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What Is The Medicare Giveback Benefit

What Is The Medicare Part B Giveback

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If you choose to enroll in a Medicare Advantage plan, you pay the premium for Part B plus the premium for the Advantage plan. As of 2023, two-thirds of all Advantage plans have $0 premiums, which means their enrollees just pay the Part B premium.

But some of those plans go a step further, offering giveback rebates that pay a portion of their enrollees Part B premiums. This benefit, also referred to as a Medicare Part B premium reduction, has been available since 2003. And although most Advantage plans do not offer a giveback rebate, the benefit has become more popular and widespread in recent years, and is increasingly marketed as a stand-out benefit by Medicare Advantage plans that do offer it.

Whats The Difference Between A Part B Give

Both of these benefits refer to Medicare Advantage plans. When you enroll in Medicare Part C, you must pay your monthly Part B premium. When you hear zero premium, the Medicare plan doesnt have an additional monthly cost.

Medicare Advantage plans that provide the benefit generally have a zero-premium. The difference is that your monthly Part B premiums would be reduced by the give-back amount provided by your plan.

Youll Need To Meet Certain Requirements To Receive The Benefit

In order to receive the Give Back benefit, youll need to meet certain requirements. Some of the requirements that youll have to meet before you can receive the benefit include:

  • Being enrolled in Original Medicare
  • Being enrolled in a qualifying Medicare Advantage plan
  • Bearing sole responsibility for paying the Medicare Part B monthly premium
  • Living in a service area of a plan that has chosen to participate in the program

Being able to participate in the Medicare Give Back program is heavily dependent on where you live. Medicare Give Back benefit zip codes actually participating in the program are relatively few and far between. In order to learn whether or not a Medicare Advantage plan provider in your area participates in the Medicare Give Back program, youll want to search for the Medicare Give Back benefit by zip code.

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What Factors Other Than Premium Should I Consider When Choosing A Medicare Advantage Plan

The total monthly premium is just one aspect of your coverage, and there are numerous other features that youre going to want to take into consideration when youre making a plan selection. For example:

  • How will the plan cover your specific prescription drugs, and what pharmacies are in-network?
  • Which doctors and hospitals are in the plans provider network?
  • What are the total out-of-pocket costs that youre likely to have under the plan?
  • What additional benefits does the plan provide, and how much value will you get from them? This can include coverage for things like over-the-counter drugs, in-home support, dental services , hearing aids, gym memberships, and more. Particularly for people with certain chronic medical conditions, Medicare Advantage plans are increasingly offering additional supplemental benefits, but you have to qualify for these based on your medical needs.
  • What star rating does the plan have?

Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.

Who Is Eligible For A Medicare Part B Premium Reduction

What Is Medicare Part B Premium Reduction

Are you wondering who qualifies for free Medicare B? There are many people who might be eligible for a Part B premium reduction, and you could be one of them. To be eligible, you need to be enrolled in a participating Medicare Advantage plan. Not all plans provide this benefit. Similarly, not all plans are offered in all areas. The plans available vary by state and county, so you will need to find a plan whose service area includes your location that offers the Part B give back benefit. You might find that no plans in your area provide this benefit. Currently, plans that provide a give back benefit exist in 48 states.

To qualify for a premium reduction, you need to be enrolled in both Medicare Part A andMedicare Part B. You must also pay your own Part B premium each month. If you have completed enrollment in another type of assistance program, such as Medicaid, that helps pay your Part B premium, you will not be eligible to participate in the give back benefit. Similarly, those participating in a Medicare Savings plan will not be eligible for the give back benefit. Most Medicare beneficiaries will be able to participate in the give back benefit once they find the right Medicare Advantage plan, with the exception of those who already receive Part B premium assistance from other sources.

Read Also: What Are Medicare Part C Benefits

Medicare Advantage Plans: Common Elements

  • All plans have a contract with the Centers for Medicare and Medicaid Services .
  • The plan must enroll anyone in the service area that has Part A and Part B, except for end-stage renal disease patients.
  • Each plan must offer an annual enrollment period.
  • You must pay your Medicare Part B premium.
  • You pay any plan premium, deductibles, or copayments.
  • All plans may provide additional benefits or services not covered by Medicare.
  • There is usually less paperwork for you.
  • The Centers for Medicare and Medicaid Services pays the plan a set amount for each month that a beneficiary is enrolled.

The Centers for Medicare and Medicaid Services monitors appeals and marketing plans. All plans, except for Private Fee-for-Service, must have a quality assurance program.

If you meet the following requirements, the Medicare Advantage plan must enroll you.

You may be under 65 and you cannot be denied coverage due to pre-existing conditions.

  • You have Medicare Part A and Part B.
  • You pay the Medicare Part B premium.
  • You live in a county serviced by the plan.
  • You pay the plan’s monthly premium.
  • You are not receiving Medicare due to end-stage kidney disease.

Another type of Medicare Managed Health Maintenance Organization is a Cost Contract HMO. These plans have different requirements for enrollment.

