Goodbye to biking

[DaveMatthews]

Got my fingers crossed for you mate, and sending all my mojo your way.

 

[BlackHand]

Appreciate the update, wishing you well.

 

[Art Deco]

Result of 10/14/25 visit with cardio surgeon. Medicare will do nothing for a heart that drops from 84 bpm to 60, every time my respiration gets above 40 cpm. Pulse should go to 120 or 132 or 144, but since ablation surgery during aerobic exercise the heart skips every other beat. But the implanted monitor caught the heart skip one beat out of 4 while I was running a chainsaw, dropping from 84 to 60. That he thinks Medicare will pay for. Running a chain saw is not real hard work and probably worthy of 96 bpm. Surgeon has also found, in addition to the Biotronik Edora pacemaker recommended above that "has closed loop modeling" (?) a pacemaker that has an accelerometer to detect exercise, then a pacemaker that detects respiriatory resistance, and when the breath speeds up, it speeds the heart up. I want one of the last kind. My respiration has hit 90 cpm sometimes when I tried to run the string trimmer or walk fast with a grocery cart. The heart monitor also recorded some A-something beats, for which he wants to prescribe metoprole ( which cuts heart ejection force) and flexipon or somethng that sounds like that. After I get the pacemaker. He says these drugs have the risk of making the heart not beat at all, so the pacemaker comes first. I'm tentatively scheduled for pacemaker installation the end of next week, if Medicare approves it. If not, I will pay cash next year, as buying the F150 for cash maxed out my RMD's this year, and any further retirement fund withdrawals incur a 100% income tax. One year my income was up $20000 due to termination & payout of 2 mutual funds. My fed income tax went from $2200 usual to $14000. SSI became 100% taxable instead of 38%, and I had to pay Alternative Minimum tax too, so my standard deduction was wiped out. Guess which promise did not get enacted in the "Big Beautiful Bill". Social Security is still taxable at the same sliding scale as before. So surgery may happen right before the weather goes to ****. At least maybe I can ride the exercycle this winter. The accelerometer equipped pacemaker would pick up nothing on the exercycle. Men exercising are supposed to play basketball, tennis, handball, or jog I suppose. My knees were too damaged by the US Army for even fast walking. .

@indianajo , I think you are getting bad advice on the financial side, especially on Federal tax issues. While 100 percent of your income may be taxable, the top Federal rate is 38 percent, so I asked my wife ( retired PDH Accounting professor ). Check with someone more knowledgeable than most tax preparation workers in your area. Suplimental Security Income shouldn't trigger the alternative minimum tax and isn't supposed to be 100% taxable.

On the pacemaker side if you can swing it get the better unit and hopefully only have to have surgery once. You could finance it , I guess, though I don't know how you feel about debt. And I'm just a random guy on the internet, not an accountant or doctor.

 

[stompandgo]

On the Medicare side, you got IRMAA'd. I expect to get it this year as we sold a family home that was technically an investment home. We paid the huge tax bill, which we expected. I also expect to get the IRMAA letter, where my Part B premium should quadruple, but it should only be for one year, as it was a one-time income boost. The key is to contact the SSA once you get the letter and follow the procedure so that your premium will go back to normal the following year. Whenever I deal with the SSA, I do it in person, at an SSA office.

 

[Roamers]

The key is to contact the SSA once you get the letter and follow the procedure so that your premium will go back to normal the following year.

Nothing to do to go back down. 2026 IRMAA will be based on 2024 MAGI. 2027 IRMAA will be based on 2025 MAGI. It's all automatic.

 

[stompandgo]

Sorry, I don't trust the government to do ANYTHING automatically. Several of my friends got caught with sticky IRMAA based payments that would not go away without a significant fight. The guy in the SSA office told me to do what I suggested, so that's what I'm going to do.

 

[Roamers]

Several of my friends got caught with sticky IRMAA based payments that would not go away

That sucks. We have varied between none, 1.4X and 2.0X for the last 6 years with no issue.

 

[indianajo]

@indianajo , I think you are getting bad advice on the financial side, especially on Federal tax issues. While 100 percent of your income may be taxable, the top Federal rate is 38 percent, so I asked my wife ( retired PDH Accounting professor ).

Ha Ha Ha Ha!. My usual federal tax bill is $2200. One year two taxable mutual funds terminated, causing my income to increase $20000. My tax bill was $14000. Social security became fully taxable instead of ~35%, and I paid Alternative Minimum Tax which took my standard deduction. Yeah, that is only 60% higher tax rate.
I have retirement funds which could pay cash for a pulse rate adjusting pacemaker, but If I take out more than the RMA this year, it is taxable at the increased rate. I spent this years RMA + some retained dividends on the F150, so it is gone. I could not reach my summer camp out of the ozone infested city, on the bicycle anymore.
The hub drive controller now rotates the motor backward more often than forwards. When I reverse 2 phase wires the performance is the same. The supply of cheap bike parts has dried up in the trade war. 1300 w geared hubs are now illegal in 41 states, so nobody imports them. The last 750 w noname motor I bought burned up on the second trip. If I buy a reliable but underpowered 750 w Bafang geared hub from bafangdirect , I have to also buy a new battery which is has too few watthours to power up all those hills. If I bought a mid-drive, I would have to buy a 52 tooth rear sprocket to get the 330 lb (60 lb groceries, 20 lb tools & parts) up the hills. All the time spent at 1 mph climbing steep hills would increase my seat time to 6 hours.

