UPDATED 4.4.2024
The Medicare income limits 2024 effect about 7% of Medicare beneficiaries. Each year, the Social Security Administration determines the income limit that the IRMAA is based on. It’s crucial to stay up to date on the annual income limits weather you are an agent or a beneficiary. In this post, we go over Medicare income limits for 2024 and how they can impact beneficiaries.
The income limits come into play with both Medicare Part B & Part D. The limits are used to determine if an individual pays either the standard premium amounts or a higher income-based premium for Part B & Part D.
Beneficiaries who earn more than the Medicare income limit have to pay an IRMAA for their Part B & Part D coverage. In 2024, the income limit is $103,000 for an individual. The income limit is $206,000 per couple.
Medicare Part A is free to most beneficiaries and no IRMAA applies.
Part B of Medicare is income based as most beneficiaries have to pay for it, with the exception of those who qualify for “Extra Help“.
Beneficiaries of Medicare Part C (Medicare Advantage Plans) only have to pay the IRMAA when the plan they choose includes prescription drug coverage. Few plans called MA only do not include prescription drug coverage and therefore, the IRMAA does not apply to those plans.
The IRMAA does apply to Medicare Part D (PDP) plans.
For 2024, the income limit is based on the beneficiaries’ 2022 tax return. In other words, each year the IRMAA is based on the tax return from 2 years prior. Medicare uses the MAGI (modified adjusted gross income) to determine who pays the IRMAA.
Although beneficiaries don’t see this amount on their tax return, they can find it by adding their income after deductions to any tax-free interest they earned.
For 2024, there is more than one income threshold used to determine the IRMAA amount each individual pays for their Part B and Part D coverage. Here are the Part B & Part D IRMAA amounts:
Single
|
Married Filing Jointly
|
Married Filing Separately
|
Part B Premium
|
Part D IRMAA
|
---|---|---|---|---|
$103,000 or less
|
$206,000 or less
|
$103,000 or less
|
$174.70
|
$0 + plan premium
|
$103,000 up to $129,000
|
$206,000 up to $258,000
|
N/A
|
$244.60
|
$12.90 + plan premium
|
$129,000 up to $161,000
|
$258,000 up to $322,000
|
N/A
|
$349.40
|
$33.30 + plan premium
|
$161,000 up to $193,000
|
$322,000 up to $386,000
|
N/A
|
$454.20
|
$53.80 + plan premium
|
$193,000 less than $500,000
|
$386,000 less than $750,000
|
$103,000 less than $397,000
|
$559.00
|
$74.20 + plan premium
|
$500,000 or above
|
$750,000 or more
|
$397,000 or more
|
$594.00
|
$81.00 + plan premium
|
Most people pay the standard Medicare Part B premium rate. The premium rate for Part D varies according to the plan selected. Beneficiaries with higher incomes pay extra for both Part B and Part D.
IRMAAs for Part B and Part D are automatically taken from their Social Security or Railroad Retirement Board benefits. Beneficiaries who do not receive monthly benefit payments receive a bill from Medicare.
For beneficiaries subject to an IRMAA for Medicare Part B & Part D, there are ways to potentially lower your MAGI and reduce premiums. Beneficiaries can consult their accountant and or financial advisor to help lower taxable income amounts.
Because the Social Security Administration bases their IRMAA determination on income reported on tax returns from 2 years prior, beneficiaries may have had a reduction in income. There are some life events that can cause a reduction in income, these include:
When beneficiaries receive notice of an IRMAA, they also receive information that explains how to request a new initial determination.
If Social Security receives a new initial determination, they may revise the amount of the IRMAA or dismiss it all together. Beneficiaries can request a redetermination by either scheduling an appointment with their local Social Security office or by submitting the following form:
beneficiaries must provide documentation of correct income or life-changing event that affected their income level in a negative way.
Beneficiaries can also call the representatives at SSA +1 800-772-1213 and request help lowering their IRMAA. Explain that Social Security used outdated or incorrect information when calculating the IRMAA.
