Client Study: Medicare D Penalties

Just this past week we assisted a new client enroll in Medicare D for the first time.  Unbeknownst to them, they were about to get hit with two big penalties – Delayed Enrollment & Income Related Monthly Adjustment Amount (IRMAA).

“Sally” is a 73 year old widow in fantastic health.  Pair this with her solid financial status, she had not enrolled during her initial enrollment period eight years ago.  With the best of intentions, i.e. not leveraging resources that she did not require as well as obviously not wanting the headache of managing the enrollment, Sally went eight years beyond her enrollment period.

When we sat down, to calculate the monthly penalty she was shocked to understand the extent of the penalty and that it would affect her premiums for the full duration of her enrollment – not just the year she had previously believed.  Anyone who delays or suspends enrollment in their Medicare product for more than 63 days is subject to this stinger.

To calculate a Delayed Enrollment Penalty, Medicare calculates the penalty by applying 1% of the National Premium Average ($33.19 for 2019 enrollments) times the number of full, uncovered months you didn’t have Part D or creditable coverage.

For Sally this meant, 99 months (Oct 2018 minus June 2010 = 99 months) without coverage and a whopping $34.70 added to her monthly bill.  Given that her regular premium is $27.40 for her selected Medicare D product this was a shocker.

To add assault to injury, Sally is classified as a “High Earning Senior” as her Modified Adjusted Gross Income (MAGI) is in excess of $125,000 this year.  For that she is also subject to “The Medicare Income Related Monthly Adjustment Amount” which is going to tack on an additional $31.90 per month to her premium.

2019 Medicare Part D IRMAA is shown below.
Beneficiaries who file individual tax returns with income that is: Beneficiaries who file joint tax returns with income that is: Medicare Part D Income Related Monthly Adjustment Amount
Less than or equal to $85,000 Less than or equal to $170,000 $0.00
Greater than $85,000 and less than or equal to $107,000 Greater than $170,000 and less than or equal to $214,000 $12.40
Greater than $107,000 and less than or equal to $133,500 Greater than $214,000 and less than or equal to $267,000 $31.90
Greater than $133,500 and less than or equal to $160,000 Greater than $267,000 and less than or equal to $320,000 $51.40
Greater than $160,000 and less than or equal to $214,000 Greater than $320,000 and less than or equal to $428,000 $70.90
Greater than $214,000 and less than or equal to $500,000 Greater than $428,000 and less than or equal to $750,000 $70.90
Greater than $500,000 Greater than $750,000 $77.40

In the short order of one hour, Sally’s monthly out of pocket cost, before seeing any benefits, is now $94.00.  A far cry from the $27.40 premium for her selected Medicare D product.

Is there any relief for Sally?  Maybe, filing an appeal on both of these penalties are worth the trouble.  What needs to be completed is a Request for Reconsideration as well as a Late Enrollment (LEP) Reconsideration Form.


Senior Security: Fraud & Identity Theft

When you consider fraud & identity theft, the first culprits that come to mind are telemarketers, right?  Well, just like any other crime, those closest to the targeted victim are most likely the offender.  This includes financial advisors, home health workers and even family members.

dreamstime_xxl_91269790According to The National Adult Protective Services Association:

  • One in nine seniors reported being abused, neglected or exploited in the past twelve months; the rate of financial exploitation is extremely high, with 1 in 20 older adults indicating some form of perceived financial mistreatment occurring in the recent past
  • Elder abuse is vastly under-reported; only one in 44 cases of financial abuse is ever reported
  • Abused seniors are three times more likely to die and elder abuse victims are four times more likely to go into a nursing home
  • 90% of abusers are family members or trusted others
  • Almost one in ten financial abuse victims will turn to Medicaid as a direct result of their own monies being stolen from them
  • Cognitive impairment and the need for help with activities of daily living make victims more vulnerable to financial abuse

The methods that can be used to milk you or your loved one out of life savings and future financial security truly can be insidious.  Just this past week, I received a call from a family seeking help for their father after he shared his Social Security number with his new neighbor on the promise of being included in a mythical real estate investment.

So, what is the best course of action to create a wall around finances & personal security?

