spending on prescriptions to about $3,000.  At the same time, cutting drug prices is a goal included in congressional Democrats' budget resolution, which calls for $3.5 trillion in spending on climate change, health-care and family service programs.VIDEO1:0801:08Speaker Pelosi urges Democrats to pass budget blueprintSquawk BoxThe Democrat-controlled Senate already approved the resolution, and the House — where Democrats also are the majority — is expected to vote on it next week. The budget plan also calls for Medicare to provide dental, vision and hearing coverage. Assuming approval, lawmakers would then create a legislative package to reflect what's in that budget framework. "There is strong public support for having the government do something about drug prices," said Tricia Neuman, executive...
    Hero Images | Getty Images You may know that once you reach age 65, you're eligible for Medicare. What surprises many people, say experts, is the cost. Even as Democratic lawmakers in Congress want to expand the health insurance program to cover dental, vision and hearing as part of their $3.5 trillion budget plan, those are not the only things excluded by Medicare. And, there are costs built in even when you have coverage for a service, procedure or other medical need. "Most clients assume Medicare is free and get upset because they worked all their lives and paid into the system," said Elizabeth Gavino, founder of Lewin & Gavino and an independent broker and general agent for Medicare plans. More from Personal Finance:Comparing lump-sum investing to dollar-cost averagingHow to handle Medicare when you're living overseasThese summer activities can impact your tax situation "The [surcharges] are even more surprising to the high-income earners," Gavino said, referring to the extra premium amounts that beneficiaries in higher tax brackets pay for certain parts of their Medicare coverage (more on that below). Some...
    President Joe Biden will on Thursday outline plans to reduce the cost of prescription drugs and call on Congress to take action on cutting the spiralling price of life-saving medication.  An official said it would be a 'forceful' message to Congress to deliver savings to millions of Americans by allowing Medicare to negotiate drug prices. At present, Medicare is allowed to negotiate prices for every other type of health except drug prices.   'Pharmaceutical companies do ground-breaking, life-saving work, but there is a difference between developing clinical breakthroughs and driving up prices for the drugs Americans rely on,' the White House said in a statement previewing Biden's remarks. 'Change is sorely needed.' President Joe Biden will on Thursday outline plans to reduce the cost of prescription drugs and call on Congress to take action on cutting the spiralling price of life-saving medication The White House handed its Twitter feed over to Gail, a diabetic mother, to highlight the high costs of prescription drugs Biden wants to penalize drug companies if the price of their products rises faster...
    milan2099 | E+ | Getty Images If you are living overseas when you reach age 65, don't overlook Medicare. That's the age when you should sign up unless you meet an exception. And depending on how long you plan to remain abroad or whether you are working there, it may make sense to be on Medicare. "It's critical that beneficiaries living abroad know the rules on this," said Danielle Roberts, co-founder of insurance firm Boomer Benefits. More from Personal Finance:3.4 million Americans are still long-term unemployedThese legislative proposals may affect your walletPayment pause for student loan borrowers extended Otherwise, she said, you could return to the U.S. and find yourself waiting on coverage to kick in — in addition to facing late-enrollment penalties. Basic Medicare consists of two parts. Part A, which provides hospital coverage, is free as long as you have at least a 10-year work history of paying into the system. Part B (outpatient care) has a premium. In 2021, the base amount is $148.50, although higher earners pay more. Except in very specific situations, basic Medicare does...
    Sen. Kyrsten Sinema, D-Ariz., second from right, speaks at a news conference in Washington, D.C., on July 28, 2021.Stefani Reynolds | Bloomberg | Getty Images As the Senate races for its summer recess, Democrats hope to pass two priorities: a $1 trillion bipartisan infrastructure plan and a budget resolution allowing them to skirt Republican opposition to their $3.5 trillion spending plan. However, other pending bills and proposals may resurface this fall or later this session. Some of these plans — which tackle retirement security, Medicare, student loans and more — may significantly affect Americans' wallets. CNBC spoke with policy experts about these measures and ranked each one with a score of zero to 10, with 10 being the most likely to happen. Here are some plans to watch after the break. More from Personal Finance:How stimulus checks changed Americans' ability to cover emergency expensesEarly end to federal unemployment pay not getting people back to workAre you protected under the new eviction ban? How to figure that outRetirement securityCongress passed sweeping changes to the U.S. retirement system with the Secure Act...