In this post, we discuss short-term vs long-term care coverage. Most people have heard of long-term care insurance. This coverage pays the cost of care when a beneficiary has a chronic illness, disability, or injury. This coverage also helps individuals who require assistance due to the effects of aging. In general, long-term care insurance helps individuals pay the costs of custodial and personal care. Some people have never heard of short-term care which provides much of the same coverage for a shorter period of time.
Long-term care insurance provides help paying for custodial care for extended periods of time. The coverage this insurance provides is not provided by either Medicare or other health insurance policies.
Long-term care involves a variety of services designed to meet a person’s health or personal care needs when they can no longer perform everyday activities.
The companies that provide this benefit make money by investing the customer premiums they receive. Due to interest rates going down in recent years, these insurance carriers have lower stream of income. They are also losing revenue due to a rising number of beneficiary claims. This has caused a rise in cost and a lessening of benefits for those who wish to purchase a long-term care plan. Companies have also implemented a more difficult pre-qualification process for those who want to purchase coverage.
For most long-term care policy applications, the cutoff age is 79, while the cutoff age for short-term policies is 89. Long-term care policies have an elimination period, which is a specific number of days that the beneficiary pays for care until the policy starts to pay. A common elimination period for the plans to pay is 90 days.
Many individuals receive long-term care at home by either family members, friends, or neighbors. In most instances, home-based care involves help with “activities of daily living” which include bathing, dressing, eating, taking medications, and supervision for personal safety. This care is sometimes supplemented by paid formal caregivers. The professionals that provide these services include nurses, home health aides, and other professional care givers.
Individuals may receive some long-term care services in their community. There are adult day care services or senior center which may be equipped to provide some degree of care including meals, social activities, personal care, activities or transportation.
Residential facilities: assisted living or nursing homes also provide long -term care. Some facilities provide housing and housekeeping only. Others provide personal care, recreational activities, meals, and medical care.
Short-term care insurance is very similar to long -term care in what it covers, Policies typically cover home care, assisted living, and nursing home care for those who cannot care for themselves. Recovery care is another name for short-term care, because it provides coverage for 12 months or less.
In some instances, short-term care insurance is used to cover gaps in Medicare coverage as a less expensive alternative to long-term care. Short-term care insurance is also a good choice to offset some long-term care expenses before long-term care kicks in.
Short-term care insurance does not usually have an elimination period; it generally pays benefits immediately. The cost for short-term insurance is less than log-term because it covers the beneficiary for much less time. Coverage options vary from days up to a year.
It’s easier for beneficiaries to qualify for short-term care insurance, there is no medical exam required. Some companies may ask a few yes-or-no questions. For those who are rejected or cannot afford a long-term care policy, short-term policies offer an alternative.
Important: policy coverage differs by state and some coverage options are only available in specific states.
Questions and requests
There are some big changes coming to Medicare Part D (PDP) plans. This includes the discontinuation of the Medicare donut hole 2025. In January 2024, CMS released a draft of the Medicare Part D payment policies.
The new design for prescription coverage will consist of three phases of coverage.
As you can see, there is no donut hole (coverage gap) phase. It is merged with the “Standard Coverage Phase”.
The changes in payment liability
This new plan design includes changes in payment liability of enrollees, plan sponsors, drug manufacturers and CMS.
The drug plans will pay similar amounts as in previous years, although a larger part of their responsibility starts much earlier than in previous years. In other words, drug plans will pay more money on more enrollees overall.
It is expected that the added costs drug companies incur may result in either higher Part D plan premiums or possibly spread across other MAPD plan costs.
Questions and requests
Anyone considering going into the field of insurance sales needs to understand why insurance agents fail. Hopefully our tips will help you avoid some of the pitfalls of insurance sales. Although insurance sales can be a profitable business, many new agents do not make if past the first year. There is a lot more to it than just getting your license and waiting for the checks to roll in.
The most important thing agents need to keep in mind is that they are there to provide a service to their clients not just to make money. Unfortunately, too many agents are focused on how much they will make instead of how to provide a valuable service that people need. When the only objective is to make money, many agents fail. It is obvious to the clients when a person has their best interest at heart, and they appreciate that. When they find a good agent, they are more than happy to spread the word to their friends, co-workers or relatives. The same is true if they are unhappy. with the service they receive. Unhappy clients make is difficult to survive in the industry for the long term.
