What Zip Codes Have The Medicare Give Back Program?
The Medicare Part B premiumThe Medicare Part B premium is the monthly charge paid by beneficiaries for their outpatient medical care, services, and supplies. A beneficiary's premium may be uplifted by an IRMAA surcharge if their income is above... reduction benefit pays all or some of your Part B monthly premium. However, the benefit is not available from all Medicare Advantage plansMedicare Advantage (MA), also known as Medicare Part C, are health plans from private insurance companies that are available to people eligible for Original Medicare (Medicare Part A and Medicare Part B).. That said, in just a couple of years, the number of plans offering a Medicare Give Back benefit has grown exponentially.
In this blog post, we’ll explore what the benefit is, who it will help, and how to find plans that offer a Part B premium reduction.
- Medicare Part BMedicare Part B is medical coverage for people with Original Medicare benefits. It covers doctor visits, preventative care, tests, durable medical equipment, and supplies. Medicare Part B pays 80 percent of most medically necessary healthcare services. premium reduction is a benefit offered by private health insurance companies through certain Medicare Advantage plans.
- The benefit is allowed by Medicare private health plans, but it is not a benefit offered by the federal agency.
- In general, premium reduction is allowed when a plan’s benefits are actuarially less than Original MedicareOriginal Medicare is private fee-for-service health insurance for people on Medicare. It has two parts. Part A is hospital coverage. Part B is medical coverage. Part B.
- The giveback benefit is sometimes referred to as a Medicare Give Back or Social Security Give Back. The official terminology is Medicare Part B premium reduction.
- The benefit is not available by zip code, per se. It is plan specific.
How Does The Medicare Part B Giveback Program Work?
When you enroll in Medicare, you owe a premium for both Part A and Part B. If you or your spouse paid Medicare taxes for 10 or more years, Part A is premium-free, but Part B isn’t.
In 2023, the basic Part B premium is $164.90 per month. The Part B premium covers your access to medical care, as well as your Part B wellness benefits.
If you join a Medicare Advantage plan, your Part B monthly premium does not go away. You must continue paying your Part B and Part A premiumsA premium is an amount that an insurance policyholder must pay for coverage. Premiums are typically paid on a monthly basis. In the federal Medicare program, there are four different types of premiums. (if any), as well as any additional premium added by your Medicare Advantage plan.
Behind the scenes, Medicare reimburses your Medicare Advantage plan for assuming responsibility for your care (i.e., your Part A and Part B benefits). Generally speaking, plans that offer more benefits have a higher additional premium. Plans with lower benefits often have no additional premium or give back some Part B premium.
More Benefits vs. More Coverage
It’s important to note that “more benefits” could mean additional services, such as prescription drug coverage or dental care, or it could mean more financial coverage. The inverse is also true, however, all plans must cover the same services as Original Medicare.
The giveback benefit is a tool health insurance companies use to be competitive in certain markets. When a plan offers fewer benefits, it allows the plan to give back some of the money it receives from Medicare, which in turn reduces your bill.
It’s important to note that you don’t actually get money back from the plan. The giveback benefit simply reduces the amount Medicare bills you for Part B. For example, if the plan you choose offers a $30 giveback, Medicare reduces your monthly premium by $30.
Unlike Medicare Savings Programs, the giveback program is not based on income or need. It is strictly based on choosing a plan in your area (i.e., your county, borough, or parish) that offers the benefit.
You qualify for a giveback benefit if you are enrolled in both Medicare Part AMedicare Part A is hospital coverage for Medicare beneficiaries. It covers inpatient care in hospitals and skilled nursing facilities. It also covers limited home healthcare services and hospice care. and Part B, join a Medicare Advantage plan offering the benefit, and live in the zip code service area of the plan. There are no other requirements.
Check to see if you qualify for the Medicare giveback program.
Who Qualifies To Join a Medicare Advantage Plan?
All Medicare beneficiaries enrolled in both Part A and Part B qualify to join a Medicare Advantage if:
- They are a U.S. citizen or legal U.S. resident (for a minimum of 5 years); and
- Live in a service area that offers Medicare private health plans.
While most areas have plans available, some rural areas, including the entire state of Alaska, do not.
Additionally, nearly all plans have a specific service area and do not allow their members to receive regular care outside of the plan’s network without additional costs. If you live in another state part-time, be sure to ask a plan about its service area rules.
How to Find a Plan
To find a plan that offers a giveback benefit, use our Medicare Advantage Plan Finder. On each plan page, under the “Plan Basics” section, look for “Part B Reduction”. The amount shown is the amount of premium giveback offered.
Depending on the number of plans offered in your area, you may have no giveback options or a dozen or more to research. Local competition plays a big part.
What To Do If You Find a Plan with a Giveback Benefit
A monthly reduction in your Medicare Part B premium is a nice benefit, but it’s important to weigh it against other factors, including:
- Out-of-pocket costsOut-of-Pocket Costs for Medicare are the remaining costs that are not covered by the beneficiary's health insurance plan. These costs can come from the beneficiary's monthly premiums, deductibles, coinsurance, and copayments.. Each Medicare Advantage plan sets its own premiums, deductiblesA deductible is an amount a beneficiary must pay for their health care expenses before the health insurance policy begins to pay its share., copaymentsA copayment, also known as a copay, is a set dollar amount you are required to pay for a medical service./coinsurance, out-of-network costs, and annual limits. Doing your homework on these costs is important. Don’t assume they are as good as, or lower than, Original Medicare.
- Provider networks. Unlike Original Medicare, which allows you to use any providers that accept Medicare payments, most Medicare Advantage plans have limited provider networks. If you go outside of your plan’s network, you may be required to pay higher costs or all costs.
- Healthcare benefits. All plans cover everything that you get with Original Medicare. And, most plans offer some additional benefits, such as prescription drug coverage and routine dental care. Be sure to balance any additional benefits offered with added premiums and/or a premium giveback.
- Prescription costs. For many people on Medicare, regular prescriptions are the number one cost factor. When evaluating a Medicare Advantage plan that includes Part D benefits, it is very important to take the time to run a cost analysis on your regular medications. When you do, you will find a wide variation in total costs.
Who is a Good Candidate for a Medicare Giveback Plan?
In our analysis of more than 50 Medicare Advantage plans offering a Part B premium reduction, 47 of the plans had higher out-of-pocket costs than the area average. This suggests that these plans would be a great opportunity for healthy members to save money.
However, these plans are likely to cost individuals with chronic health conditions more money due to their higher-than-average copays and deductibles.
How can you tell?
When you search for plans using our Medicare Advantage Plan Finder tool, each plan page shows you a cost breakdown for the most common services. You will also find a download button so you can download and print this information. Examine costs carefully for the service you use most.
Citations & References
- Medicare.gov, “Costs“, Accessed May 24, 2023.
- CMS.gov, “2023 Medicare Parts A & B Premiums and Deductibles 2023 Medicare Part D Income-Related Monthly Adjustment Amounts“, Accessed May 24, 2023.