Medicare Health Insurance and Social Security Card on medical report and stethoscope

by Jeff Deiss

The Social Security Administration announced last week that benefits and the maximum amount of wages subject to payroll taxes will increase by 1.3% in 2021.  This reverses the trend of higher increases over the past two years and while it is more than a full percentage point less than the 2.8% increase for 2019 and behind the average 1.4% increase per year over the past decade.

Social Security benefits increase automatically if the CPI-W, which measures price inflation for urban workers, increases in the third quarter (July, August & September) of the current year over the third quarter of the previous year.  So some of you might recall that 2019’s larger 2.8% increase was somewhat impacted by temporary issues, namely hurricanes Florence and Michael, that occurred during the third quarter of 2018.

Payroll Tax Impact

From a wage perspective, employers and employees each pay 6.2% in payroll taxes to help fund Social Security.  In 2020, the payroll tax applied to the first $137,700 of a worker’s gross earnings.  In 2021, a 1.3% increase will raise the taxable wage limit by about $5,100, to roughly $142,800.

Impact on workers who claim early Social Security Benefits

Individuals will also be able to earn a bit more from a job without jeopardizing any of their benefits if they claim Social Security before their “full retirement age”.

If you’ve claimed Social Security early and are working, then you can earn up to $18,960 in 2021 without jeopardizing any benefits (up from $18,240) this year.  Any earnings above this cap mean that you lose $1 of Social Security benefits for each $2 over the $18,960 limit.  This earnings cap does not apply to “unearned” income like pensions or investment income.

In the year that you reach your full retirement age, there is a more generous cap.  If your full retirement age is next year, for example, then you can earn up to $50,250 in the months that lead up to your birthday, after which you lose $1 in benefits for every $3 earned over the cap.

Once you reach full retirement age, which is currently 66 and moving toward 67 depending on the year you were born, these income restrictions disappear.

Impact on Social Security Retirement Income beneficiaries

In December 2020, Social Security COLA notices will be available online to most of the 63 million beneficiaries who receive social security income benefits in the message center of their “my social security” account on the website.

The average monthly benefit for a retired worker is expected to rise by $20, to $1,543, in 20201, while a retired couple will grow by $33 a month, to $2,596.  Higher Medicare Part B premiums will slightly reduce retirees’ “net” monthly Social Security payments.

Medicare Part A & B Premiums and Deductibles

The changes to Medicare Part A Deductible and Cost Sharing are summarized as follows:

deductible coinsurance

The annual deductible for all Part B beneficiaries for 2021 is $203, an increase from $198 in 2020.

High-income retirees continue to pay more for the same Medicare Coverage (IRMAA)

For 2021, the basic Medicare Part B premium is projected to increase by $3.90, to $148.50 per month, up from $144.60 this year.

Individuals with a modified adjusted gross income (MAGI = Adjusted Gross Income plus tax-exempt interest from municipal bonds) above Medicare’s thresholds pay a surcharge on both their Medicare Part B (doctors) and Part D (prescription drug) premiums.  There are six tiers that determine surcharges on about 5% of total Medicare beneficiaries whose income is high enough for them to apply (CMS estimates that only 7% of all Medicare recipients will have to pay surcharges in 2021).

These surcharges, also known as an income-related monthly adjustment amount, or IRMAA, are based on your tax return from two years prior.  In 2020, the surcharges were based on your MAGI for 2018 and, in 2021, the surcharges will be based on your MAGI from your 2019 tax return.  The surcharge paid is not constant as it can go up, or down, in a given year depending on your income.

For 2021, just $1 of MAGI over the lowest bracket can cost a single filer an extra $712.80 in Medicare Part B premiums ($59.40 x 12 months) due to the surcharge on the first bracket jump (from $88,000 or less to $88,001).


IRMAA started to be indexed to inflation Jan 1, 2020

For the first time in a decade, the income brackets used to determine Medicare premium surcharges were indexed to inflation in 2020.  As we mentioned last year, there is some good news and bad news as a result.

The good news is that the brackets are higher, meaning that you can earn a bit more income before being kicked into a surcharge bracket.   This translates to an additional $2,000 to for single filers and $4,000 for joint filers just for 2021.  And the brackets will continue to be adjusted for inflation going forward, with the exception of the top bracket (Tier 6), which won’t be indexed until 2028.

Previously, the brackets had essentially been fixed since 2011, which meant that a growing number of beneficiaries had become subject to the surcharges.