 

[stompandgo]

Ouch.

 

[Roamers]

My usual federal tax bill is $2200. One year two taxable mutual funds terminated, causing my income to increase $20000. My tax bill was $14000. Social security became fully taxable instead of ~35%, a

You have a unique tax situation that would be interesting to see what is going on. SS is never 100% taxable; 85% at most. Other numbers you talk about just don't make sense either. Did you mean $200k vs. $20k mutual fund sale?

Fingers crossed you resolve your health issues.

 

[Art Deco]

Ha Ha Ha Ha!. My usual federal tax bill is $2200. One year two taxable mutual funds terminated, causing my income to increase $20000. My tax bill was $14000. Social security became fully taxable instead of ~35%, and I paid Alternative Minimum Tax which took my standard deduction. Yeah, that is only 60% higher tax rate.
I have retirement funds which could pay cash for a pulse rate adjusting pacemaker, but If I take out more than the RMA this year, it is taxable at the increased rate. I spent this years RMA + some retained dividends on the F150, so it is gone. I could not reach my summer camp out of the ozone infested city, on the bicycle anymore.
The hub drive controller now rotates the motor backward more often than forwards. When I reverse 2 phase wires the performance is the same. The supply of cheap bike parts has dried up in the trade war. 1300 w geared hubs are now illegal in 41 states, so nobody imports them. The last 750 w noname motor I bought burned up on the second trip. If I buy a reliable but underpowered 750 w Bafang geared hub from bafangdirect , I have to also buy a new battery which is has too few watthours to power up all those hills. If I bought a mid-drive, I would have to buy a 52 tooth rear sprocket to get the 330 lb (60 lb groceries, 20 lb tools & parts) up the hills. All the time spent at 1 mph climbing steep hills would increase my seat time to 6 hours.

Still sounds like it's worth double checking with a tax professional, you have a unique tax situation and there are usually loopholes and exceptions for those, most of which only someone who works will that stuff daily knows.

 

[Rexlion]

With that much $$$ involved, it's definitely worth having a pro take a second look. If there's a way to cut the tax bill from a previous filing, a revision can be filed to obtain a refund of some of the payment that was already made.

 

[indianajo]

With that much $$$ involved, it's definitely worth having a pro take a second look.

Rather than paying a tax pro, the surgeon has arranged the pacemaker installation in November. So I will pay for it, perhaps helped by Medicare, in January. That is a new tax year. Medicare denies two thirds of all my medical care claims, so I am not optimistic about this one. Pacemaker is not for sudden death, it is for aerobic heart/lung maintenance program as explained by Dr. Ken Cooper. In a call Tuesday, he explained the Boston Scientific pacemaker is the one that measures my breath rate, and boosts heart rate in response to fast breathing. With the implanted heart monitor he now has observed "AV block" whatever that means. I'm ready for the pacemaker. I was panting 1 breath per second yesterday just for walking from the truck into the grocery and home Depot.

 

[Roamers]

Rather than paying a tax pro, the surgeon has arranged the pacemaker installation in November. So I will pay for it, perhaps helped by Medicare, in January. That is a new tax year. Medicare denies two thirds of all my medical care claims, so I am not optimistic about this one. Pacemaker is not for sudden death, it is for aerobic heart/lung maintenance program as explained by Dr. Ken Cooper. In a call Tuesday, he explained the Boston Scientific pacemaker is the one that measures my breath rate, and boosts heart rate in response to fast breathing. With the implanted heart monitor he now has observed "AV block" whatever that means. I'm ready for the pacemaker. I was panting 1 breath per second yesterday just for walking from the truck into the grocery and home Depot.

Good to read a potential resolution to your problem.

 

[Bicyclista]

Rather than paying a tax pro, the surgeon has arranged the pacemaker installation in November. So I will pay for it, perhaps helped by Medicare, in January. That is a new tax year. Medicare denies two thirds of all my medical care claims, so I am not optimistic about this one. Pacemaker is not for sudden death, it is for aerobic heart/lung maintenance program as explained by Dr. Ken Cooper. In a call Tuesday, he explained the Boston Scientific pacemaker is the one that measures my breath rate, and boosts heart rate in response to fast breathing. With the implanted heart monitor he now has observed "AV block" whatever that means. I'm ready for the pacemaker. I was panting 1 breath per second yesterday just for walking from the truck into the grocery and home Depot.

Medicare paid for my Biotronick pacemaker, no questions asked. I have Medicare Advantage with Kaiser, so the whole procedure may be different.

 

[indianajo]

Per Clevelandclinic.org "​

Types of heart blockSecond-degree (incomplete) heart block: With this type, your heart’s impulses only get to the lower chambers some of the time. The types of second-degree heart block are:​

Type II, also called Mobitz Type II: While most of the electrical signals reach your ventricles, every so often, some don’t. Your heartbeat becomes irregular and slower than normal. This form of second-degree heart block is more serious and may warrant a pacemaker.
Yeah, that is me. Every other beat is skipped when I need more oxygen, above 84 bpm. Did not happen before PVD prevention ablatiion surgery 4/22/25. Sorry about the bold print, cntl-b does not make it go away.