  1. Put a freeze on your credit.  By contacting TransUnion or Experian credit bureaus, you can put your credit on lock down so any perpetrator can’t get past even opening an account.  This is one of the few preventative steps you can take.  With PIN access, credit can be “re-activated” for use as appropriate.
  2. Good ol’ Life Lock.   This is where the internet works for you.  Scouring the net for your information to raise the red flag if a new account is opened or if there may be changes to your credit.
  3. Careful vetting of your “Guardians” – your trusted circle that helps maintain home, health & lifestyle.  This includes your CPA, estate lawyer, financial advisor, physicians, daily money manager and even your insurance agent.  Each of these individuals must come to you with not only familiar personal recommendations but endorsements from local and national organizations as well that you can verify directly.
  4. Do you have help within the home?  From housekeepers to home health aides – there is inherent risk.  Get organized.  There is a laundry list of security steps that everyone should take prior to having regular help within the home.  This includes but is not limited to:
    • Removal of any/all account or statement information.  Bank information, estate plans, utility bills, real estate documentation….. the list is extensive.  This critical information can be stored with a loved one or kept in a lock box.
    • Depending on health status and other factors, forwarding mail to a PO Box or a trusted individual may be wise.
      • To that end, if there is a level of comfort without paper records, activating paperless billing & statements is a safe bet.
    • PIN numbers & passwords must be activated on cable/internet access.  Running up Pay Per View charges and spending working hours surfing the web are abuse.
    • Install a personal safe or rent a safety deposit box for valuables.
    • Background checks:  how & when were they last completed?
  5. Passwords.  Each account needs it’s own security and must be guarded. Like it or not, the financial world is digital and the trail of logins, passwords, payment information, and other sensitive personal information is precarious.  Using a digital password keeper like LastPass or DashLane keeps your information accessible while still under the highest of security.  Further, you can designate a POA or another trusted individual access in the case of emergency, thus insuring bills are continually paid and your finances stay on track.

What’s still at stake despite all these measures?  Your Social Security number can still be used for medical and tax fraud.

Medical identity theft is on the rise as it enables the perpetrator to obtain drugs or submit fake bills in your name.  Your best course of action is to keep a record of all EOBs and immediately flag any charges that are not familiar.

Tax identity theft occurs when an individual files a false report under your name to obtain refund.  Being well prepared to file early & quickly is the safest recourse.  Any subsequent attempts to file will be rejected by the IRS.  Being organized throughout the year so when January rolls around, you can swiftly hand off your tax package to your vetted & trusted CPA is best.

At the end of the day, security for your identity and finances require ongoing support.  Incoming mail, email, statements and billing require scrutiny and evaluation.  Engaging your Guardians and family to assist is the first step to creating your own firewall of safety.

Deductions: A quick guide to healthcare write offs

Get the most out of your dependent medical expenses…… money back!

The devil is in the details.  Well, in this instance the devil is tracking out of pocket medical expenses.  Once out of pocket expenditures exceed 10% of adjusted gross income you’ve got deductions!   Do you have a running account of all the money you’ve been spending on you and your dependents?  This is an exercise in accounting well worth completing.  Below is a high level list of what’s deductible but you’ll want to check the IRS’s Publication 502 for greater detail.

  • Copays & deductibles
  • Accepted therapies that may not be covered by your insurer
  • Glasses
  • Ambulance charges
  • Acupuncture
  • Physical therapy
  • Memory care
  • Bandages / care supplies
  • Hearing aids
  • Activities for older people (dual eligibles)
  • Some required home and vehicle modifications for safety
  • Professional health assistance for respite care
  • Transportation for medical appts or services
  • Adult day care or in-home health assistance (if you are working)

How to capture this information?  It can be as simple as putting pen to paper with an envelope of receipts attached or a digital spreadsheet.  The most important part is to have all your receipts & detail of the charge accounted for at the end of the year.  Receipts must include the following:

  • Patient Name
  • Date of Service
  • Diagnosis / Reason for Service
  •  Amount Paid Out of Pocket
    • This is important – make sure it notes that the account has been paid or you have cancelled check or credit card receipt to back the expenditure up.

The importance of a Certified Senior Advisor®️

The senior community is growing at an incredibly fast clip and the technology that runs our every day life is growing just as quickly.  The rub – the accessibility and understanding of today’s paperless accounting and online management has created a vast divide between technology and user.

“Research has also shown that even cognitively normal people may reach a point where financial decision-making becomes more challenging.” (NYT, Bernard)  Making daily decisions about bills to be paid, marketing offers that pop up in snail mail and e-mail, the landmine of Medicare options and home management create stress and chip away at self-confidence.  The Center For Retirement Research at Boston College ran a study with startling results regarding one’s ability to understand credit card balance transfer offers for new cardholders.  Essentially, this study tracked how long it would take the subject to uncover the hidden loophole on how the lower APR would be applied.  They called this the “Eureka Moment”.

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The startling results are that the “Eureka Moment” comes at the same time for the 18-24 year old group as the 65+ group.