One study on this issue by Healthview profiled several case studies, such as a single, 65-year old woman living to age 89 and with an income of $100,000 (Tier 2).  The expected outcome of inflation indexing indicated that she can expect to save more than $50,000 over her lifetime as a result of indexing going forward vs. a scenario where the surcharge brackets were not indexed for inflation.

The bad news is that reduced revenues from Medicare surcharges could put added pressure on the Medicare Trust fund longer term.  So retirees should expect additional changes and cost-shifting in order to make up for the lost revenue.

Managing Surcharges in Retirement

Required minimum distributions (RMDs) from IRAs are added to MAGI and can impact Medicare surcharges in retirement if you are not expecting this and particularly for surviving spouses who find themselves subject to individual tax brackets.  If you have large retirement accounts, then you may have an increase in your taxable income once your RMDs start (when you turn age 72) and push you into a higher, surcharge bracket.

It’s important to understand the impact RMDs have as well as opportunities to manage or reduce surcharges by incorporating helpful planning techniques.  We’ve discussed many of these in previous posts including Roth IRAsHealth Care Savings Accounts (HSAs), Qualified Charitable Distributions (QCDs) and Reverse Mortgages.  Distributions of cash value from permanent life insurance policies (up to your cost basis) would also fall into this category.  If you have questions, reach out to your ACM Wealth Advisor for information and assistance.

Medicare Part D

The Part D annual deductible for 2021 will be $445, up from $435 in 2020.

 During the open enrollment period from October 15 to December 7 each year, Medicare beneficiaries can enroll in Medicare Part D (prescription drug) plans.  Part D plans can change from year to year, so for those with “traditional” Medicare (Parts A, B and a Medicare Supplement plan), we recommend that you shop your Medicare Part D plan each year during open enrollment. This is easy to do by entering your prescription drug information into the plan finder at  The average Medicare beneficiary has a choice of 30 stand-alone plans to choose from for 2021, a 5% increase from 2020.  The Kaiser Family Foundation projects that nearly 8 in 10 non-low-income-subsidy enrollees will face higher premiums if they remain in their current plan, and many may face higher deductibles and cost sharing for covered drugs.

The average monthly Part D plan premium for 2021 is projected to be $41.00, up 9% from $38 in 2020 according to the Kaiser Family Foundation and reversing a downward trend over the past two years. This average is based on a range of projected stand-alone plan premiums from $7/month to $89/month, which includes enhanced plans (that have higher premiums than basic plans).  The CMS has reported that the average monthly premium for basic Part D coverage will be $30.

The monthly Part D premium you pay may include a surcharge, like Part B, depending on your income.

medicare surcharges

New for 2021, beneficiaries in each state will have the option to enroll in a Part D plan participating in the Trump Administration’s new Innovation Center model in which enhanced drug plans cover insulin products at a monthly co-payment of $35 in the deductible, initial coverage, and coverage gap phases of the Part D benefit. Participating plans do not have to cover all insulin products at the $35 monthly co-payment amount, just one of each dosage form (vial, pen) and insulin type (rapid-acting, short-acting, intermediate-acting, and long-acting).

Part D enrollees are expected to pay much higher cost-sharing amounts for Brand name and Non-preferred drugs then for generic drugs.

cost sharing amounts

With the Donut hole now extinct, below is the projected Part D Benefit Cost-Sharing summary for 2021.

standard plan cost sharing

If you are not comfortable with the computer or the internet when it comes to picking your 2021 prescription drug plan, then find a friend or relative who is to help you.   If you are plum out of friends and relatives, then pick up the phone and call Medicare at 800-633-4227.  Unlike Social Security, Medicare is open 24/7 and the best time to call is late when volumes are low and you’re likely to get more attention.  Be sure to have your medications, dosages, and preferred pharmacy info handy when you call so that they can help you find the best plan.

Using Medicare’s own Plan Finder tool (rather than a third party’s tool) allows you to hold Medicare and your Part D plan accountable if any information turns out to be inaccurate. You should be able to change plans during the year if that turns out to be the case and you can back it up with proof that a plan gave you incorrect information when you were selecting it.

If you can’t find a plan that covers all your medications, then you may be able to work with your doctor to get your existing plan (where they have changed a medication to require pre-authorization) to cover the drug anyway.  Keep any correspondence from your Part D insurer that show they’ve approved the drug for the year as evidence to submit to support your case. Also, if your plan benefit has changed for next year, then your existing insurer generally must still offer you a 90-day filling of your current medications (known as “transition fill”).

