Category Archives: Medicare

Accessing Stanford or Sutter with Medicare

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Navigating Medicare with Stanford or Sutter/PAMF

Accessing Stanford or Sutter/Palo Alto Medical Foundation (PAMF) with your Medicare has become progressively more challenging in recent years.  However, it’s not impossible.

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Gone are the days of purchasing a Medicare policy and keeping it forever. The dynamic Medicare market in the Bay Area is fluid and constantly changing e.g. a new major Plan Closure. Utilize the experience and knowledge of a local, independent agent to make informed decisions about your Medicare options. There is no added cost to your policy for this service. Given the ever-changing nature of Medicare, you may need someone in your corner to help you navigate these complexities in the future.

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Choosing Between Medigap and Medicare Advantage

Depending on your objectives, you might find that traditional Medicare combined with a solid Medigap supplemental policy suits your needs best. In other situations, accessing your physicians through a contracted Medicare Advantage plan may be your best option. An independent agent can act as a time-saving advisor to help you understand the pros and cons of either choice.

“Leverage your time and research with the experience and knowledge of a local, independent agent.”

Our specialty is assisting Bay Area residents who prefer original Medicare plus some type of Medigap Supplemental Plan G and wish to retain their specialists at Sutter PAMF and/or Stanford Medicine. Our advice is free of charge—there are no added premiums or fees. If you’d prefer not to speak with an agent, you can also self-enroll at CaliforniaEnrollment.com.

If you’re facing deadlines and need immediate answers, please complete the Contact Request Form at the bottom of this page. A licensed, San Jose-based independent agent will respond within 24 hours to discuss your options under traditional Medicare.

Act Now to Secure Your Medicare Coverage

Understanding and selecting the right Medicare plan can be daunting. Whether you choose to work with an independent agent or self-enroll, taking action now can ensure you have the coverage you need, tailored to your specific medical requirements at top-tier institutions like Stanford and Sutter/PAMF. Schedule your free 15-minute telephone consultation today and take the first step towards seamless Medicare coverage.

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Schedule a Consult:  (408) 252-7300

Related article:  2025 Sutter PAMF Medicare Options

Timelines and Deadlines of Medicare Part B

Applying for Medigap Insurance is easy, but understanding the timelines and deadlines of Medicare Part B is critical, and will be the focus of the remainder of this article.  Insurers will not issue you Medigap (Medicare Supplement) Insurance until you are enrolled in Medicare Parts A and Part B. However, many will accept your application early and pend it, while your Medicare application is being processed.

Timelines and deadlines of Medicare Part B

The official U.S. Government Handbook on Medicare is called Medicare and You. Another valuable government publication is Choosing a Medigap Policy.  These combine for 128 pages of valuable information.  Yes, it’s a lot of pages, and if you want the readers digest version, ask for help:  Connect with an independent agent in west San Jose- it’s FREE and will save you hours of time: (408) 252-7300.  The links to publications are at the bottom of this article, and the following are some important excerpts:

Timelines and Deadlines of Medicare Part B:  Initial Enrollment Period

I encourage everyone to get a local consultation e.g. Silicon Valley/Bay Area by age 62, in order to understand “what you are getting into.”  But once you reach your Initial Enrollment Period or IEP, you can first sign up for Part A and/or Part B during the 7-month period that begins 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65. If you sign up for Part A and/or Part B during the first 3 months

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of your Initial Enrollment Period, in most cases, your coverage starts the first day of your birthday month. However, if your birthday is on the first day of the month, your coverage will start the first day of the prior month. If you enroll in Part A (that you have to pay for) and/or Part B the month you turn 65 or during the last 3 months of your Initial Enrollment Period, the start date for your Part B coverage will be delayed. 

“Remember, in most cases, if you don’t sign up for Part A (if you have to buy it) and Part B when you’re first eligible, you may have to pay a late enrollment penalty.”

Still need help?  Then get an independent agent– Did you know there is no extra cost for these services?  They are compensated by your Medigap insurance company and you will pay the same low premium with or without an agent.

Timelines and Deadlines of Medicare Part B:  General Enrollment Period 

If you didn’t sign up for Part A (if you have to buy it) and/or Part B (for which you must pay premiums) during your Initial Enrollment Period, and you don’t qualify for a Special Enrollment Period, you can sign up between January 1–March 31 each year. If you enroll using this SEP, Your coverage won’t start until July 1 of that year, and you may have to pay a higher Part A and/or Part B premium for late enrollment.

What’s the Part B Late Enrollment Penalty? 

If you don’t sign up for Part B when you’re first eligible, you may have to pay a late enrollment penalty for as long as you have Part B. Your monthly premium for Part B may go up 10% for each full 12 months in the period that you could’ve had Part B, but didn’t sign up for it. If you’re allowed to sign up for Part B during a Special Enrollment Period, you usually don’t pay a late enrollment penalty. See page 17

Still need help?  Then get an independent agent– there is no extra cost for these services.

In California, many of us work past Age 65, how does that affect timelines and deadlines?