Where Can You Get The Medicare Give Back Benefit

To take advantage of the Medicare give back benefit, you need to live in an area where one is offered. Plans with Part B reductions can be sold anywhere in the nation, but theyre not available everywhere. To see where you can get a plan with a Medicare give back benefit, you have a few options, including:

Theyll look at options in your area and see if any of their policies feature Part B premium reductions. The only drawback? They probably wont show you options from their competitors.

Contact an independent, licensed insurance agent. They can give a more well-rounded view of your choices as they often have access to plans from several different carriers and can compare more options in your area. Many, like the agents at GoHealth, are paid by the carriers, which means you typically dont have to pay for this guidance.

If youre the dedicated do-it-yourself type, however, there are ways to find plans with the Medicare give back benefit on your own if you know where to look.

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What Is The Give Back Benefit On Medicare Plans

The Part B give back benefit helps those on Medicare lower their monthly health care spending by reducing the amount of their Medicare Part B premium. When you enroll in a Medicare Advantage plan that offers this benefit, the carrier pays either a part of or the entire premium for your outpatient coverage each month.

How Much Is The Medicare Part B Premium

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The standard premium for Medicare Part B is $164.90 per month in 2023. However, higher income earners may have to pay a higher premium due to the Income Related Monthly Adjusted Amount, or IRMAA. The adjusted gross income reported on your taxes from two years prior is used to determine your IRMAA liability.

The table below shows how much you can expect to pay for your Medicare Part B premium in 2023.

Medicare Part B IRMAA
2021 Married and separate tax return 2023 Part B monthly premium
$97,000 or less
More than $97,000 and up to $123,000 More than $194,000 and up to $246,000 N/A
More than $123,000 up to $153,000 More than $246,000 up to $306,000 N/A
More than $153,000 up to $183,000 More than $306,000 up to $366,000 N/A
More than $183,000 up to $500,000 More than $366,000 up to $750,000 More than $97,000 up to $403,000 $527.50
More than or equal to $500,000 More than or equal to $750,000 More than or equal to $403,000 $560.50

Also Check: Medicare Benefit Policy Manual Chapter 1 Section 10

Around 40% Of Medicare Advantage Plans Have No Monthly Premium But Did You Know Some Plans Actually Reduce Your Part B Premium

The Medicare giveback benefit, or Part B premium reduction plan, is becoming more available and popular among beneficiaries. Though not an official Medicare program, this benefit is offered by some Medicare Advantage plans and covers some or all of your Part B monthly premium .

While not all plans offer this benefit, it’s possible to find one where you’d pay a reduced premium amount up to $164.90. This can help maximize your savings while on Medicare, though there are a number of considerations when deciding if these plans are right for you. Read on to learn more about the giveback benefit and how you could qualify.

Its Important To Know Your Options

If youd like to participate in the Medicare Give Back program, but you currently arent enrolled in a Medicare Advantage plan, or youre enrolled in an Advantage plan that doesnt participate, always remember that you have options. There are numerous Medicare Give Back benefit zip codes out there, and yours may be one of them.

To see if Medicare Advantage plans in your area offer the benefit, search for the Medicare Give Back benefit by zip code today. You may find a qualifying plan that works for you!

Find a Medicare Advantage plan in your area that works for you. Call us today at to speak with one of our licensed agents.

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Premium Reductions Are Only Available With Medicare Advantage Plans

Premium reductions are only available with Medicare Advantage plans, which cover the same services as Original Medicare , and often come with additional benefits, including the Give Back Benefit. This means that Medicare beneficiaries who choose to stay on Original Medicare, do not have access to plans with premium reductions.

Wondering if a Medicare Advantage plan is right for you? One of our Advisors can help you understand the benefits of the different Medicare plans available to you.

Are Medicare Advantage Plans Worth It Or Are They A Ripoff

What Is Medicare Giveback Benefit

It is impossible to make a blanket statement about Medicare Advantage being good or bad. It all depends on your personal situation.

For some people, extra benefits make them worth the potential risk and the inconvenience of getting referrals. For others, they cost far more than Original Medicare, making them a ripoff.

The only way to know for sure is to understand the biggest disadvantage of Medicare Advantage and balance that with your healthcare needs. When you do this you will discover:

  • If you are healthy A Medicare Advantage plan is a great way to save money if you are healthy. If you take advantage of the preventative care benefits, and additional benefits, you will get a lot for your money.
  • If you have employer health benefits Many employers offer workers and retirees health benefits that pay their Medicare Advantage plan premiums and other costs. If you have employer benefits, its a great way to save money.
  • If you qualify for both Medicare and Medicaid Nearly 3-million people have a Medicare Advantage Special Needs Plan . The majority of these people qualify for an SNP for financial reasons and pay minimal copays and coinsurance costs when they use services. If you can qualify, and an SNP is available in your county, it is the best way to get your healthcare.
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    Who Qualifies For Medicare Advantage Premium Reduction

    As mentioned above, the Medicare Part B premium reduction benefit is only available through a participating Medicare Advantage plan. This means that to get the benefit you must be living in a service area of a Part C plan that participates in the program.

