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. Send your questions to Phil.
Kris – Md.: My 67-year-old mother had a leg amputation in September 2106. I left Florida and moved to Maryland to help her out. I am the only family member. Last December, she had two massive right brain strokes. She needs help with everything, including the bathroom because of incontinence. I haven’t been able to work in a year. The Office of Aging here put her on a waiting list for care help but says it may be a five-year wait! Medicare only gives her two hours of help with bathing a week. She only has Medicare A. She makes only $17,000 a year, but this is too much to qualify for Medicaid here. Is there anything I can do to get some help? I don’t want to put her in a nursing home, but I’m 46 years old, I have no life or income, and it’s very difficult doing this 24/7 by myself.
Phil Moeller: This story should be required reading by everyone in Congress who plans to vote to cut Medicare and Medicaid by $1.5 trillion in the Republicans’ latest budget bill. There is a reason we need strong social safety nets in this country, and it’s not so that welfare deadbeats can live in the lap of luxury at the expense of hard-working taxpayers. It’s so that people like Kris and her mom can have a semblance of a life.
To Kris, all I can say is that I am so sorry about your mom, and how much her problems have affected your own quality of life. She is lucky to have had your strong support, but I understand the heavy personal toll of such caregiving.
Medicare, as you’ve learned, does not cover the kind of in-home custodial care your mom needs. Medicaid would but, as you note, her income is too high to qualify.
I think you should find an eldercare attorney to help you. Perhaps the Office of Aging can recommend someone. I have no special insights here, but it seems that either you need to sign over her income to an assisted care facility and place her there (which you say you don’t want to do) or figure out a way to deal with her income so that she qualifies for Medicaid.
If the Office of Aging folks can’t help, you might try the Center for Medicare Advocacy. It provides free Medicare counseling and might have some ideas.
Kath: At 65, I have signed up for Medicare A and B at $134 a month. In addition, I have purchased a Medigap letter G plan for $123 a month. Since I am new to this, and doing this alone, I wanted to make sure I have not over purchased health coverage.
I am appalled at how difficult it has been for me to decipher Medicare. I am a nurse practitioner, and used to think I was a smart woman!
Phil Moeller: I agree that it is a shame if not national disgrace that Medicare is so complicated. Weren’t things supposed to get easier when we got old?
The rates you quote seem reasonable, but you did not mention whether you also were getting a Part D drug plan. I’d recommend you do so.
Medicare’s annual open enrollment season runs this year through December 7. I suggest you use this time to check plans for 2018. In particular, you should consider whether it might make sense for you to scrap your Medigap and Part D plans and get a Medicare Advantage plan instead.
For a person in good health, Medicare Advantage (or MA) plans can offer decent health care at a price much lower than what you have (which, by the way, is called traditional or original Medicare). MA plans must cover everything covered by Parts A and B of Medicare, and usually include a Part D drug plan as well. They also offer caps on your out-of-pocket health expenses, and thus serve much the same function as a Medigap plan.
The downside is that MA plans require you to use doctors and hospitals in the plan’s provider network, whereas traditional Medicare lets you use any doctor or hospital in the country that accepts Medicare. I’ve heard from people who love MA and others who have needed medical specialists and find their MA plans did not provide them the access to medical experts that they wanted.
Linda – Ill.: I am so frustrated! The dermatology practice I rely on is refusing to accept my Medicare Advantage plan, although I know it accepts at least one another insurer’s Advanatage plan. My only option is to pay their fee in advance and then seek reimbursement from my insurer. This seems like a scam. My understanding is that a medical provider who accepts any Medicare patients must accept all Medicare patients. If this is so, then this practice is violating the law. If not, and there is a loophole allowing providers to opt out of Medicare health care plans administered by third parties, then we Medicare recipients have been placed at a severe disadvantage for our health care. I sincerely hope this is not the case.
Phil Moeller: I understand your frustration. Unfortunately, just because a doctor accepts Medicare patients does not mean that he or she must also work with all Medicare insurance plans. Medicare Advantage plans usually permit customers to use only the medical providers in the plan’s network. In some cases, out-of-network care is permitted but at higher rates. What this means is that not all practices are included in every Medicare Advantage provider network.