If you didn’t sign up for Part B when you were first eligible because you’re covered under a group health plan based on current employment, then you can sign up for Part B anytime while you’re still covered by a current employer group medical plan.  You also may sign up for Part B during the 8-month period, immediately after employment or coverage ends (the period begins based on whichever occurs first). This is referred to as a Special Enrollment Period.  

If you are working past 65, and thinking about transitioning off employer health insurance,  we have prepared a checklist to help you, but read this first.

There are other Special Enrollment Periods, in certain situations. Get an independent agent to guide you at no extra cost or phone Medicare directly at 1‑800‑MEDICARE (1‑800‑633‑4227).

Resources and Links

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San Jose, California

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Before You Reach Medicare

Understand What You Are Signing Up For- Medicare (Before You Do It)

Do not apply for Medicare in the next 3 to 6 years if you are not familiar with the hazards highlighted in this article. What you do (or don’t do) today matters in the future, when you sign up for Medicare.  I feel compelled to share real life experiences to help those in the early planning stages of “life after 65.” This includes people age 61, 62, and persons working and deferring Medicare until age 68, 70 and later. Before you reach Medicare, you should understand what you are signing up for.   This article is dedicated to the many, sad phone callers like this one:

“…I signed up for Medicare 2 months ago, and then applied for Medicare Supplement (medigap) insurance, as well as my Part D prescription drug plan.  I don’t understand why I just received an invoice for $1,482.00 from the Department of Health & Human Services…is this a monthly bill?  Is this my new supplemental insurance?”

The Problem

Individuals go to the Social Security Administration (SSA) to sign up for Medicare Part A & B.  Do you understanding everything you are signing up for?  Before You Reach MedicareLong before you reach Medicare, talk to your CERTIFIED FINANCIAL PLANNER™, as well as a local, independent agent.

“Best Advice:  Talk to your financial advisor and an independent agent when you turn 62.”

Whereas Medicare Part A is free for most people, Part B is not.  Medicare Part B enrollees pay a monthly premium representing about 25% of the Part B estimated program costs.  For 2022, this so-called, Standard premium is $170.10 per month.  The government subsidizes the rest, but…

The Cost is Greater Than You Think

In truth, many individuals residing in the Santa Clara Valley pay more, because the Standard Part B premium is adjusted higher for income:  this increased amount is called “IRMAA.”   My

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observation during the last 12 months:  there is a real problem with SSA failing to educate applicants. Early education and understanding gives you a fair chance to delay Medicare, where possible, to reduce the IRMAA.  No offense intended for the good folks at SSA, but based on the sheer number of phone calls I receive… I think the organization can do better.

Introduction to IRMAA

Best Advice:  Talk to an independent agent and your financial advisor when you turn 62.  If you are working past age 65, initiate contact at least three years before you apply to Medicare or leave your current employer health plan.

IRMAA is the Acronym for Income-Related Monthly Adjustment Amount; there are two versions associated with Medicare:

  1. IRMAA-B for Medicare Part B
  2. IRMAA-D for Medicare Part D

The short introduction is, your cost to participate in Medicare Part B and Part D is higher if your income exceeds a certain threshold.  For 2022, you trigger the first IRMAA threshold at $91,000 (filing Single).  For greater detail, schedule a phone call or read Part 2 of this article.  The balance of this page will keep it simple.

Good-To-Know (Before You Reach Medicare)

Here is a “good-to-know” aspect of IRMAA:  the IRMAA calculation is based on IRS information provided to the Social Security Administration (SSA) from two or three years earlier.  You trigger an IRMAA when your income exceeds certain thresholds.  “Income” is based on your MAGI (line 11 of your 1040 Federal Income tax return), plus adjustments.  Fortunately, the IRMAA is not permanent and SSA recalculates your amount each year.  You may appeal the IRMAA in certain situations.

“The potential for an IRMAA should factor into the timing of receiving capital gains and your retirement date.”

The potential for an IRMAA should factor into the timing of taking capital gains.  Other factors include your retirement date, and ultimately your application for Medicare.  You have greater control of these factors the three or four years prior to retirement, so talk to an independent agent early in the process; definitely include your tax and financial advisors in the discussion.

Before You Reach Medicare

An independent agent can discuss mitigation strategies and options.  Perhaps you could work a few months longer than scheduled, while carefully avoiding late enrollment penalties (Part B and Part D).  Good agents are highly sought after, so start a conversation early, and build that business relationship before you need it.

408-252-7300

Would you like me to be your independent agent?  Call me at 408-252-7300 to discuss if we are a good fit.

Editor’s Note:  Marc Derendinger is an independent agent serving Santa Clara County residents for more than 30 years.  He helped the City of San Jose establish its first-ever group voluntary long-term care plan in 2001, served as an advisor to the State of California DHCS California Partnership for Long-term Care, and currently serves as insurance broker for the San Jose Police Officers’ Association.  Marc offers free assistance to new Medicare beneficiaries residing in California, at (408) 252-7300.