It’s Annual Election Season:  Part Two

The other option you have from Oct 15 to Dec 7 every year is to shop your Medicare Advantage Plan, also known as Medicare Part C.

Medicare Advantage Plans are heavily marketed this time of year and are a constant source of confusion.   It can even be a little intimidating because there are so many different plans and it can be difficult to determine if you are getting a good deal. Medicare Advantage Plans are also increasingly popular as you can see below.

private health enrollment

When you turn 65, or otherwise initially enroll in Medicare, you have the option of choosing “traditional” Medicare, which consists of Parts A, B, and typically Part D and a Medicare Supplement (aka “Medigap”) plan, OR you can choose a Medicare Advantage Plan.

There is a lot to like about Medicare Advantage plans in that they include a maximum annual out-of-pocket expense for hospital (Part A) and outpatient (Part B) coverage, they typically include prescription drug coverage as well as other services such as dental, vision, hearing.  For chronically ill enrollees, and new in 2020, some plans will even be able to offer meal delivery, transportation, grocery shopping and support for family caregivers.  Original Medicare doesn’t offer all of these services or a maximum annual out-of-pocket expense.

In exchange for typically lower premiums and expanded benefits, the tradeoff vs. original Medicare is that most Medicare Advantage plans require members to use their “in-network” health care providers and the plans often require prior approval to see specialists.

Medicare Advantage plan members still pay Part B premiums (and any related surcharges), but they can’t buy a Medigap policy and usually don’t need to buy a Part D plan.  So the monthly premiums might be lower without a Part D and Medigap plan, but out-of-pocket costs can be higher (due to deductibles, coinsurance and co-payments).

Traditional Medicare typically has higher premiums and does not cover vision, dental and hearing, but when combined with a comprehensive Medicare Supplement plan, your premiums cover the majority all of your health insurance expenses.  So you don’t have to shop from year-to-year (other than your Part D plan) or worry that your doctors are no longer “in-network” in your plan.  As a result, traditional Medicare can have fewer “moving parts” vs. Medicare Advantage plans.

Medicare Advantage plans are issued by private insurance companies, which can set their own deductibles, co-payments, coinsurance amounts and networks of providers.  These variables can vary widely from plan to plan and company to company from year to year.  So some homework is required to choose a plan and it can be complicated to know if you are getting a good deal.

There have been 40 studies reviewed by the Kaiser Family Foundation concluding that older, sicker Medicare beneficiaries receive better access and a higher quality of care through traditional Medicare while Medicare Advantage members typically end up choosing lower-rated nursing homes when the time comes.  As a result, there is a trend of older, sicker individuals moving back to original Medicare later in life.  This is not always easy to do as it can be challenging, or even impossible, to obtain a Medicare Supplement plan if you are sick/after your initial enrollment period.

Medicare is now the fastest-growing segment of the health insurance market and there is a lot of competition for baby boomers.  There will be even more Medicare choices next year and more tradeoffs between original Medicare and Medicare Advantage plans.

The average Medicare Advantage plan premium is expected to decrease by -34% for 2021, the lowest in 14 years, and it’s projected that 2,100 additional plans will be available, for a total of 4,800 nationwide.

Bottom line:  Consider what’s important to you, whether it’s access to your preferred doctors, lower monthly premiums or the best plan to help with your specific drug needs.  Consider the “moving parts” as well.  Health care expenses typically grow as we age, while our decision-making capacity declines.  Whether you have a good support network in place, or not, is important in terms of managing the complexity of your health insurance coverage when the time comes.

Final Thoughts

Your cash flow may be particularly impacted by rising health care costs in retirement.  Out-of-pocket expenses for a couple could add up to $295,000, based on Fidelity estimates of expenses that will be incurred during retirement.   This is confirmation that health care still represents one of the largest expenses for retirees and must be part of an overall retirement strategy.  And it does not include all health care related expenses, such as over-the-counter medications, dental care or nursing homes and long term care (which is a separate and important conversation).

Like wading through the minefield of investment options, managing your healthcare in retirement and Medicare options is no less daunting, particularly as we all get older.  The confidence of knowing that your health care is covered is one of the most valuable things you can take into retirement.

Please reach out to your ACM Wealth Advisor with questions on your plan and these important issues and consider engaging us in a conversation about your retirement cash flow if you haven’t already.

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