2011 Part B Premium Amounts for Persons with Higher Income Levels

Most Medicare beneficiaries continue to pay the same $96.40 or $110.50 Part B premium amount in 2011. Beneficiaries who currently have the Social Security Administration (SSA) withhold their Part B premium and have incomes of $85,000 or less ($170,000 or less for joint filers) did not have an increase in their Part B premium for 2011.  For all others, the standard Medicare Part B monthly premium is $115.40 in 2011, which is a 4.4% increase over the 2010 premium. The Medicare Part B premium increased in 2011 due to increases in Part B costs.  

If your income is above $85,000 (single) or $170,000 (married couple), then your Medicare Part B premium may be higher than $115.40 per month.  Social Security will use the income reported two years ago on your IRS income tax return to determine your premium (if unavailable, SSA will use income from three years ago).  For example, the income reported on your 2009 tax return will be used to determine your monthly Part B premium in 2011. If your income has decreased since 2009, you can ask that the income from a more recent tax year be used to determine your premium, but you must meet certain criteria.

The chart below shows the Part B monthly premium amounts based on income. These amounts change each year. There may be a late-enrollment penalty.

Table 1: Part B Monthly Premium
   Beneficiaries who file an individual tax return with income   Beneficiaries who file a joint tax return with income
Your 2011 Part B Monthly Premium Is If Your Yearly Income Is
$96.40 if beneficiary had SSA withhold in 2009 

$110.50 if beneficiary was new in 2010 and had SSA withhold

$115.40 for all others

 $85,000 or less $170,000 or less

(increased by $46.10 due to IRMAA)

 $85,001-$107,000 $170,001-$214,000

(increased by $115.30 due to IRMAA)

 $107,001-$160,000 $214,001-$320,000

(increased by $184.50 due to IRMAA)

 $160,001-$214,000 $320,001-$428,000

(increased by $253.70 due to IRMAA)

 Above $214,000 Above $428,000
Table 2: Part B Monthly Premium
Beneficiaries who are married, but file a separate tax return from their spouse and lived with his or her spouse at some time during the taxable year
Your 2010 Monthly Premium is Beneficiaries who are married but file a separate tax return from his or her spouse
 $96.40 if beneficiary had SSA withhold in 2009

$110.50 if beneficiary was new in 2010 and had SSA withhold

$115.40 for all others

 $85,000 or less

(increased by $184.50 due to IRMAA)


(increased by $253.70 due to IRMAA)

Above $129,000

If you are having trouble paying your premiums, you should call your State Medical Assistance (Medicaid) office to see if you qualify for some help. Some states refer to the Medicaid office as the Public Aid office, the Public Assistance office, or the State Medical Assistance office.


The Internal Revenue Service supplies your tax filing status, your adjusted gross income, and your tax-exempt interest income to the Social Security Administration to determine if you have an income related monthly adjustment amount (IRMAA). The Social Security Administration will add your adjusted gross income together with your tax-exempt interest income to get an amount called the modified adjusted gross income (MAGI).

The income-related monthly adjustment amount is effective from January 1 through December 31 each calendar year. The Social Security Administration will refigure your Medicare Part B premium amount again next year when the Internal Revenue Service updates the information.

For more information, please refer to the Medicare website at www.medicare.gov.

Anthem Individual Rate Hike July 1, 2011

Anthem Blue Cross Life and Health Insurance Company (Anthem) has agreed to a request by the California Department of Insurance to modify its pending rate filing, and will move ahead with revised premium increases effective July 1, 2011. 

They will begin notifying members affected by the July 1 rate change as early as mid-April.  Anthem is doing so following the end of a 60-day postponement requested by the state insurance commissioner.   

As part of the agreement, they will delay certain benefit changes in our original filing from a July 1, 2011 implementation to a January 1, 2012 implementation. In addition, the average premium increase will be slightly lower, averaging 9.1%, vs. the 9.8% in the company’s original rate filing.  An estimated 80,000 California customers will receive rate decreases per the original filing.

Choosing the Right Individual Health Plan


As so many American are leaving their jobs (voluntarily or otherwise), there is a need for alternatives to high priced COBRA coverage.  The best option in an individual plan.  There are so many options and plans available, and the task of finding the right one can be daunting.  These  tips can help you find a low-cost individual health insurance policy that fits your needs.


Find Out What’s Covered
 Before you choose a health plan, find out what’s covered. For instance, is your family doctor covered? What is the coverage for prescription drugs?  You want a health insurance policy that covers all your medical needs, so check the details before you buy.

Find Out What’s Not Covered
After you learn what’s covered, find out what ism’t. For instance, many policies won’t cover acupuncture or in-home nursing care. Others won’t cover treatment for depression, anxiety and other mood disorders.

If you have a specific condition that requires a specialist, make sure it’s covered under your prospective plan.

Choose Between an HMO or a PPO
For low-cost care, an HMO is best. HMO’s typically have low deductibles and co-payments, resulting in minimal out-of-pocket costs. However, HMO’s also require you to select an in-network doctor to coordinate all of your medical care, and you cannot visit a specialist without being referred by your primary care doctor.

PPOs, on the other hand, offer a much broader range of health care—but it comes at a price. Patients can see almost any doctor of their choice, provided they are part of the network. Plus, visits to specialists don’t require referrals. However, premiums and deductibles for PPO plans are generally higher than those of HMO plans.

