Medicare Blog

what is part b medicare hold harmless provision

by Hertha Metz Published 2 years ago Updated 1 year ago
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  • Medicare Part B premiums are often taken out of a recipient’s Social Security income.
  • If Medicare premiums increase, a hold harmless provision protects recipients to ensure that any cost of living adjustment won’t be wiped out.
  • There are exceptions to the protections that hold harmless provisions provide.

The Medicare hold harmless provision prevents a recipient's Social Security benefits from being reduced due to Medicare Part B premiums. People who pay Part B premiums directly to Medicare—or who have premiums paid by Medicaid—do not qualify for the hold harmless provision.

Is Medicare Part B a good deal?

Yes is the short answer, but there are a few exceptions and details. Part B coverage (physician and outpatient coverage) is a good deal overall. The basic premium you pay only covers about one-fourth of the cost; the federal government pays the rest through general revenue.

What is the penalty for Medicare Part B?

Your Part B premium penalty is 20% of the standard premium, and you’ll have to pay this penalty for as long as you have Part B. (Even though you weren't covered a total of 27 months, this included only 2 full 12-month periods.) Find out what Part B covers. Find out who to call about Medicare options, claims and more.

Should I terminate Part B of Medicare?

You can voluntarily terminate your Medicare Part B (medical insurance). However, since this is a serious decision, you may need to have a personal interview. A Social Security representative will help you complete Form CMS 1763.

What is the monthly premium for Medicare Part B?

The standard monthly premium for Medicare Part B is $148.50 per month in 2021. Some Medicare beneficiaries may pay more or less per month for their Part B coverage. The Part B premium is based on your reported income from two years ago (2019).

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What is the Social Security hold harmless rule?

There is a special rule for Social Security recipients, called the "hold harmless rule," that ensures that Social Security checks will not decline from one year to the next because of increases in Medicare Part B premiums. The hold harmless rule applies to most, but not all, Social Security recipients.

How do I put my Medicare Part B on hold?

If your employer's coverage is primary and you decide to drop Part B, you need to submit Form CMS-1763 to the Social Security Administration. That's because the agency processes both Medicare enrollments and cancellations for the Centers for Medicare and Medicaid Services (CMS), which administers the Medicare program.

Are Medicare Part B premiums locked in?

This is called the “hold harmless” provision, and it protects about 70 percent of Medicare beneficiaries from having to pay the full amount of the Part B premium increase in years when the COLA wouldn't be enough to cover the premium hike.

Why does Medicare Part B go up every year?

And in recent years Part B costs have risen. Why? According to CMS.gov, “The increase in the Part B premiums and deductible is largely due to rising spending on physician-administered drugs. These higher costs have a ripple effect and result in higher Part B premiums and deductible.”

Can you cancel Medicare Part B at any time?

Voluntary Termination of Medicare Part B You can voluntarily terminate your Medicare Part B (medical insurance). It is a serious decision. You must submit Form CMS-1763 (PDF, Download Adobe Reader) to the Social Security Administration (SSA). Visit or call the SSA (1-800-772-1213) to get this form.

Can I drop Medicare Part B anytime?

So long as you have creditable coverage elsewhere, you can disenroll from Medicare Part B without incurring late penalties. Although Medicare offers very good coverage for most enrollees, there are various reasons why you may want to cancel your coverage.

Is Medicare Part B automatically deducted from Social Security?

Yes. In fact, if you are signed up for both Social Security and Medicare Part B — the portion of Medicare that provides standard health insurance — the Social Security Administration will automatically deduct the premium from your monthly benefit.

Does everyone pay the same for Medicare Part B?

Medicare premiums are calculated based on your modified adjusted gross income from two years prior. Thus, your premium can change if you receive a change in income. Does everyone pay the same for Medicare Part B? No, each beneficiary will pay a Medicare Part B premium that is based on their income.

Does your Medicare Part B premium change every year?

Monthly premiums vary based on which plan you join. The amount can change each year. You must keep paying your Part B premium to stay in your plan. Deductibles, coinsurance, and copayments vary based on which plan you join.

How can I reduce my Medicare Part B premium?

To request a reduction of your Medicare premium, contact your local Social Security office to schedule an appointment or fill out form SSA-44 and submit it to the office by mail or in person.

How do I get my $144 back from Medicare?

Even though you're paying less for the monthly premium, you don't technically get money back. Instead, you just pay the reduced amount and are saving the amount you'd normally pay. If your premium comes out of your Social Security check, your payment will reflect the lower amount.

How much does Social Security take out for Medicare each month?

In 2021, based on the average social security benefit of $1,514, a beneficiary paid around 9.8 percent of their income for the Part B premium. Next year, that figure will increase to 10.6 percent.

What Is the Medicare Hold Harmless Provision?

What is the hold harmless provision in Medicare? It sounds like a fancy legal term, but it’s actually a simple protection put in place for recipients. It ensures that this year’s Medicare premium increases won’t completely eliminate the cost of living increase you received this year.