    MEDICARE has helped millions of people throughout the United States. The program ensures that people get health insurance and are able to take care of themselves. 2Medicare is run by the federal governmentCredit: Getty What is Medicare? Medicare, not to be confused with Medicaid, is a national federal health insurance program. The program began in 1965 under the Social Security Administration and has since been administered by the Centers for Medicare and Medicaid Services. While the program is designed for people 65 and over, those who are younger can qualify if they have certain disabilities. Those who have End-Stage Renal Disease also qualify no matter what age. What are the parts of Medicare? Medicare has three parts. According to the Medicare website, those part include: Medicare Part A, which covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care Medicare Part B, which covers certain doctors' services, outpatient care, medical supplies, and preventive services Medicare Part D, which covers the cost of prescription drugs...
    lechatnoir | E+ | Getty Images Workers who are nearing age 65 and have health insurance through their job may want to consider how Medicare could factor into their medical coverage. While not everyone must sign up for Medicare at that age of eligibility, many are required to enroll — or otherwise face lifelong late-enrollment penalties. "The biggest mistake ... is to assume that you don't need Medicare and to miss enrolling in it when you should have," said Danielle Roberts, co-founder of insurance firm Boomer Benefits. More from Personal Finance:Stock market volatility can be opportunity for investorsWhere efforts to raise federal minimum wage standCovid scams cost Americans nearly $500 million Roughly 10 million workers are in the 65-and-older crowd, or 17.9% of that age group, according to the Bureau of Labor Statistics. The general rule for Medicare signup is that unless you meet an exception, you get a seven-month enrollment window that starts three months before your 65th birthday month and ends three months after it.  Having qualifying insurance through your employer is one of those exceptions. Here's what...
    An effort by liberal Democrats to lower the Medicare eligibility age by five years could add billions more to the $3.5 trillion infrastructure and social welfare package the party is aiming to pass without GOP votes. Vermont socialist Bernie Sanders is leading the push to make adults 60-64 years old eligible for the government health program, which could add about $200 billion in spending over the next 10 years to the party's go-it-alone package, according to an estimate by the Committee for a Responsible Federal Budget. This means the yearly cost would add roughly 2.5% more to what the federal government spent overall on Medicare in 2020 — about $776 billion. But that figure comes “with a huge range of uncertainty,” according to Maya MacGuineas, the president of the Committee for a Responsible Federal Budget. The CRFB estimate was based on “the best information we have” from President Joe Biden's 2020 campaign, MacGuineas said. An updated proposal from lawmakers in Congress outlining how the proposal will be paid for has not been released. DEMOCRATS INCLUDE SANDERS...
    (CNN) — The controversial new drug for Alzheimer’s disease, Aduhelm, is priced at $56,000 a year for treatment — but Alzheimer’s patients won’t be the only ones shouldering the cost. All of Medicare’s roughly 60 million enrollees will likely see their premiums rise to cover the new medication, experts say — and the burden will also fall to federal and state governments and, therefore, to taxpayers. READ MORE: Maryland Ranks Tenth On List Of Rudest Drivers By State Here’s how it’s expected to work: Because Aduhelm will be administered in physicians’ offices, it should be covered under Medicare Part B, not Part D plans, which pay for medications bought at pharmacies. For new Part B drugs, Medicare typically reimburses 103% of the list price. So if 500,000 of the estimated roughly 6 million Americans with Alzheimer’s disease are prescribed Aduhelm, total spending for one year would be nearly $29 billion, which would far exceed spending on any other drug covered under Medicare Part B or Part D in 2019, according to the Kaiser Family Foundation. Total Medicare spending for all...