Decide Whether You Want a Low Premium or Cheap Co-Pays
What’s better—low premiums or cheap co-payments? It depends entirely on your situation.

Healthy applicants who rarely visit doctors may opt for lower premiums and higher co-pays. However, those with chronic health conditions may save money with cheaper co-pays and higher premiums.

  1. Lifetime Maximum Benefit
    A lifetime maximum is a cap on the amount of benefits you can receive, usually around $1 million. For most people that amount is adequate. However, if a chronic condition forces you into the hospital every few months, a $1 million cap may not be enough.
  2. Make Sure Your Prescriptions Are Covered
    If you take prescription drugs, make sure your medication is covered. Many monthly prescriptions cost hundreds of dollars out-of-pocket, so make sure all your medication is covered before purchasing a policy.

Health insurance premiums can vary greatly by company—sometimes by as much as 50% for similar plans. So it pays to shop around.  Individual plan carriers can reject an applicant or increase the premium based on the health condions advised.

New Enhancements to Anthem Program

Anthem Blue Cross of California recently enhanced its Resource Advisor member-assistance service to include Beneficiary Companion and Identity Theft Victim Recovery Services programs at no additional cost to customers.

The Beneficiary Companion not only notifies financial institutions and public agencies of a loved one’s death, but also closes accounts and places a freeze on credit reports, according to Nicholas Brecker, president of Anthem’s life and disability business.

The ID theft service assigns a fraud resolution specialist to members for an entire year to work closely with creditors, collection companies, collection law firms and credit reporting agencies in the event of an identity theft.

Health Insurance for Children – What Now?

Effective today, individual health insurers cannot deny coverage to children with pre-existing conditions.  As a predictable reaction to this change in federal law, CIGNA, Health Net Anthem and Aetna have stopped selling individual health plans to children.

 What can be done for children who need              insurance now???

 For those children who are currently covered by a child only health plan, they will remain covered as long as premium payments are made on a timely basis.  The carriers will not rescind coverage.  For those children who will need coverage as of 9-23-10, Legislation has recently been passed in California that would block California insurers from denying coverage to children with preexisting conditions, but would let them charge significantly higher premiums to those who don’t sign up during open enrollment periods each year and impose surcharges on those who try to abuse the system by dropping coverage when children are healthy. This legislation would limit how much children with preexisting conditions would have to pay if they signed up during open enrollment.  Carriers that refuse to participate would face penalties.

 This bill, AB 2244, is pending signature by Gov. Schwarzenegger. He is expected to sign the bill.


When the Obama Administration’s health reform laws take full effect in 2014, insurance carriers will no longer be able to deny coverage to adult individuals with preexisting medical conditions. Until then, there are federally funded high-risk pools. To qualify for these, you have to be without insurance for six months and you must show you have applied for and been denied insurance in the private market.

If you have a preexisting condition and can’t qualify for the high-risk pools, it’s a smart idea to at least check out the plans available within the private insurance market. “Don’t assume if one insurer rejects you that they all will,” says Anthony Wright, executive director of Health Access California, a statewide advocacy group.   By being a smart consumer you can improve your changes of obtaining coverage. Below are suggestions that we hope will help you in finding individual coverage:

Eligibility Laws
If you’ve exhausted your  COBRA and or CAL COBRA benefits available after leaving a job, federal law guarantees you a HIPAA policy from private insurers if you apply for one within 63 days from loss of other coverage.  Please make sure to retain a copy of the prior carrier’s “Certificate of Creditable Coverage” as proof that you did have coverage and that the loss of coverage occurred within 63 days of the application date.


In California carriers can review your health history, age and gender in order to determine the premium to be charged if you have a history of certain medical conditions.    The carriers are looking for those applicants that may potentially charge a large amount in claims costs.   The carriers also subscribe to a service that tracks your prescription drug records, the MIB Group.  You can request a copy of your 5 year usage history at http://www.mib.com/html/request_your_record.html.

Carefully answer the application

In order to determine the premium to be charged, the carrier’s application will ask many questions about your health.  Please remember to fully answer only the question asked.  Underwriters are looking to see if a medical situation has been resolved, or there are upcoming charges or procedures that may indicate a large expense.  Remember that omitting information may actually cause the coverage to be rescinded.  Sometimes the carriers will schedule a telephone interview in order to gain a better understanding of your medical history, so it is best if you have a copy of your medical records with you during the call, so you don’t have to try to remember all the details, which may be a costly mistake.

Manage your health

Of course it is always best for you to try to maintain optimum health, not only for obtaining health insurance, but to maintain your quality of life.  If a medication is working don’t change it unless there is a generic available.  Lose weight, exercise. Commit to a healthy lifestyle.  

Ask your medical provider to review your records and correct any inaccuracies and update your health history.  Not only will this effect a health insurance application, it is important to have all records be accurate for medical and legal reasons.

Work with a knowledgeable agent

The current insurance atmosphere is in a state of flux, with many changes to happen over the next few years.  Talk to someone in the field for help.  You can contact the National Assn. of Health Underwriters’ website, http://www.nahu.org or you can contact our office at (888) 474-6627   for assistance with the application process.