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Heathcare Expenses - Calculating Insurance Premiums Beyond Calculated Value

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Last Post by NC 3 years ago

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(@nc-cpl)

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Topic starter September 15, 2023 1:48 pm

Need clarification here. You put Supplemental and Part D premiums in the Insurance Premiums Beyond Calculated Values cell, but, if you also have a large IRMAA surcharge for Part D that you're factoring into this cell, how does PRC adjust for this when your income drops and the IRMA surcharge drops (or goes away entirely)? Seem like if you add it into this cell, its going to keep including the high IRMAA surcharge even after it goes away, or am I missing something?

Why I'm asking: I'm trying to calculate healthcare costs and will be going on Medicare before end of this year. We will also be hit with a very large IRMAA surcharge in 2024 and 2025. If I include that extra cost in the Insurance Premiums Beyond Calculated Values cell but then it drops down in 2026, how will PRC know that?

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Stuart Matthews

(@smatthews51)

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September 15, 2023 7:46 pm

@nc-cpl You should NOT put Part D premiums in the Insurance Premiums Beyond Calculated Value field. If you check the box that tells PRC to calculate your Medicare premiums, that includes both Part B and Part D and any associated IRMAA charges (please see the comment in that field).

Stuart

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(@nc-cpl)

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Topic starter September 17, 2023 9:22 am

@smatthews51 OK, so by having PRC automatically calculate both Part B AND Part D premiums, you would EITHER be going with A) a Med Supp/Medigap plan where you need to tack on a drug plan, OR B) a Med Advantage plan that does NOT offer drug coverage (thus requiring a separate Part D plan), since it's going to add in PART D costs regardless, correct?

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James Mittel

(@jj_ejm009_jj0)

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September 17, 2023 1:20 pm

Medicare part D premiums are not defined like part B. The IRMAA related increase to the basic part D premium is known but the base amount is plan provider specific. How does Pralana know what to use. The hover help on "Auto-Calculate Medicare Premiums" indicates it is auto-calculated, not quite sure how ???

https://www.medicare.gov/drug-coverage-part-d/costs-for-medicare-drug-coverage/monthly-premium-for-drug-plans

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(@nc-cpl)

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Topic starter September 17, 2023 3:07 pm

@jj_ejm009_jj0 Jim - was wondering same thing myself because my calculated premium for 2024 (after adding in IRMAA) is different than what PRC is autocalculating for me. Not by a huge amount but different nonetheless.

Any additional insight on this Stuart?

This post was modified 3 years ago 2 times by NC

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Stuart Matthews

(@smatthews51)

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September 19, 2023 1:52 pm

@nc-cpl PRC is implementing the algorithm for Part B/D, including IRMAA, but if your specific plans have additional premiums then those are what go into the "Insurance premiums above the calculated value" field.

Stuart

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Stuart Matthews

(@smatthews51)

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Posts: 618

September 19, 2023 1:56 pm

@jj_ejm009_jj0 PRC automatically deals with the IRMAA-related costs of Part D (if the box is checked) but the base amount goes into the "Insurance premiums above the calculated value" field.

Stuart

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Stuart Matthews

(@smatthews51)

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September 19, 2023 1:58 pm

@nc-cpl Please see my other responses. Thanks.

Stuart

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(@nc-cpl)

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Topic starter September 20, 2023 10:05 am

@smatthews51 So to summarize, Part B base premium ($164.20 for 2023), any Part B IRMAA and any PART D IRMAA are all that is included in the auto-calculated formula.

Med Supp plan premium, Part D plan premium (both dependent on what Part B plan a person chooses), and any dental and/or vision plan premiums are put in the "Insurance premiums above the calculated value" field.

Any drug copays, deductibles, and other estimated OOP costs go into the OOP field.

Is this correct?

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