Who Qualifies for Medicare Premium Refund and How to Get It?

Medicare premiums vary depending on the type of Medicare coverage you have. Most people do not pay a premium for Medicare Part A. However, Medicare Part B comes with a premium, and so does Medicare Part C and D. As such, seniors should be mindful of the amount they should be paying each month for their premiums. There may be instances where you can receive a refund of your premium, and this article will review some of these important scenarios.

What is a Medicare premium refund?

Medicare may issue a monthly premium refund under certain conditions. Generally, refunds are issued due to overpayments, such as the death of a Medicare beneficiary or overpayment due to being charged incorrectly by Medicare. Examples of such charges include an inaccurate late enrollment penalty or a premium surcharge.

ADVERTISEMENT

Who qualifies for a Medicare premium refund?

There are several scenarios in which a Medicare beneficiary may be eligible for a premium refund. Some common scenarios are listed below.

  • Refund of late enrollment penalties. If you were incorrectly charged a late enrollment penalty when you were eligible for a special enrollment, you may be eligible for a refund.
  • Refunds due to premium billing errors. Sometimes billing errors happen. If you think you are being charged more than the standard amount or the adjustment based on your income is incorrect, you may consider requesting a refund.
  • Removal of premium surcharges. Medicare Part B provides medical insurance and Medicare Part D covers prescription drugs. Both of these coverage options require you to pay a monthly plan premium. If your income is above a certain amount, you may pay an extra amount each month in addition to your Medicare Part B or D premium called an income-related monthly adjustment amount (IRMAA). If your income changed and you were charged this surcharge incorrectly, you may be eligible for a refund.
  • Deceased beneficiary. An overpayment could also occur if the Medicare beneficiary received any Social Security benefits while alive. Oftentimes, payment for Medicare coverage is taken out of your Social Security benefits in advance. This means if the policyholder passed away in July, the Social Security benefit they received that same month already includes the deducted Medicare premium cost from their benefit that applies to the month of August.

How to get a Medicare premium refund

To apply for a refund, you have to follow the steps outlined by the Social Security Administration (SSA). You can contact the SSA directly, and a representative will be able to assist you with submitting the claim. Be sure to complete all required forms in their entirety and be prepared to provide proof of overpayment with documentation such as receipts, or bank statements.

If you are filing a claim on behalf of a deceased Medicare beneficiary, be sure to submit your claim within 12 months after the date of their passing. If you fail to file your claim in this 12-month window, you may lose out on receiving your Medicare premium overpayment refund. This applies to both loved ones and family members as well as personal or legal representatives acting on the deceased beneficiary’s behalf.

Filing an appeal

If Medicare does not approve your refund request, you can file an appeal. The appeals process varies based on the type of coverage you have, but in general, there are five levels to the appeals process. You can continue to advance your appeal through all five stages until a final decision is made at the 5th level. For more information on filing an appeal, you can visit the Centers for Medicare and Medicaid Services.

ADVERTISEMENT

How are Medicare premiums calculated?

The Medicare program consists of several different parts, and the amount of your monthly Medicare premiums varies based on your coverage. The monthly premium for Medicare Part A for most people is $0 because Medicare taxes were paid while working. For those who are not eligible to receive Medicare Part A without a premium, the premium will be $278 or $505 each month and is based on how long you or your spouse worked and paid Medicare taxes. Additionally, you will need to be enrolled in Medicare Part B to purchase Part A.

Calculating Medicare premiums becomes more complex if you have a higher total adjusted gross income. The premium for Medicare Part B in 2024 will be at least $174.70 per month. For individuals with Medicare Part B, you may be subject to an income-related monthly adjustment amount and pay higher premiums. If when you filed your taxes in 2022 your modified adjusted gross income was more than $103,000 filing individually and more than $206,000 filing jointly, you will likely pay more than the base Part B premium of $174.70 per month.

Medicare prescription drug coverage premiums for Medicare Part D plans vary based on the plan you have chosen and are also subject to an income-related monthly adjustment amount surcharge. Additionally, you could also be charged a penalty for not enrolling in Medicare Part D when you initially obtained Medicare coverage. This penalty will be added to your premium each month.

Individuals with a Medicare Advantage Plan, also known as Medicare Part C, will have various premiums based on where you live, the policy purchased, and other factors.

Common issues and how to avoid overpayments

Obtaining a Medicare premium refund can be challenging and requires several steps. Listed below are a few considerations to help you avoid Medicare overpayments.

  1. Monitor your monthly premiums. Monitoring the amount you pay for your Medicare premium each month. If you notice any unexpected changes to your premium, contact your insurance company.
  2. Ensure your income data is accurate. Update your income information each year so that your premiums for Medicare Part B and Medicare Part D are accurate.
  3. Avoid late penalties. If you do not enroll in Medicare Part D when you are eligible, maintain proof of your other eligible medical insurance to ensure you are not charged a late penalty if you decide to enroll in Medicare Part D later. If you enroll in Medicare Part B, it is best to enroll during a Special Enrollment Period to avoid late penalties.

Requesting a Medicare premium requires meeting specific criteria, and it is important to have accurate and complete documentation justifying your request. Review your statements regularly and contact Medicare as soon as possible if you notice any discrepancies.

FAQ

ADVERTISEMENT
Key takeaways:

ADVERTISEMENT

Leave a reply

Your email will not be published. All fields are required.

Comments

M. FURMAN
prefix 4 months ago
Medicare advised me in a letter dated November 2022 that I was due a refund for Medicare Part B premiums. Medicare identified the amount of the refund in the letter. Though Medicare has all of the up dated information necessary to document the amount of the refund, the refund has not been received. Repeated inquires to the SSA has not had any success. In the most recent effort I was informed that an inquiry was submitted to the Seattle office of the Center for Medicare and Medicaid, but there is apparently some undefined obstacle and no one in SSA is interested in resolving. I have been attempting to obtain the refund for a year-and-a-half now and I've encountered misdirection and dismissive indifferent responsive. There is some dysfunction in the Medicare system