Kiplingers Personal Finance

36 KIPLINGER’S PERSONAL FINANCE^ 05/2017

MONEY

your doctor can fix and resubmit.

Or Medicare may cover an expense

but not submit the claim to your sup-

plemental insurer (go to http://www.my

medicare.gov to update this informa-

tion). Drug coverage may be denied if

you didn’t follow procedures for step

therapy or prior authorization, but

that denial may be reversed when you

resubmit the forms.

If that doesn’t work, you have 120

days to appeal the denial. Look on the

back of the Medicare summary notice

for details, and see http://www.medicare.gov

for more about each level of appeal.

You have just 60 days to file an initial

appeal for Medicare Advantage or

Part D; follow the instructions on

the explanation of benefits.

You can get help appealing a claim

from your state health insurance assis-

tance program (www.shiptacenter

.org) or the Medicare Rights Center

(www.medicarerights.org; 800-333-

4114). Or use the Center for Medicare

Advocacy’s appeal self-help packet

(www.medicareadvocacy.org). ■

Administration to base premiums

on your more-recent income by filing

Form SSA-44 and providing documen-

tation. (See “Medicare Premiums:

Rules for Higher-Income Beneficia-

ries,” at http://www.ssa.gov.)

My doctor prescribed an expensive drug

and even with my Part D coverage, I have

to pay a lot of the cost out of pocket. What

can I do to pay less? First, ask your doc-

tor if you can use a generic drug or a

“therapeutic alternative” that costs

less under your plan. Also see if you

can reduce co-pays by using a pre-

ferred pharmacy (ask your insurer

which pharmacies are preferred).

Then look for a new plan during open

enrollment in the fall. Use the Medi-

care Plan Finder (www.medicare.gov/

find-a-plan) to compare premiums

plus out-of-pocket costs for your

drugs. See if there are restrictions,

such as requiring prior authorization

from your provider before covering

pricey drugs, or step therapy, which

means you have to try less-expensive

drugs first, if possible.

After I’m on Medicare, can I use HSA

money for medical expenses without

paying taxes on it? Even though

you can no longer contribute to

an HSA after you sign up for

Medicare, you can use money

already in the account tax-free

for medical expenses. You

can also use the HSA money

tax-free for Part B, Part D

and Medicare Advan-

tage premiums (but

not medigap).

APPEALING

DENIED

CLAIMS

My Medicare

claim was

denied. What

can I do? First

find out why

it was denied.

It may be a

coding error

The doctor I want to use isn’t covered by

my Medicare Advantage plan. When can I

switch to a different plan? You generally

can’t switch to another Medicare Ad-

vantage plan until open enrollment in

the fall, which runs from October 15

to December 7, 2017, for 2018 coverage.

There are a few exceptions: You can

switch plans if you qualify for a special

enrollment period, such as if you move

to an address that isn’t in your plan’s

service area. You can also switch to a

Medicare Advantage plan with a five-

star quality rating anytime during the

year. But there are only 17 five-star

plans in the U.S. in 2017 (look up

“Medicare health plans” by zip code

at http://www.medicare.gov/find-a-plan).

If you join a Medicare Advantage

plan when you are first eligible for

Medicare and switch back to tradi-

tional Medicare within 12 months, you

can buy a medigap policy and a Part D

plan within 63 days of the change.

Each year, you can switch from Medi-

care Advantage back to traditional

Medicare and get a Part D drug plan

from January 1 to February 14. But

you could be rejected or charged more

for medigap because of a preexisting

condition. For more about the rules,

see Medicare Interactive at www

.medicareinteractive.org.

SAVING MONEY

How high must my income be to get

snagged by the Medicare high-income

surcharge? If the total of your adjusted

gross income plus tax-exempt interest

income is more than $85,000 if you’re

single or $170,000 if you’re married

and filing jointly, you have to pay extra

for Part B, with monthly premiums of

$187.50 to $428.60 in 2017, depending

on your income. You’ll also have to pay

an extra $13.30 to $76.20 each month

for Part D drug coverage.

The high-income surcharge is based

on your last tax return on file—for

2017 premiums, that’s your 2015 re-

turn. If your income has dropped since

then because of certain life-changing

events, such as divorce or retirement,

you can ask the Social Security ROSE BLAKE