Many first-time agents think once they have their license, they will be making lots of money. In reality, it is not easy to get into the field of insurance sales and it can take a few years before you really start to see a large paycheck. The business is built one sale at a time and good agents keep their current clients happy as well as work at expanding their book every year. It is a good idea to set small goals that lead to reaching larger ones. There are many carrier certifications for products like Medicare, a newer agent may not be aware of the time and effort it takes to get set up to offer the number of carriers they need or to complete all the CMS certifications. They also need to know, these are things that they will need to complete annually in order to be ready to sell. It can be a bit overwhelming when first starting out.
It is imperative to build a business plan. Decide where you are going to work (home or in an office space). Get the proper tools to be successful, (computer, phone copier office supplies). Organize yourself, think about how you are going to track commissions and clients. Prepare a filing system and how you are going to build your book of business.
There is no way to be successful in insurance sales if you don’t build good relationships with your clients. We cannot stress this enough! When your client has a question about a product you offer, your name needs to come to their mind. If they do not know you are there for any questions or concerns they have, they may ask someone else and then you lose that business. Be available to them as much as possible. Do not let another agent do the job you want.
The most important way to build a relationship is to understand the client’s needs and do your best to provide what they want. It is great to focus on the sale but if the client is unhappy, you lose not only the sale but the referral. That can cost you in the end. Great customer service promotes long-lasting relationships. If you don’t have these, you have no book of business.
As an insurance agent, you may have licenses to sell several different products. When getting started, it is best to focus on one type of product. It is important that you understand any product you are trying to sell to someone else very well. This way you can answer any questions that come up and ensure that the client gets the product that best fits their needs.
It is easy to get carried away and want to offer every possible product. It is best to set yourself up as an expert in an area and add other products once you are ready.
Finding good leads is one of the biggest issues insurance agents face. Good leads usually do not come cheap and cheap leads don’t usually result in a large number of sales and require a lot of work and multiple attempts before a sale is made. Agents working leads need to be able to handle rejection and even anger at times. In other words, it costs money to make money. Good leads result in more sales but you need the capital to purchase them in the first place. The frustration of bad leads can cause an otherwise good agent to struggle and even give up on their business.
Not staying up to date with the tools that are available can keep an agent from growing. In this industry there are always changes. There are new tools introduced that make life easier every day. This can save hours every day and give you the option to meet more potential clients and in turn make more sales. remaining aware of what’s going on will help agents stay current and provide the best service to clients.
Technology adds so many options to reach a greater audience than it did just a few years ago. Things like Facebook, zoom meetings and other social media platforms allow agents to reach a wide audience. Employing these tools can make a huge difference in getting your name and business out in front of an audience. the more people know about your business the better chance you have a being recognized as an authority on the products you offer and your chances of making a sale increase.
It is imperative to build relationships with other professionals in the business. They provide a wealth of information and experiences, tips and ideas that can be invaluable. Other agents provide insights as to what works and does not and can save you from learning the hard way. Other agents know how difficult it is to get started and can provide encouragement. They can explain which tools are worth the time and which ones are not. Networking also includes other professionals in other fields that may have leads to send your way.
Agents need support that goes beyond their network of professionals. A good mentor or upline is a great way to get advice who has your best interest at heart. These are people who are willing to invest time into your career and want you to succeed. A few things uplines can help you with are, contracting, answering any questions about carriers, products or sale. They also might help you figure out the best business plan for your personal sales style. A mentor is a great asset to have especially if they have been in the business a long time and have had success.
The support of friends and family helps ensure agents do not give up when they are frustrated and may also provide guidance when needed. There are many moving parts when it comes to the insurance industry, if an agent can navigate them and remain focused, positive, educated and compliant, they can have a successful career.
Medicare Extra Help is a federal program put in place to help individuals whose income and financial resources are limited. It provides help for those who qualify to pay the costs of their Medicare prescription drugs. The subsidies provided by this program cover premiums, deductibles, as well as co-pays for the costs of Medicare prescription drug plans (Part D). To qualify for this program, individuals must meet the income criteria set by the federal government each year. In this post, we will go over the Extra Help income limits 2024.
