Medicare Blog

what is the hold harmless in medicare costs

by Reynold Grady Published 3 years ago Updated 2 years ago
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The Medicare hold-harmless provision is a special rule designed to protect retirees’ Social Security checks from rising Medicare Part B costs. If Medicare Part B premiums rise higher than the cost-of-living-adjustment, the recipient's premium cost will be reduced instead of their Social Security benefit checks.

A: A policy known as the “hold harmless” provision protects many Medicare beneficiaries by essentially capping Medicare Part B premiums so increases aren't higher than Social Security's Cost of Living Adjustment (COLA).

Full Answer

What is the Medicare hold harmless provision?

The Medicare hold harmless provision prohibits Medicare Part B premiums from reducing the amount of your Social Security benefits year over year. This limits the rise in Medicare Part B premiums paid by Social Security beneficiaries in a given year to no more than the cost of living increase provided by Social Security.

What does the hold harmless rule mean for You?

The other thing to remember about the hold-harmless provision is that it doesn't permanently reduce your monthly Medicare premiums. When future-year COLAs exceed the increase in Medicare costs, then you'll have to make up the difference with additional Medicare premium boosts that you temporarily avoided because of the rule.

How does the hold harmless provision affect Part B premiums?

By law, Medicare must collect a portion of its Part B expenses from beneficiaries. Low COLA increases can put the calculation of the standard premium in tension with the hold harmless provision because it affects the majority of Part B enrollees. This can place an increased burden on those who are exempt from the hold harmless provision.

Does hold harmless apply to you in 2021?

The hold harmless provision does NOT protect you if: You are new to Medicare in 2021. 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.

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What is Medicare hold harmless?

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.

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.”

What are the surcharges for Medicare?

First, here's how the charges break down as of 2022 for modified adjusted gross incomes reported two years prior: You'll pay an extra $68 monthly for Part B and $12.40 extra for Part D if you're married and made $182,000 to $228,000 jointly or $91,000 to $114,000 as an individual.

Why is my Medicare Part B premium so high?

If you file your taxes as “married, filing jointly” and your MAGI is greater than $182,000, you'll pay higher premiums for your Part B and Medicare prescription drug coverage. If you file your taxes using a different status, and your MAGI is greater than $91,000, you'll pay higher premiums.

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.

What is the cost of Part B Medicare for 2022?

$170.10The standard Part B premium amount in 2022 is $170.10. Most people pay the standard Part B premium amount. If your modified adjusted gross income as reported on your IRS tax return from 2 years ago is above a certain amount, you'll pay the standard premium amount and an Income Related Monthly Adjustment Amount (IRMAA).

What is the Medicare surcharge for 2021?

Higher-income Medicare beneficiaries will pay more. In 2021, individuals with modified adjusted gross income of $88,000 or more and married couples with MAGIs of $176,000 or more will pay additional surcharges ranging from $59.40 per month to $356.40 per month on top of the standard Part B premium.

How do I avoid Medicare surcharges?

To avoid getting issued an IRMAA, you can proactively tell the SSA of any changes your income has seen in the past two years using a “Medicare Income-Related Monthly Adjustment Amount – Life-Changing Event” form or by scheduling an interview with your local Social Security office (1-800-772-1213).

How do I avoid Medicare levy surcharge?

If your income is less than $90,000 (singles) or $180,000 (couples, families and single parents), then you won't need to pay the MLS at all. If your income is above these amounts, you can avoid paying the MLS by taking out a private health insurance policy that includes hospital cover.

What is the standard Medicare Part B premium for 2021?

$148.50Medicare Part B Premium and Deductible The standard monthly premium for Medicare Part B enrollees will be $170.10 for 2022, an increase of $21.60 from $148.50 in 2021. The annual deductible for all Medicare Part B beneficiaries is $233 in 2022, an increase of $30 from the annual deductible of $203 in 2021.

How can I lower 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.

Does Social Security count as income for Medicare?

All types of Social Security income, whether taxable or not, received by a tax filer counts toward household income for eligibility purposes for both Medicaid and Marketplace financial assistance.

What is a hold harmless for Medicare?

The Medicare hold harmless provision prohibits Medicare Part B premiums from reducing the amount of your Social Security benefits year over year. This limits the rise in Medicare Part B premiums paid by Social Security beneficiaries in a given year to no more than the cost of living increase provided by Social Security. The hold harmless provision limits the financial strain certain Social Security recipients may experience if Medicare costs rise.

What Is the Medicare Hold Harmless Provision?

The Medicare hold harmless provision prohibits Medicare Part B premiums from reducing the amount of your Social Security benefits year over year. This limits the rise in Medicare Part B premiums paid by Social Security beneficiaries in a given year to no more than the cost of living increase provided by Social Security. The hold harmless provision limits the financial strain certain Social Security recipients may experience if Medicare costs rise. 1

How Much Will My Medicare Costs Increase Each Year?

For 2022, it is estimated that this cost increase will be 5.9% , a notable increase from 1.3% in 2021. 2

What happens when the COLA moves from zero to higher numbers?

Another unintended consequence of the hold harmless provision occurs when the COLA moves from near zero to higher numbers. Social Security adjusts the COLA in response to changes in the Consumer Price Index for Urban Wage Earners and Clerical Workers (CPI-W). In theory, this means rises in Social Security benefits should cover increased prices for goods and services.

