I like using holistic doctors. Do I really need Medicare Part B?
Editor’s Note: Journalist Philip Moeller is here to provide the answers you need on aging and retirement. His weekly column, “Ask Phil,” aims to help older Americans and their families by answering their health care and financial questions. Phil is the author of the new book, “Get What’s Yours for Medicare,” and co-author of “Get What’s Yours: The Revised Secrets to Maxing Out Your Social Security.” Send your questions to Phil.
Alara – California: I am 64 and have to decide by August whether to get Medicare. I only have $1,845 a month to live on. I was a nurse and massage therapist, which led me to becoming a natural health expert. This also allows me to get my Ayurvedic herbs and mushrooms wholesale. I rarely need a doctor. I’m debating whether or not to sign up for Part B of Medicare. It’s $134 a month, which is a lot of money to pay for something I may not need. Many doctors have a cash price. So do testing places. I like holistic doctors. OK, now it’s your turn!
Phil Moeller: Alara’s question, I fear, will be asked by more and more older Americans who are being squeezed between inadequate retirement finances and a health care system that is unable or unwilling to provide them the care they need at a reasonable price. I do have what I’ll call my textbook answer for her. But this is not to deny that she asks a very reasonable question and that she might be better off taking a pass for now, and perhaps forever, on Medicare.
And now, to the textbook. Forgoing health insurance is fine until you get sick. In your case, you can defer this moment of truth or perhaps avoid it altogether by taking fantastic care of yourself.
However, as my broken-record advice always points out, health insurance is not for the “current” you, but the “future” you, and the odds are that the future you will need considerable health care.
If you avoid Medicare for the time being, you can get it whenever you want, but there might be a lag of several months or more depending on when in the year you apply. So you would either need to self-insure for those months or go without care.
When you did sign up, you would face late-enrollment penalties for Part B (doctor, outpatient and durable medical equipment expenses) and Part D (prescription drugs).
The Part B penalty tacks 10 percent onto your premiums for every year you’re late in enrollment, measured from the date you first became eligible for Medicare and were not covered by employer group insurance.) The monthly Part B premium is now $134, as you note.
The Part D premium penalty is 1 percent a month or 12 percent a year. A typical Part D drug plan has a premium ranging from $40 to $60 a month.
Both penalties last for the rest of your life.
Alternatively, you could spend down your money and assets, and if you weren’t making much money, you could see if you qualify for Medicaid. Of course, as I lamented yesterday, it’s not clear what Medicaid might look like if this takes place.
Anonymous – Pennsylvania: My husband was approved for Social Security disability in October 2015. We received notification that he will be eligible for Medicare 24 months after this date. Should I remove him from my employer’s health insurance coverage or can he use both?
Phil Moeller: He certainly can use both, but he’d then pay for both. So this is normally an “either-or” decision. However, given the range of different employer health plans and employee payment terms, there is no standard answer to your question.
The first thing I would do is compare the coverage and cost of the employer plan versus the type(s) of Medicare policies available. This would be the either-or approach.
As you may know, your husband is entitled to premium-free Part A of Medicare, which covers hospital and nursing-home care. He then can buy Part B, which covers doctors, other outpatient expenses and durable medical equipment. It costs $134 a month for most people.
Parts A and B are known as basic or original Medicare. Once he has basic Medicare, he has a choice of other private insurance plans. He can get a Part D drug plan and also a Medigap supplement policy, which plugs a lot of holes for things that basic Medicare either does not pay or does not pay completely. Alternatively, he could get basic Medicare and then buy a Medicare Advantage plan, which must cover what basic Medicare covers, usually includes a Part D drug plan, and also has out-of-pocket spending limits that make a Medigap plan unnecessary.
After you’ve taken a look at employer coverage versus Medicare, you then can look at having both. If you like the terms and cost of your employer plan, you can always keep him on it. Then, if he also gets Medicare, it would normally become the secondary payer of covered health claims.
In this case, your decision would be driven by how well his employer insurance covered his expenses and the value of having Medicare as a secondary insurer. In this case, you would likely use only basic Medicare and wouldn’t also need a private Medicare insurance plan.
Donna: My ex-husband died in August 2012. When I went to apply for my Social Security in 2014, they advised that I collect his since I was still working. They started paying me in 2014 on his account until I switched to my own Social Security in February 2016 when I lost my job. My question is, could I have gotten retroactive payment of his Social Security from the time he passed away in 2012? I did not know he had passed until the time I wanted to start collecting. If I could have collected a retroactive payment, could I still pursue this?
Phil Moeller: Sadly, there is a limit on retroactive payments, and Social Security has no obligation to tell you that your ex-husband had died. In fact, it doesn’t have a way of linking a beneficiary to an ex-spouse’s earnings record until you apply for a survivor’s benefit.
You might be entitled to up to six months of retroactive benefits, but only if you filed for the survivor benefit after you had reached full retirement age. In that case, you’d be entitled to one month of retroactive benefits for each month past full retirement age that you filed, up to a maximum of six months. Benefit claims filed before full retirement age do not qualify for retroactive payments.
If you are entitled to a retroactive payment, you can still request it. I know of no “statute of limitations” on such entitlements.
Chuck – Pennsylvania: I was just wondering what the financial status is of Social Security and when it is expected to go broke if no changes are made?
Phil Moeller: Under present laws, Social Security will be able to continue paying 100 percent of its benefit obligations until the year 2035, at which time it would exhaust its trust fund reserves. Thereafter, it would be able to continue paying 77 percent of benefit obligations, based on expected levels of payroll tax revenues flowing into the program at that time.
These projections come from the 2016 Social Security trustees’ report, which was issued last summer. This annual report is considered the official source of Social Security solvency projections.
Silvia – Connecticut: My mother is 90 years old and has congestive heart failure. She was hospitalized in December in the Bronx and discharged to a nursing home rehabilitation facility. Upon discharge from this facility, the social workers promised all steps were taken for her to get home-based care and the equipment that she needed in her apartment. An agency was sent to make an evaluation the day after her discharge to her home.
This person never opened her case, my mother never got any home care at all, and she had to be hospitalized four days later. This ordeal continued for several months of nursing homes and hospital stays, until we, her family, helped her choose a nursing home for long-term care. After reading your article, I realized our ordeal with my mom was not an isolated case. We were frustrated by having to make calls to agencies begging for help that was never provided. My question is, do we have any recourse, and can we apply to be reimbursed for all the private care our mom received? Is there any way to fix such a complex and corrupt system? A person who worked more than 50 years and paid taxes should have had the help they needed in their old age at home, as that was her wish.
Phil Moeller: Thank you so much for sharing your mom’s story. Home-based care for older Americans is a crisis in the making. As to being reimbursed, I am afraid I don’t see this as a possibility.
Trying to establish that your mother was entitled to Medicare’s home-health benefit would also require that you found a home-health agency willing to provide that benefit, but that it failed to do so or that the Medicare agency itself somehow fell down on the job. It does not sound like you ever made it to that stage of the care process. Like a lot of other people, you just assumed that the social workers would “do the right thing.”
I am so sorry this happened to you mom. She deserves better, and so do millions of other moms.