    (CNN)The controversial new drug for Alzheimer's disease, Aduhelm, is priced at $56,000 a year for treatment -- but Alzheimer's patients won't be the only ones shouldering the cost.All of Medicare's roughly 60 million enrollees will likely see their premiums rise to cover the new medication, experts say -- and the burden will also fall to federal and state governments and, therefore, to taxpayers. Acting FDA commissioner calls for independent investigation into approval of Alzheimers drugHere's how it's expected to work: Because Aduhelm will be administered in physicians' offices, it should be covered under Medicare Part B, not Part D plans, which pay for medications bought at pharmacies. For new Part B drugs, Medicare typically reimburses 103% of the list price.So if 500,000 of the estimated roughly 6 million Americans with Alzheimer's disease are prescribed Aduhelm, total spending for one year would be nearly $29 billion, which would far exceed spending on any other drug covered under Medicare Part B or Part D in 2019, according to the Kaiser Family Foundation. Total Medicare spending for all Part B drugs was $37...
    MEDICARE and Medicaid have two very similar names and functions, though one is managed by states and the other is federal. However, they are both government health insurance programs seeking to help lessen the burden of medical costs. 4Medicare and Medicaid are healthcare plans and benefits that are part of the US healthcare systemCredit: Getty What is the difference between Medicare and Medicaid? Medicare and Medicaid are programs that pertain to the US healthcare system. Medicare is a national health insurance program run by the federal government. It typically covers people aged 65 or older and certain individuals under age 65 who may qualify due to a disability or another special situation. There are four parts to Medicare, which include: Part A: Helps pay for hospital stays and inpatient care. Part B: Helps pay for doctor visits and outpatient care. Part C: Combines Part A (hospital insurance) and Part B (medical insurance) in one plan that often includes prescription drug coverage too. Part D: Prescription drug coverage. 4Medicare is a national health insurance program...
    (CNN)Medicare spent billions more money on generic drugs for its beneficiaries than warehouse chain Costco did for the same drugs, according to an analysis published Tuesday. This overspending hit $2.6 billion in 2018, Erin Trish, associate director of the University of Southern California's Schaeffer Center for Health Policy and Economics, and colleagues wrote in a letter to the Journal of the American Medical Association's JAMA internal Medicine.They compared the amount Medicare pays for common generic prescriptions in its Part D prescription coverage with prices available to patients without insurance at Costco for 184 common generic drug products. Challenges to the Affordable Care Act arent over "Medicare overspent by 13.2% in 2017 and 20.6% in 2018 compared with Costco member prices for these prescriptions," they wrote. "Total overspending increased from $1.7 billion in 2017 to $2.6 billion in 2018."Read MoreBeneficiaries did not pay this difference directly -- their average cost sharing was $1 for preferred generic medications and $6 for nonpreferred generic medications in 2018. But Medicare costs come out of taxpayer money, and part D members pay premiums."These low out...
    Choreograph | iStock | Getty Images For some Medicare beneficiaries, health-care coverage ends up costing more than it does for most of their peers — and it's not by choice. While there are costs that individuals often are aware of — i.e., they purchase a supplemental policy or choose a more expensive plan — some premium-related expenses sneak up on enrollees. And depending on the person, they could add up to thousands of dollars extra a year. Roughly 62.6 million people — the majority of whom are age 65 or older — are enrolled in Medicare. Most pay no premium for Part A (hospital coverage) because they have at least a 10-year work history of paying into the system through payroll taxes. VIDEO3:4203:42How to know if you make enough money to use a financial advisorInvest in You: Ready. Set. Grow.When it comes to Part B (outpatient care) and Part D (prescription drug coverage), however, you may encounter some surprise premium costs. And that can happen whether you stick with original Medicare (Parts A and B) or choose to get your benefits...
    In this article BIIBA pedestrian walks past Biogen Inc. headquarters in Cambridge, Massachusetts, on Monday, June 7, 2021.Adam Glanzman | Bloomberg | Getty ImagesBiogen's pricy new Alzheimer's drug, Aduhelm, could cost Medicare billions of dollars a year, according to an analysis published Thursday by the non-profit Kaiser Family Foundation. The Food and Drug Administration on Monday approved the company's drug, the first medication cleared by U.S. regulators to slow cognitive decline in people living with Alzheimer's and the first new medicine for the disease in nearly two decades. The biotech company said it is charging $56,000 for an annual course of the new treatment, higher than the $10,000 to $25,000 price some Wall Street analysts were expecting. That's the wholesale price, and the out-of-pocket cost patients will actually pay will depend on their health coverage. Alzheimer's disease is estimated to affect more than 6 million Americans, the vast majority of whom are age 65 and older. Biogen has said it expects about 80% of Alzheimer's patients to be covered by Medicare, the federal health insurance program for the elderly. It...