How long do you have to have Medicare Part B?

To qualify, recipients must receive Social Security benefits and have their Medicare Part B premiums paid by those benefits for a minimum of two months in the previous calendar year.

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 

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.

When do Medicare Part B premiums have to be deducted from Social Security?

Medicare Part B premiums must have been deducted from your Social Security income from November to January.

Is COLA good for Social Security?

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.

Does Medicare wipe out Social Security?

The government also has protections in place to ensure your Social Security Part B premium increase under Medicare doesn’t wipe out your Social Security payment increase.

Is Medicare Part B taken out of Social Security?

Medicare Part B premiums are often taken out of a recipient’s Social Security income.

Will Social Security pay inflation?

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 Certified Financial Planner® can help you account for those years when your premiums will rise almost as much as your COLA.

Did Medicare see a rate increase in 2016?

As recently as 2016, 70 percent of enrollees didn’t see the Medicare rate hike because of the provision. But that doesn’t stop Medicare from boosting premiums to offset the loss. Those hikes may be paid by the people who aren’t protected by the provision or made up in future years, when COLA allows Social Security payments to begin outpacing the rise in Medicare premiums once again.

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 ...

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 act?

The Hold Harmless Act protects those receiving Social Security benefits while enrolled into Medicare from ever experiencing a reduction in Social Security benefits from “too high” of Medicare Part B premium increases in a given year.

What happens if you have too much income for Medicare?

Ultimately, if you have too much income you pay more for your Medicare.

How much did Medicare Part B cost in 2015?

In 2015, the Medicare Part B premium cost was $104.90 a month. By 2016 Social Security announced that there would NOT be a cost of living adjustment (COLA) during that year. At the same time the Medicare Part B premium increased by $16.90 a month to $121.80 (16.1% increase).

How to control health costs in retirement?

To control your health costs in retirement, save your Social Security benefit through the protection of the Hold Harmless Act proper planning for retirement is a must.

When did Medicare implement IRMAA?

In 2007, through the “ Medicare Modernization Act of 2003 “, Medicare implemented the Income Related Monthly Adjustment Amount ( IRMAA ).

Did Medicare Part B increase in 2018?

By 2018 the Medicare Part B premium did not increase and, thankfully, Social Security provided a 2% COLA or roughly a $27.38 increase in benefits.

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);

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.

Why is the hold harmless provision important?

The hold-harmless provision is a key tool to prevent financial hardship for Social Security recipients on Medicare. But it doesn't work as well as many people think it should. Unfortunately, limiting Medicare premium increases to the percentage rate of Social Security COLAs would be a lot more burdensome on Medicare's financial viability, and so it's unlikely that retirees will see any changes in that direction in the near future.

How does Social Security work with Medicare?

One of the most important ways that Social Security and Medicare work together is in preventing Social Security recipients from suffering financial harm as a result of Medicare increases. A key rule known as the hold-harmless provision helps to ensure that Social Security recipients won't face painful reductions in their monthly benefits even when costs under Medicare are on the rise. However, the way that the hold-harmless provision works doesn't quite match up with the mistaken ideas that many recipients have about how it should work. It's essential to know the facts so that you can avoid any nasty surprises during your retired years.

What is the role of Social Security and Medicare?

Together, Social Security and Medicare aim to give retirees vital assistance with their medical and financial obligations. The Centers for Medicare and Medicaid Services, or CMS, cooperate and work together with the Social Security Administration, or SSA, in a variety of ways to ensure that the two programs work as smoothly as possible.

How much did Part B premiums rise in 2013?

As an example, turn back the clock to 2013. In that year, Part B premium rose by 5% , climbing from $99.90 per month to $104.90 per month. By contrast, Social Security's COLA that took effect that year was just 1.7%.

Does Medicare have to be deposited into Social Security?

That way, you don't have to worry about the SSA making a deposit to your account at the same time the CMS is trying to draw from the same account.

Is Medicare premium higher than Social Security?

During some years, the increase in monthly charges for Medicare premiums has been higher than the boost in monthly benefit amounts for Social Security recipients. Those who rely on Social Security would have to deal with the prospect of seeing an outright decline in their net monthly checks during such periods.

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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 is a hold harmless policy?

A: A policy known as the “hold harmless” provision protects many Medicare beneficiaries by essentially capping Medicare Part B premiums so increases aren’t higher than Social Security’s Cost of Living Adjustment (COLA).

What is the connection between Social Security benefits and Medicare premiums?

Most Medicare beneficiaries are also receiving Social Security benefits, and their Part B premiums are automatically deducted from their Social Security checks. Social Security benefits also tend to increase over time due to the Cost of Living Adjustment (COLA). 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 $3/month smaller in the second year).

What was the average Medicare Part B premium in 2018?

Once again, the full COLA for most beneficiaries went towards the higher Part B premiums, and didn’t quite cover the full amount. So the average Medicare Part B enrollee was paying about $130/month in 2018.

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.

How much did Medicare pay in 2017?

For 2017, the provision meant that the 10 percent rate increase for that year (from $121.80/month to $134/month) only applied to about 30 percent of Medicare enrollees. The other 70 percent paid about $109/month (up from $104.90/month in 2016).

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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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