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“I thought that I completely understood [Social Security strategies] but I sure didn’t understand the Medicare Part A/HSA complication.

Please make sure that your readers are aware of this significant complication, which doesn’t exist if you don’t have an HSA.” The complication the reader is referring to is that, beginning with the first month you are enrolled in Medicare, you cannot contribute to a health savings account (HSA).

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The potential trouble arises as a result of the fact that it’s possible to become enrolled in Medicare be enrolled in Medicare Part A* when you reach age 65 if at that time you are already receiving Social Security retirement benefits (or spousal or widow/widower benefits) or have been receiving Social Security disability benefits for more than 24 months.

Alternatively, if you claim Social Security benefits (including as a part of a “file and suspend” strategy) at any point after age 65, you’ll automatically be enrolled in Medicare Part A at that time.

Many commercial insurers allow physician practices to bill for diagnostic lab tests that the practices purchase from reference labs.

You might want to confirm that there are no state laws, akin to the Medicare provision, that would affect your ability to do this with Medicaid or commercial patients.

Both your patients and the referral specialists have to comply with the requirements of the managed care contract.