Hold Harmless Provision Requirements

Once you understand what the hold harmless agreement represents in Medicare, it’s time to look at some of the exceptions to the provision. In order to cap your Medicare increases, you have to meet the following criteria as a Social Security recipient:

Special Considerations

COLA has been pretty good to Social Security recipients in recent years. But it wasn’t too long ago that the economy was suffering, leading the COLA to fall to zero. In 2016, this was the case for only the third time in 40 years. The cost of Medicare for social security recipients had to stay stagnant because of the hold harmless provision.

Final Thoughts

Inflation is inevitable, but at least Social Security recipients know they’ll get a raise to compensate for it. Medicare premiums could increase, as well, though. Thanks to the hold harmless provision, Social Security recipients have the confidence of knowing they won’t lose money because premiums increased more than the cost of living.

What is the hold harmless provision for Medicare?

The Medicare hold harmless provision stems from a statutory restriction that prevents Medicare from raising most Social Security recipients’ Medicare Part B premiums by more than the cost of living adjustment (COLA) provided by Social Security in a given year. The administration calculated the adjustment for 2021 at 1.3%. 1 

Do you have to pay out of your Social Security for Medicare Part B?

To qualify for reduced payments under this provision, you must receive Social Security benefits and have Part B premiums paid out of those benefits for at least two months in the previous year. Those who make payments for Part B insurance directly to Medicare and those who have premiums paid by Medicaid do not qualify and, as a result, may be subject to higher premiums. 2 

How to qualify for hold harmless?

To qualify for the hold harmless provision, you must: Receive Social Security benefits or be entitled to Social Security benefits for November and December of the current year. Have your Medicare Part B premiums for December and January deducted from your monthly benefits.

Why do people pay Medicare premiums?

Most people with Medicare will pay the new premium amount because the increase in their benefit amount will cover the increase. However, a small number of people will see little or no increase in their Part B premium — and their Social Security benefit checks will remain the same — because the amount of their cost-of-living adjustment isn’t large ...

What is the Medicare premium for 2021?

The Part B base premium for 2021 is $148.50, which is $3.90 higher than the 2020 base premium. Most people with Medicare will pay the new premium amount because ...

Does Social Security reduce Medicare?

Social Security works together with the Centers for Medicare & Medicaid Services to make sure you won’t have a reduction in your Social Security benefits as a result of Medicare Part B premium increases.

Does hold harmless apply to Part B?

The hold harmless provision does NOT apply to you if: You enroll in Part B for the first time in 2021. You pay an income-related monthly adjustment amount premium. You are dually eligible for Medicaid and have your premium paid by a state Medicaid agency. You can learn more by visiting Medicare. Tags: Medicare.

What is the hold harmless rule?

The hold harmless rule protects you from having your previous year’s Social Security benefit level reduced by an increase in the Part B premium so long as: You are entitled to Social Security benefits for November and December of the current year (2019);

When will Medicare Part B be deducted from Social Security?

The Medicare Part B premium will be or was deducted from your Social Security benefits in November 2019 through January 2020; You do not already pay higher Part B premiums because of eligibility; And, you do not receive a Cost of Living Adjustment (COLA) large enough to cover the increased premium. COLA is additional income given ...

What is the Part B premium for 2020?

In 2020, the Part B base premium will be $144.60. Most people will pay this amount. A small number of people pay a premium that is lower than the base premium. These people are protected by the hold harmless rule. The hold harmless rule protects you from having your previous year’s Social Security benefit level reduced by an increase in ...

Does Hold harmless apply to 2020?

You are new to Medicare in 2020. Hold harmless does not apply to you because you have not been enrolled in Medicare Part B long enough to qualify. You are subject to IRMAA. You are enrolled in a Medicare Savings Program (MSP). However, the MSP should continue paying for your full Part B premium.

Can you waive a Part B late enrollment penalty?

Note: If you qualify for the hold harmless provision but pay a Part B late enrollment penalty, the penalty will not be waived, and it may increase. This is because the penalty will be calculated based on the new, higher premium—even if you are not paying that higher amount.

Does COLA cover Part B?

The COLA in 2020 is likely to cover the full Part B premium for most people. If your COLA is large enough to cover the full amount of your increased premium, you will not be held harmless and your premium will increase to $144.60. The hold harmless provision does NOT protect you if: You are new to Medicare in 2020.

What is the hold harmless provision for Medicare?

This is called the “hold harmless” provision, and it protects about 70 percent of Medicare beneficiaries from having to pay the full amount of the Part B premium increase in years when the COLA wouldn’t be enough to cover the premium hike.

What percentage of Medicare Part B will receive COLA?

The federal government estimated that only about 3.5 percent of Medicare Part B enrollees would receive COLAs that still weren’t sufficient to cover the full increase in their Part B premiums, and would thus still be paying less than the standard premium in 2019. For 2018, the Social Security COLA was 2 percent.

What was the Medicare premium for 2016?

For 2016, the standard Medicare Part B premium was $121.80/month. But about 70 percent of enrollees were only paying $104.90 (the same rate they paid in 2015), because they were “held harmless” from the rate hike in 2016.

When did Medicare Part B premiums increase?