    If you arent already enrolled in a Part C plan, you can do so during the Medicare Open Enrollment Period or as a new Medicare beneficiary. But to be eligible for Part C coverage, you must first be enrolled or eligible for enrollment in Original Medicare Parts A and B. You must also be actively paying your own Medicare Part B monthly premium.

    You arent eligible for the Medicare Advantage Giveback benefit if you get assistance paying your Part B premium from Medicaid or another government program.

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    How Much Can I Get Back

    The amount you get back ranges from $10 or less in some counties up to the full Part B premium amount of $148.50. In most cases, it falls somewhere between $20 and $100.

    The exact amount you get back depends on plan options in your area. Dont be surprised if you find out that the same plan has different premium reduction amounts in different counties and states.

    The other thing that could impact how much you get back is that Medicare Advantage plans individually set fees for premiums, deductibles, and services. Although plan providers must follow Medicares rules for coverage, they can change the fees associated with their plans once each year. These changes go into effect annually on January 1.

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    How To Get A Medicare Part B Give Back Plan

    Its important to compare Medicare Advantage and Medigap plans before enrolling in either option. Many beneficiaries are unaware of the many limitations that come with Medicare Advantage plans, so a Medicare Part B premium reduction may not be worth the additional cost-sharing for some. It is essential to fully understand your policy limitations before deciding on a plan.

    If you want to keep Original Medicare but wish to save money on monthly premiums, you should consider the High Deductible Plan G or High Deductible Plan F Medigap options. Another comprehensive yet affordable Medigap option is Plan N.

    Whichever route you decide to go, speaking with a licensed agent is always helpful when comparing benefits. To see what Medicare Advantage options are available in your area, enter your ZIP Code in this portal.

    Medicare Give Back What Is It

    Medicare 101

    If you are on Medicare and looking forward to maximizing your savings, you might wonder what the Medicare give back benefit is. This is a term for a Medicare Part B premium decrease featured in some Medicare Advantage plans rather than an official Medicare program. The Part B premium reduction is the give back benefit. The terms of the plan you choose and a few other considerations will determine whether you receive this discount.

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    What Exactly Is The Program

    The Medicare Give Back Benefit is actually a Medicare Part B premium reduction, or buy down.

    Only some Medicare Advantage plans qualify or include the buy down. Simply explained, the federal government pays Advantage plans to provide covered care for plan enrollees. Medicare doesnt pay individual claims the MA provider covers the cost. The insurance company pays back some of the amount to Medicare. This amount is paid back to you in your Social Security benefit,

    How To Get A Give Back Benefit

    So how do you get a Give Back benefit? Well it depends on the area where you live and whether or not there is a Medicare Advantage Plan that offers this benefit. With Medicare Advantage Plans, in order to enroll, you have to reside in the service area of the plan.

    If there are no plans that offer a Give Back benefit then you wont be able to get it unless you moved to another area where one of the plans are available.

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    Avoid Overlooking These Details

    When it comes to the monthly cost of Medicare, premiums are top of mind for most. Whether you go to the doctor or not, you have to pay your premiums, which is why a premium reduction can be tempting. Below are questions you should ask to avoid the Give Back Benefit costing you something you cant afford to lose:

    • Are your preferred doctors in-network?

    • Are your prescription drugs covered?

    • What is the difference in copay amounts?

    • Are the services you need covered?

    • What is the annual out of pocket maximum?

    Despite limitations and drawbacks present in plans with a give back program, the benefit has risen in popularity in the past few years.

    Are There Any Protections If I Enroll In A Plan And Do Not Like It

    Income Limit For Medicare Part B 2020

    In order to enable beneficiaries to try a Medicare Advantage plan, but still have the option of returning to Original Medicare, a number of protections are in place. These protections will enable beneficiaries, in certain situations, to try a plan, but then return to Original Medicare and a Medicare Supplement policy if they want to do so.

    Under these protections, beneficiaries will have guarantee issue of a Medicare Supplement policy as long as they meet one of the following criteria. For eligible beneficiaries, companies which sell supplement policies will not be able to deny coverage, charge more, or exclude benefits. However, to receive these protections, beneficiaries must apply for a supplement policy within 63 days of disenrolling from the health plan, or within 63 days of the termination of the health plan.

    A beneficiary would be eligible for the Medicare Supplement protections if they meet one of the following criteria.

    Case #1

    You are enrolled in a Medicare Advantage plan and one of the following happens:

    • The contract between Medicare and the plan ends.
    • The plan service area no longer covers the county where you live.
    • You move out of the plan service area.
    • There are violations by the plan.

    Protection: In this case, you would get a guaranteed issue of a Medicare Supplement Plan A, B, C, or F from any company .

    Case #2

    Case #3

    Protection: You are guaranteed to get any Medicare Supplement plan with any company .

    Case #4

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