    Marcos Elihu Castillo Ramirez | iStock | Getty Images Medicare may not be top of mind if you're nearing the eligibility age of 65 and already have health insurance through your employer. However, it probably deserves some attention. While not everyone must sign up, many are required to enroll unless they want to face life-lasting late-enrollment penalties. "The biggest mistake ... is to assume that you don't need Medicare and to miss enrolling in it when you should have," said Danielle Roberts, co-founder of insurance firm Boomer Benefits. More from Personal Finance:How to get $100,000 in annual tax-free income in retirementStrategies to reduce taxes you'll pay on retirement accountsA Roth IRA could help you buy a home. Here’s what to know Roughly 10 million workers are in the 65-and-older crowd, or 17.9% of that age group, according to the most recent data from the Bureau of Labor Statistics. It's a share that has been steadily growing over the years, although the Covid-induced economic crisis pushed some workers out of the labor force, either via layoffs or early retirements. In January...
    Millions of seniors enrolled in Medicare would miss out on the expanded access to in-home care benefits proposed in the Biden administration's $400 billion plan to boost the caregiving industry. The administration’s $2 trillion infrastructure package, called the American Jobs Plan, would use $400 billion to expand access to in-home care under Medicaid, the government insurance program for the very poor and people with disabilities, in a way that meant is to support well-paying jobs for caregivers. But the plan does not address the lack of coverage for many in-home care services under Medicare, the government-funded health insurance program for those age 65 and older. President Joe Biden campaigned on a similar plan to spend even more money, $50 billion more, to shore up Medicaid funding for states. “It will be a huge benefit to a lot of people, but at the same time, it is our hope that Medicare becomes part of that conversation,” said David Lipschutz, associate director of the Center for Medicare Advocacy. “It would include Medicaid eligibility criteria, which would leave a good...
    U.S. Senator Bernie SandersJemal Countess | Getty Images Sen. Bernie Sanders hopes to include a Medicare expansion in Democrats' upcoming economic recovery plan. The Vermont independent and Senate Budget Committee chair hopes to lower the eligibility age for coverage to either 60 or 55 from the current 65, a Sanders aide confirmed Friday. Sanders also wants to ensure Medicare covers dental visits and glasses, among other medical needs. He aims to fund the coverage expansion by allowing Medicare to negotiate prices directly with drug companies. Politico first reported the senator's plans. Sanders wants to include the provision in Democrats' next budget reconciliation bill, which can pass with no Republican votes in the Senate split 50-50 by party. The party may have to pass part or all of its sprawling infrastructure and economic recovery package — which could top $3 trillion — through the process. The GOP has generally opposed the growth of government-run health-care programs. President Joe Biden plans to unveil more details about his infrastructure proposal during a speech in Pittsburgh next week. Democrats want to address not only...
    fstop123 If you've discovered your 2021 Medicare Advantage Plan is not a good fit for you, now is the time to do something about it. Through the end of March, Advantage enrollees can either drop their plan and return to basic Medicare (Part A hospital coverage and Part B outpatient care) or switch to another Advantage Plan. If the latter is your preference, there are a few things to watch for before you finalize your choice, experts say. For starters, you generally won't get another chance in 2021 to change your mind.VIDEO2:5702:57Masks could be optional by the end of the year, U.S. doctor saysStreet Signs Asia"Be aware that you are now locked into that plan for the rest of the year unless you [qualify] for a special election period," said Danielle Roberts, co-founder of insurance firm Boomer Benefits. "Considering the lock-in period, due diligence is required," Roberts said.  Roughly 63 million individuals are enrolled in Medicare, the majority of whom are age 65 or older, according to government data. The remainder are younger with disabilities or individuals with end-stage renal...
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