To enroll in Original Medicare, individuals must either be a United States citizen or a legal resident for at least 5 years. In turn, to enroll in Medicare’s Extra Help program, an individual must qualify for Medicare.
Beneficiaries must be enrolled in at least one part of original Medicare. They do not need to enroll in Part D before applying for Extra help. If the beneficiary does not currently have Part D coverage, they are automatically enrolled in one once the Extra Help is approved.
Individuals cannot exceed the asset and income limits to qualify for Extra Help. If an individual is eligible for Medicaid or any of the Medicare Savings Programs, they automatically qualify for Extra Help. Individuals do not have to apply for Extra Help if they automatically qualify. They will be enrolled in the Extra Help program as well as a Medicare drug plan.
Important: the Extra Help income limits are based on the adjusted gross income reported on the individual’s tax return. Governmental assistance such as food stamps, housing or home energy assistance do not negatively impact your acceptance.
Marital Rights | Resource Limit 2024 | Resource Limit with Burial Expenses 2024 | Extra Help Income Limit 2024 |
---|---|---|---|
Single | $17,220 | an additional $1,500 | $22,590 |
Married | $34,360 | an additional $3,000 | $34,360 |
In some instances, individuals with income that exceeds the limit may still qualify for Extra Help. The following circumstances may allow for special consideration of Extra Help acceptance:
Because resource limits also count towards determining eligibility, we listed a few examples of what does and does not count below.
These are some things that count as resources:
1.Money in Checking or savings accounts
2.Real estate that does not include a primary residence.
3. Stocks, Bonds & Mutual funds, IRAs or cash
These are some things that DO NOT count as resources:
1. An individual’s primary residence
2. Any vehicles owned by the individual
3. Expense set aside for the individual’s burial; this includes interest on money set aside for burial
4. Personal belongings
For a comprehensive list of what does and does not qualify, contact the local Social Security office.
After the application is submitted, Social Security sends a letter to let the beneficiary know if they qualify and what level of Extra Help they will receive.
Extra Help is crucial for individuals who require assistance with the costs of prescription drugs. Understanding the requirements is the first step to finding the necessary help to ensure the needed coverage is received.
If you are a Medicare agent, one thing that you are always looking for is Medicare leads. There are many places you can find leads. The most valuable leads are T-65 leads. These leads are the best to get because insurance carriers pay the highest commissions for new to Medicare enrollments.
Individuals turning 65 are also a great lead to get because an agent that does their job well, now has a new client on his books for quite a long time to come. As long as the agent provides useful guidance to the beneficiary and ensures they are happy with their plan choice, they can develop a mutually beneficial relationship.
Before you contact anyone, it is very important to understand the CMS rules of how to do it. Click here for details.
In reality, many leads sources like online leads, inbound calls and pre-set leads do not produce many T-65 prospects. What they do provide is the contact information for current Medicare beneficiaries. In reality, many of the people already have an agent and are not seeking guidance, although agents may find individuals who are unhappy with their current plan and/or their agent. If you find a valid enrollment period, you can provide the assistance and coverage that the beneficiary is looking for.
If the potential client decides to enlist your assistance as an agent, you may need them to list you as their AOR. Some Insurnace carriers allow clients to designate an agent as AOR even if they do not write a plan at that time. When this happens, you have a client added to your book and can help them change their plan at a later date if it is appropriate. Learn how to make AOR changes.
A great way to meet several individuals turning 65 is by hosting an educational event. Our seminar selling program is an effective tool to provide needed information to the people who need it. This is truly a turn-key program that guarantees agents get in front of T-65 leads. Find out more about the seminar program.
Watch a video on the T-65 seminar program
If you decide to host an educational event, it is important to follow CMS guidelines for hosting an educational event. If you decide to do a sales event, there are specific guidelines to follow as well.
Additionally, Crowe agents can access to a preset lead program. This program provides leads at a very good close ratio.