Retirement years should be filled with the reward of relaxation and earned leisure.  Instead, many seniors find themselves carving out significant hours to manage their cash flow, research healthcare and analyze the mountain of mail and paperwork that accumulates on their dining room table.  Not wanting to trouble family or friends and most importantly, not jeopardize their autonomy, most don’t raise their hand to seek advice.

This is where a Certified Senior Advisor® comes in.  A professional that is trained and accredited in understanding and navigating the daily life of a senior.  Helping clients transverse the intersection of financial security, personal independence, the ever changing healthcare landscape and most importantly, maintaining respect for the individual.  A Certified Senior Advisor® works alongside their client to insure that their wishes are followed to a T.  It really is that simple.

Money Management – Monitoring the household budget and cash flow is running efficiently

Healthcare claims & enrollments – Insuring that your benefits are being maximized to fit your healthcare needs

Taxes & Portfolio – Creating ease around the functions of tax prep, end of year distributions and charitable giving

Household – Assisting or managing projects to make your house work better for your needs

At Senior Checks & Balances, our mission encompasses a wide holistic approach that creates safety around household & finance, as well as nurtures independence and individual empowerment.

Client Study:  “Anne”

Photo by rawpixel on Unsplash

Age:  94 years old

Support:  Widow, no children or local family.  No POA

Health Status:  Legally blind, significant hearing loss & two other chronic conditions requiring pain management and a walker.  Aging in place & homebound.

Financial Resources:  SS & Teacher’s Pension

May 2018, Anne requested assistance from a home health agency after her most recent hospital discharge.  Part of her service request was tax preparation assistance as her taxes had not been filed and her previous CPA was no longer in business.  The home health agency referred her to Senior Checks & Balances (SCB) for guidance.

After an introductory phone call with a Senior Checks & Balances advisor and the initial in-home assessment, a work plan and calendar were laid out that Anne was comfortable moving forward with.

  •      Two sessions per week @ two hours each for two weeks
  •      Daily activity logs for Anne to review
  •      Filing system to organize documentation based on the following headers:

o   Tax documents

o   Income documentation (including SS)

o   Healthcare spending/expenses

o   Gifting/Charitable receipts

o   Real estate/tax info

o   Banking Info

Over the course of the sessions, Anne & her SCB advisor were able to capture & organize her 2017 tax documents, relevant receipts and other documentation.  For those items that were not available or misplaced, SCB worked as Anne’s agent to obtain copies in a timely manner. Once the tax package was complete, SCB introduced Anne to a trusted CPA that worked on her behalf directly with the IRS to have penalties abated based on medical exemption and file her return.

While there are no concrete numbers on how often taxes are not filed due to illness or lack of support, the greater concern is that there are no current safety nets in the system to insure all filings and enrollments for seniors are done in a timely manner.  More often than not, failure to file is not caught until the individual has past away or finances have reached a critical failure. At this juncture, the individual’s estate will be further compromised through audit and probate.


In 2019, the IRS will be introducing the 1040SR which is available to any taxpayer 65 or older without significant income restrictions.  Similar to the 1040EZ, this new filing tool was developed for those, like Anne, with relatively simple or uncomplicated finances – but therein lies the issue.  Senior finances are complicated. First, it does not further insure that a chronically ill senior with diminished competency will file. Also, tax code and deductions around senior living and healthcare are extremely complicated and require professional assistance to insure all deductions are captured appropriately.  Only the standard deductions can be taken when using the 1040SR.


Despite popular beliefs, dementia is not always at play.  As we age, our ability to perform or recall the steps to tasks that were once routine diminish with or without any cognitive decline.  Having the conversation early and often is the key to staving off financial errors or incidents. In the case where family is available to step in once their loved one is not longer capable of managing their day to day, the focus remains on the physical health of the individual while the financial health of their estate remains a secondary concern.  Installing safeguards and systems well before there is a critical life event – health or financial.


While Anne’s case is unfortunate, as she has no local family nor a designated POA, anyone can easily fall into the same situation even with an extensive support structure around them.  Any individual managing declining health that inherently creates greater financial oversight is best served by engaging a professional to oversee the “workflow” of daily finance, healthcare spending and financial management.  A Certified Senior Advisor can establish baseline efficiencies and protections for not only day to day finances but of the overall estate as well when engaged early on.  Further a CSA, serves as a valuable member of the individual’s “support structure” for continued autonomy as well as neutral point of contact for all family members.  


Financial Caregiving

When it comes to engaging assistance as we age, the focus weighs heavily on the physical end of the spectrum.  Creating safe environments that allow us to age in place while managing new and changing states of health seems to dominate the conversation.  Home health aides, caregivers and companions offer a host of solutions and assistance that create a seamless transition into our senior years.