Watch this video on YouTube.
San Jose, California

Schedule a Consult:  (408) 252-7300

More About IRMAA

More About IRMAA:  For audiences age 61 to 64

In the last 12 months, I received too many callers, “surprised (or shocked) by IRMAA,” which inspired a previous, introductory (Part 1) article on the topic.  Today’s article, “More About IRMAA,” is Part 2, and goes into greater detail, providing resources for further research.  We hope it is helpful.

Short Background

Whereas Medicare Part A is free for most people, Part B is not.  Part B enrollees pay a monthly premium representing about 25% of the Part B estimated program costs.  For 2022,  this so-called, “Standard” premium is $170.10 per month.  The government subsidizes the rest, but…

The Cost is Greater Than You Think

Your cost to participate in Medicare Part B and Part D is higher if your income exceeds certain thresholds. For 2022, the first IRMAA threshold is triggered when a person files as Single and has income over $91,000 ($182,000 for Married, filing Jointly).

“Your cost to participate in Medicare Part B and Part D is higher if your income exceeds certain thresholds”

More About IRMAA

IRMAA is the Acronym for Income-Related Monthly Adjustment Amount; there are two versions associated with Medicare:

  1. IRMAA-B for Medicare Part B
  2. IRMAA-D for Medicare Part D

How bad can this get?  In 2022, the max out (worst case) IRMAA is $578.30 monthly for Part B, and $77.90 for the Part D IRMAA.  Consider that this cost “doubles” when a couple enrolls in Medicare A and B, meaning the annual IRMAA cost could be as high as $15,748.  For the planners in my audience, the monthly budget breaks down like this:

Monthly Costs for Spouse 1:

  • Part B Standard premium: $170.10
  • Part B IRMAA: $578.30
  • Part D IRMAA: $77.90
  • Medicare Supplement Plan G: $127.52 (65 year-old in Santa Clara County)
  • Part D Prescription Drug Plan: $33.37 (national average)

Monthly Costs for Spouse 2:

  • Same as above, (less a Household discount for the Medicare Supplement policy)

IRMAA Seems Worse in The South Bay

IRMAA impacts 4% of Medicare beneficiaries, according to the Social Security Administration.  In practice, we have observed it closer to 40% to 50%:  Many individuals residing in the San Jose

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metro area pay more because the threshold is low i.e. $182,000 (Married, filing Jointly) or $91,000 for all other filers.

Compounding the problem, “income” is taken from two (sometimes three) years prior to Medicare, which is often the pinnacle of your career.  During this period “income spikes” may occur, due to cashing in of stock options, taking capital gains etc.  These show up in your MAGI (line 11), but with foreknowledge (and a little financial engineering), I believe many can reduce the size of IRMAA.

Know and Prepare for IRMAA

In the years leading up to your Medicare application, Individuals should consider contacting a local independent agent experienced in Medicare and bring your CPA/ tax advisor into the conversation.  There are a few solid agents willing to discuss your options now, in exchange for an opportunity to represent your supplemental insurance in the future.

Do Not Pay Too Much

Recently, a delightful couple called me from I received a call from Saratoga:  the younger spouse is turning 65 in two months, but the older spouse is a senior engineer, and at age 72, not yet ready to retire.  The younger spouse was concerned of Medicare penalties if they did not enroll in Part A and Part B.  While every situation is unique, her phone call saved the family thousands of dollars by learning how she could delay Medicare, without penalty.  Do not pay too much:  just to be sure, request a consult at 408-252-7300.

In The Good-To-Know Corner

“Income” is based on MAGI (line 11 of your 1040 Federal Income tax return), plus adjustments for tax-free interest.  Fortunately, the IRMAA is not permanent, and SSA recalculates it every  year.  You may file an appeal in limited circumstances.

“The potential for an IRMAA should factor into the timing of receiving capital gains and the scheduling of your retirement date.”

The potential for an IRMAA should factor into the timing of receiving capital gains and your retirement date, and ultimately your application for Medicare.  Key Point:  You have greater control of these factors during the three or four years prior to retirement, so talk to your tax advisor and find a local, independent agent early in the process..

Local Is Good – Independent is Better

A local, independent agent can discuss mitigation strategies and options, such as the fine balance of working a few months longer than scheduled, while carefully avoiding late enrollment penalties (Part B and Part D).  Due to baby boomer demographics, good agents are much sought after, so start a conversation early, and build that business relationship before you need it.

Watch this video on YouTube.
San Jose, California

408-252-7300

Would you like me to be your independent agent?  Call me and let’s have a discussion, to make sure we are a good fit.  Request a phone meeting with Marc, at 408-252-7300.

Editor’s Note:  Marc Derendinger is an independent agent serving Santa Clara County residents for more than 30 years.  He helped the City of San Jose establish its first-ever group voluntary long-term care plan in 2001, served as an advisor to the State of California DHCS California Partnership for Long-term Care, and currently serves as insurance broker for the San Jose Police Officers’ Association.  Marc gives back to the community by offering free assistance to new Medicare beneficiaries, residing in California:  Call (408) 252-7300.

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