Agents who put in the effort to ensure their clients are happy with their coverage choices can easily earn referrals. In order to ensure clients are happy, agents must be in contact with their clients and go over new plan options each year during the AEP. As well as other times during the year to maintain the relationship and ensure clients are happy and do not seek answers to Medicare questions elsewhere.
It is a great idea to introduce yourself to healthcare professionals, doctors and clinics in your area as well as other professionals who work with clients that may need your advice. Once they know you and are aware of the services you provide, it is easy to build a partnership and open doors to new lead prospects. This will help establish you as a knowledgeable resource for anyone who needs advice.
If you have a client that needs a Medicare plan outside their IEP, you need a Medicare special enrollment period to get them the coverage they need. In this post, we go over the different special enrollment periods and how clients qualify.
Medicare Special Enrollment Periods are designated times outside of the IEP (Initial Enrollment Period) or the AEP (Annual Enrollment Period) when individuals can make changes to their Medicare coverage. These periods are only allowed under specific circumstances. The SEP provides an opportunity for individuals to enroll in a Medicare plan or change their existing coverage.
There are several life events that provide Medicare beneficiaries an opportunity for a Special Enrollment Period. We have listed some of the more common events that qualifying for an SEP below.
If a beneficiary moves to a new location that isn’t served by their current Medicare plan, they are eligible for an SEP.
When an employee or their spouse loses their existing employer-sponsored health coverage, they qualify for a SEP to enroll in Medicare.
If a beneficiary qualifies for either their state’s Extra Help program or Medicaid, they qualify for an SEP and have the ability to change their plan as much as 1 time per quarter for the first 3 quarters of each year.
If your client qualifies for a Special Enrollment Period, it’s essential to act promptly to make sure they get the coverage they need within the time limits for the SEP. Here’s what you need to know to use the SEPs:
Know the deadlines
Each Special Enrollment Period has a specific deadline, so be sure to understand when the enrollment window opens and closes.
Review all plan options
Agents should take the time to review their client’s Medicare coverage options carefully. Consider factors such as premiums, deductibles, copays, network of providers as well as prescription drug coverage (when applicable) to find the plan that best fits their personal needs.
We provide many benefits to all our agents, including free quoting & enrollment tools. These quote engines make it easy to look at the top plans side by side for your clients review.
Learn about Connecture & Sunfire
Explore Additional Benefits
Medicare Advantage plans offer additional benefits beyond Original Medicare, such as dental, vision, otc benefits, and much more. Show the client a side by side comparison of the top plans and see e which one fits their needs.
Stay Informed
Keep yourself informed about changes to Medicare rules and regulations, as well as any updates to coverage options. Staying informed helps agents remain compliant and provide the best advice to their clients.
Medicare Special Enrollment Periods are valuable opportunities for individuals to changes their coverage outside of typical enrollment periods. By understanding who qualifies for a Special Enrollment Period and how to use it, you ensure that clients have the coverage they need.
It is important to review all the options available to your clients and be sure they make an informed decision. Click here to learn why you should contract with multiple Medicare carriers.
If you are a Medicare agent, it is a good idea to consider adding hospital indemnity plans to your product offerings. In the event someone becomes ill and is hospitalized, these plans provide clients an additional layer of coverage. Hospital Indemnity insurance provides policyholders a chance to protect their savings and lower their out-of-pocket costs.
It is important to note; when it comes to hospitalization, there are limits to what Medicare Advantage or Medicare supplement plans cover. When that happens, a hospital indemnity plan can provide an extra peace of mind for beneficiaries.
Hospital indemnity insurance is additional health coverage that individuals can purchase and add an extra layer of protection. These plans have a monthly premium like other insurance coverage. If the beneficiary has to stay in the hospital, they receive a fixed payment amount they can use to cover any out-of-pocket costs members incur. Beneficiaries can use the payment to cover whatever they need such as, deductibles, co-pays, medication or for things like rehabilitation or home care expenses.
Unlike other insurance plans, hospital indemnity policies send payments directly to the policyholder. This gives beneficiaries more freedom to choose where their money goes. A good hospital indemnity plan should be easy to get, has no deductible or pre-certification and is not difficult to get payments from when you need them.
