What is covered by Medicare? Ask the lawyer - The Daily Breeze

Q: I am going to be eligible for Medicare soon. What are parts A, B and D? Also I keep hearing about a supplement, letter G.

H.D., Torrance

Ron Sokol

A: Medicare is our national health insurance program, which began in 1965 and today is administered by the Centers for Medicare and Medicaid Services. The initials you mention are different categories of Medicare coverage. Part A is hospital insurance. This includes inpatient hospital care, a skilled nursing facility, hospice, lab tests, surgery and home health care. Part B covers the medical insurance, such as doctor services, outpatient care, durable medical equipment, home health care and some preventive services. Part D is the prescription drug plan. Part G is indeed supplemental coverage, not your primary coverage, but addresses gaps in a Medicare policy. It is not the only supplement to consider.

Bottom line: It is most prudent to consult with a knowledgeable professional about Medicare, so you can address the questions you have, including about premiums that may come into play. Note that the person you consult with may be able to secure coverage from a number of carriers, but not all. Ask what companies the professional works with, and then consider directly contacting one or more others directly if you want to compare what they can provide and at what cost.

Q: I have Medicare A and B. I was quoted a standard rate for B. In the “fine print” is language that the amount due per month may not be the actual total based on my reported income. After signing up, getting my Medicare B card and canceling my prior insurance, a letter just arrived that indicates my premium is increasing quite a bit because of my and my wife’s income on our joint return. Can I challenge this?

S.R., Long Beach

A: The premium for Part B Medicare coverage can be higher than the “standard rate” if your income is high enough. You are then required to pay an income-related monthly adjustment amount (known as an IRMMA). In evaluating your Part B premium, Medicare can obtain information from the IRS that shows your modified adjusted gross income (your adjusted gross income plus certain amounts of income that are not taxable). Based on that figure, there is a formula by which the Part B premium can be higher than the standard rate.

You can file for redetermination if you believe the calculation is erroneous. Also, if you have a life-changing event (such as loss of income or divorce), you may refile or file for redetermination. There is Form SSA-44, which you can find online. Then, if you do not agree with the redetermination, there is a formalized appeal process. You can find information on the appeal process on the U.S. Department of Health and Human Services website, hhs.gov, or by searching “IRMMA Medicare appeal” in your browser.

Ron Sokol has been a practicing attorney for over 35 years, and has also served many times as a judge pro tem, mediator, and arbitrator. It is important to keep in mind that this column presents a summary of the law, and is not to be treated or considered legal advice, let alone a substitute for actual consultation with a qualified professional.