After remaining steady for three years, Medicare Part B premiums started increasing again in 2016, and again in 2017. They remained steady in 2018, but increased again in 2019. However, because COLAs weren’t large enough to cover the increases in 2016 and 2017, most beneficiaries were paying less than the standard amount for their Part B coverage.

How much is Part B insurance?

But the Part B premium is $144.60 per month as of 2020. Although there have been some stretches of time when the premium declined from one year to the next or remained steady – 2013 through 2015, for example, when it was $104.90/month each year – it has generally increased every year.

Is Medicare Part B premium larger than Social Security?

But sometimes the Medicare Part B premium increase is larger than the Social Security COLA. In that situation, the result would be a decrease in net Social Security checks from one year to the next (for example, if the COLA only adds $5/month to a person’s check but their Part B premiums go up by $8/month, their net Social Security check would be ...

Did Medicare Part B increase in 2016?

The COLA was zero percent that year, so Medicare Part B premiums couldn’t increase at all for most enrollees. 2016 was only the third time in 40 years that the COLA was zero. Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006.

Lower COLA, higher premiums

In 2016, the COLA is expected to be zero (see chart below). This won’t impact the majority of Medicare beneficiaries who fall under the hold harmless rule. By law, they won’t face any premium increases next year. Instead, they’ll continue to pay the current premium of $104.90.

Explore your payment options

Any COLA-related increases have not formally passed yet. But once they do, those affected must pay the higher premiums. As such, those paying their premiums directly to Social Security should sign up for Social Security before the end of the year.

When did Medicare Part B hold harmful?

The Medicare Part B Hold Harmless Provision In 2010 And 2011 When Social Security COLAs Went To 0.0%. When Social Security benefits didn’t increase at all in 2010 (and again in 2011) due to the 0.0% COLA, it meant any dollar increase in Medicare Part B would trigger the Hold Harmless provision.

What is Medicare Part B?

Medicare Part B, also known as the “Medical Insurance” portion , covers the typical range of doctors’ services, preventive care, outpatient services and lab tests, etc.

What was the Medicare premium in 2014?

At the same time, the premium for Medicare Part B in 2014 was $104.90/month. Given that Social Security benefits had increased by $22/month, even if Medicare Part B premiums had risen by 10% for 2015, to $115.40, the Medicare Part B premium “Hold Harmless” provision still wouldn’t have applied. While Medicare premiums would have been up 10% ...

What is Medicare for retirees?

For virtually all retirees, Medicare is the core means by which health insurance is obtained in retirement. Coverage is provided via a combination of Medicare Part A (for hospital insurance) that is free, plus Part B (for medical insurance covering doctor’s visits, outpatient procedures, and more) for a subsidized premium, and Part D (for prescription drugs) also paid via a separate premium. Together, the Medicare system goes a long way to stabilizing the unknown of health care costs in retirement into a series of known health insurance premiums.

Does the Hold Harmless Medicare Part B apply to Part B?

At the other end of the spectrum, the Hold Harmless provisions for Medicare premiums also don’t apply to anyone who is subject to the aforementioned income-related monthly adjustment amount (IRMAA) to Part B premiums.

Does the hold harmless provision apply to everyone?

When The Hold Harmless Provision On Medicare Part B Premiums Does NOT Apply. Notably, the Hold Harmless provision on Medicare Part B premiums doesn’t apply to everyone. In order for the rule to apply, the retiree must have Medicare Part B premiums being deducted from his/her Social Security benefits in the first place.

Can I pay Medicare Part B and Part D from Social Security?

Paying Medicare Part B And Part D Premiums From Social Security Retirement Benefits. When a retiree is signed up for Medicare Part B and is receiving Social Security benefits, the Medicare premiums are normally subtracted directly from the Social Security check. If the retiree is signed up for a Medicare Part D plan, ...

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What Is The Medicare Hold Harmless Provision?

  • What is the hold harmless provision in Medicare? It sounds like a fancy legal term, but it’s actually a simple protection put in place for recipients. It ensures that this year’s Medicare premium increases won’t completely eliminate the cost of living increase you received this year. Here’s an example of the Medicare Part B hold harmless provision....
See more on retirable.com

Hold Harmless Provision Requirements

  • Once you understand what the hold harmless agreement represents in Medicare, it’s time to look at some of the exceptions to the provision. In order to cap your Medicare increases, you have to meet the following criteriaas a Social Security recipient: 1. You must have been entitled to benefits in both November and December of the current year. 2. Medicare Part B premiums mus…
See more on retirable.com

Special Considerations

  • COLA has been pretty good to Social Security recipients in recent years. But it wasn’t too long ago that the economy was suffering, leading the COLA to fall to zero. In 2016, this was the case for only the third timein 40 years. The cost of Medicare for social security recipients had to stay stagnant because of the hold harmless provision. As recently as 2016, 70 percent of enrollees di…
See more on retirable.com

Final Thoughts

  • Inflation is inevitable, but at least Social Security recipients know they’ll get a raise to compensate for it. Medicare premiums could increase, as well, though. Thanks to the hold harmless provision, Social Security recipients have the confidence of knowing they won’t lose money because premiums increased more than the cost of living. If you’re currently planning your retirement, a C…
See more on retirable.com

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