Yet, very rarely is any emphasis placed on the finance of the household during this period of transition.  Many believe that if they have engaged a wealth manager or financial planner to oversee savings, IRAs or investments that all is secure and sound.   Overlooking the day to day finances of health and home can create even greater implications on the individual as they age.

There are five areas where we seek professional guidance to protect our lifestyle and future –

  1.  Investment/Savings – CPAs, CFPs, Wealth Managers, etc..
  2. Healthcare – From doctors to in home assistance
  3. Insurance – Agents supplying policies covering health, property and life.
  4. Estate – Lawyers and professionals creating the “firewalls” for the protection of your holdings and interests.
  5. Home & Lifestyle – Who is protecting and advising on household budgets, household spending, tax documentation preparation, Medicare enrollments and the litany of other details that clog our inboxes and mail slots?  Who is insuring that the other four stakeholders, listed above, are working in concert?


The stakes of household and healthcare finance are higher as we age.  Keeping accounts current, meeting bill deadlines, assessing the validity of charges, navigating online billings, recurring charges – all can create significant damage to our lifestyle if not managed correctly.  Additionally,  there is the necessary understanding and expertise of the health insurance landscape that can have detrimental effects, financially & physically, if not management appropriately.

The same way we engage home health aides to insure physical safety at home, the need for Daily Money Management and Certified Senior Advisors to protect our cash flow and access to healthcare is vital. 

  • Setting up a sound budget that anticipates expenditures and can clearly track changes as they occur.
  • A living record of healthcare spending that follows the life of each claim and captures out of pocket spending.
  • Clear communication with all other “custodians” (doctors, CFPs, CPAs, lawyers….) so enrollments, taxes and distributions are completed with the least amount of stress and uncertainty.

Engaging a professional to assist with the business of household and healthcare insures peace of mind that daily cashflow and access to care are secure and protected.

Contact us today to discuss how we may assist you and your loved ones.

What We Leave Behind

I’m feeling a little bit shell shocked so forgive the frank post.

Senior Checks and Balances means a lot of different things to many different people.  Relief for an overwhelming situation, assistance in maintaining independence, financial security or simply freedom to enjoy retirement.  Working with one particular client has been especially rewarding – a 50 year old woman whose chronic illnesses had overcome her ability to manage household, three dependent children, a husband who works away during the week and an invalid mother.   We’d been working on Medicare/Medicaid re-enrollments, bill consolidation and building a working household budget.

This morning her husband called.  She past away suddenly a two days ago.

All I can do now, is give her husband and children the relief of managing all that is outstanding.   Their grief shouldn’t be compounded by the stress of the mounds of mail and paperwork on the dining room table.  I’ll spend a couple of days each week for the next month shepherding their accounts through adjudication and getting them onto solid ground.

She left behind no will, no power of attorney (healthcare or durable), no instructions, no living will….. no estate plan of any kind.  Now, I can launch into all of the terrible scenarios that can result from not having any of these simple documents – like debates over life sustaining measures or ending up in probate court.  They are all terrible and lead to stress and heart ache for your loved ones amidst their grief.

Instead, I implore you to take a couple of hours and get your house in order.  A couple of hours.

  1. Employ an estate planner (I know some outstanding and upstanding professionals!) or just log on to legalzoom – just get the proverbial pen to paper.  Costs are lower than you think and can save you from losing upwards of 70% of your estate to legal fees and estate taxes.  Yes, 70%!  Also, the average length of time an estate will stay in probate is anywhere from 6 months to 2 years.
  2. We live in a digital age that is full of paperless statements and usernames/passwords.  Utilize a username/password tool such as LastPass or Keeper.  These tools allow for a designated person to have access after an emergency or unexpected death.  They will also assist with a digital will.
  3.  The day to day stuff.  The comcast bill, the landscaper……..  every vendor you pay on a regular basis needs to be notated.  Googledocs or OneDrive is your simplest way to give life to your household budget.
  4. The three wise (wo)men – your insurance agent (health &/or life), your lawyer and your accountant/CFA.  If you employ any of these professionals, your estate will work in conjunction with them in an event of a crisis or passing.  Have their info in the hands of your loved ones all the time.

Share the whereabouts or existence with this information with your whomever you decide is your “person”.  No personal or account information needs to be shared – just who to contact and how to proceed.  Laugh if you like, but every year I get an email from my mother entitled “Dead” – it contains an update on who to call, where a specific item may be or directive for her final wishes.  Morbid or not, it gives her a greater sense of security if anything should happen and I know that I will be able to follow all of her final wishes to a T – financial and personal.

Contact me to discuss any question or detail.