The coverage provided by a hospital indemnity plan depends on the plan chosen and the riders added. We have listed a few basic things these plans cover below.
Additionally, there are plans that offer coverage of all or some of the items listed below.
In most cases, there is a 30 day waiting period for illnesses that result in a hospital stay. The waiting period varies by carrier and the plan chosen. However, some plans will not have a waiting period for hospitalization for an accidental injury. It is important that enrollees understand all benefits of their plan choice, including waiting periods, before they decide on a policy.
Hospital indemnity plans charge a monthly premium like any other health insurance. The cost depends on several factors including the plan & company choice, as well as age, gender and location.
It is important to consider if hospital indemnity insurance is worth getting or not. The beneficiary needs to consider what their current health plan covers, their out-of-pocket cost including deductibles and co-pays and co-insurance and the cost for an average hospital stay. They also have to take into account their personal financial situation and if they can better afford the coverage or payment for the out-of-pocket expenses.
Hospital indemnity plans provide a great opportunity for Medicare agents to make a cross sale. Many of your current clients could benefit by purchasing one of these plans. Clients who enroll in a Medicare advantage plan without a premium ($0) may want to add an affordable hospital indemnity plan that adds that extra layer of protection. Their Medicare advantage plan may leave them paying high co-pays or deductible for a hospitalization. Be sure to go over their budget and possible value of adding the coverage.
Agents should go over the average cost of a hospital stay and the possible out-of-pocket cost as compared to the cost of adding a hospital indemnity plan. Do the Math for them. Make sure it is a viable option before they sign up.
It is important to remember, there are rules to follow when you offer a hospital indemnity plan to a client. Agents cannot mention this or any other product at a Medicare appointment if it is not included on the scope of appointment.
If you are either getting close to your 65th birthday or are in Medicare sales, you should understand the Medicare enrollment dates.
Enrolling in Medicare can be confusing for beneficiaries and understanding the enrollment process is crucial to access the benefits your clients need. From IEPs to SEPs, the Medicare system is designed to accommodate various life circumstances. In this post, we go over several of the Medicare enrollment periods and how beneficiaries can use them to get the healthcare coverage they need.
The Initial Enrollment Period (IEP) is the first opportunity for most individuals to enroll in Medicare. IEP is a 7 month time frame that starts 3 months before the month of your 65th birthday, includes your birthday month, and ends three months after the month you turn 65. During this period, individuals can sign up for Medicare Part A (Hospital Insurance) and Part B (Medical Insurance) if they choose to.
Special Enrollment Periods (SEPs) are designated times outside the initial enrollment period when individuals can sign up for Medicare due to specific qualifying events. Some of the most common qualifying events include:
If a beneficiary is covered under a group health plan through their own or their spouse’s current employment, they are eligible for an SEP when they lose the employer coverage.
When a client moves out of their plan’s service area, they qualify for an SEP to enroll in a new Medicare plan.
Individuals who become eligible for Extra Help with Medicare prescription drug costs qualify for an SEP to enroll in a Medicare Prescription Drug Plan (Part D) or Medicare Advantage Plan (Part C) that includes prescription drug coverage.
For individuals who miss their initial enrollment period, the General Enrollment Period (GEP) provides another chance to enroll in Medicare. The GEP runs each year from January 1st to March 31st. Coverage obtained during this period begins the first of the month after you enroll. it’s important to note, beneficiaries who wait until the GEP may have to pay a late enrollment penalty.
The Annual Enrollment Period (AEP), also known as the Medicare Open Enrollment Period, runs each year from October 15th until December 7th. During this time, Medicare beneficiaries can make changes to their Medicare coverage. This includes; switching from Original Medicare and Medicare Advantage plans, as well as joining, dropping, or switching prescription drug plans.
Understanding Medicare enrollment dates is essential for to ensure beneficiaries have access to the healthcare coverage they need. By familiarizing yourself with the various enrollment periods and their significance, you can navigate the Medicare system with confidence and peace of mind. Remember, staying informed and proactive is key to making the most of your Medicare enrollments.
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