The provider networks used by Medicare Advantage plans are a major source of cost savings to the plans, but also often a weak link in terms of allowing broad access to doctors and hospitals that you would like. Basic Medicare (Parts A and B), by contrast, allow people to use any health care provider in the country who accepts Medicare. Whether they can actually get in to see a specific provider, however, is another matter. Popular doctors can have enormous wait times for new patients, assuming their practices are even accepting new patients.
The question in your case is whether your plan ever included this dermatology practice in its network. The plan has a legal responsibility to provide you a current copy of its provider network each fall. However, even if this practice was in the network at the start of the plan year, the plan is allowed to change providers during a plan year. This is a really weak spot of Medicare regulations, and has received lots of criticism.
I wish I had better news for you. I would note that your dermatology practice might not be at fault here. If it’s not in your plan’s network, it cannot accept you as an insured patient, nor agree to accept the payment rates negotiated by your insurer. I’d hope your plan would explain this situation to you.
Bob – Calif.: Thank you for your excellent book. I need some guidance on making a restricted application for spousal benefits, but I am confused by how this will work. I will reach my full retirement age (FRA) next Jan. 1; my wife reaches her FRA in Oct. 2019. Our full-retirement income amounts are roughly equal.
Does my wife make the application for spousal benefits once I reach my FRA, or do I make the application when she reaches her FRA? Also, in general, does it make sense to make a restricted application? We do not have a pressing need for the income now, and we could easily wait to draw our benefits until we each reach age 70.
Phil Moeller: In order for one of you to make a restricted application for just a spousal benefit, the other spouse must have filed for their own retirement benefit. Doing so would require that spouse to begin benefits before they age 70, when they will reach their maximum amount.
Because your wife is more than 19 months younger than you, I’d suggest you do nothing until you turn 70. When you file for your own retirement then, your wife can file a restricted application for just her spousal benefit. She would receive this for 19 months and then can file for her own maximum retirement benefit when she turns 70. This way, both of you will be able to maximize your respective retirement benefits.
If you had an immediate need for funds, or one or both of you was in poor health, I might suggest a different approach. Otherwise, I believe maximizing your monthly benefits is the best strategy.
Pamela: My husband died of cancer in 1996; he was only 44. I am going to be 61 next year, have not remarried, and wondered how I would go about claiming survivor benefits? I earn about $42,000 a year.
Phil Moeller: You will need access to your husband’s earnings record, and probably a friendly Social Security representative. First, you should check out the percentage impact on your survivor benefit related to different filing ages. This benefit reaches its maximum amount if you wait until your full retirement age to file for it. However, there can be lots of valid reasons to file earlier.
Also, if you file for this benefit before your full retirement age, your wage income is high enough that your benefit could be temporarily reduced or even eliminated by Social Security’s earnings test.
Armed with this information, you should call Social Security and seek information about the range of survivor benefits available to you. Be careful during this call to make clear that you do not want to file for a benefit right now, but just to get information to help you make an informed decision. Some Social Security representatives can be in a hurry to get you to file, so you need to be careful not to accidentally do this.
Jami – Ore.: Why are people forced to have Medicare? I am currently on OHP. [The Oregon Health Plan is the state’s Medicaid insurance program.] I cannot afford any medical insurance. When I turn 65 at the end of this year, will I be forced onto Medicare and taken off OHP? I cannot make heads or tails of anything I read. It is like a foreign language to me. My head hurts!
Phil Moeller: People aren’t forced to get Medicare. But when a person turns 65 and does not have employer-provided health insurance, they must get Medicare if they want health insurance.
If your income is low enough, most of your Medicare expenses would continue to be paid by Medicaid. Roughly 20 percent of Medicare enrollees are dually eligible for Medicaid as well. The State Health Insurance Assistance Program (SHIP) provides free Medicare counseling, and should be able to help you determine whether Medicaid would continue to pay for your health care when you turn 65.
Ira: If I continue to work in late 60s and beyond, are any of those years going to be included among the top 35 earnings years on which Social Security bases my benefits?
Phil Moeller: Any year that’s in the top 35 will count, regardless of how old a person is when the money was earned. If a new top-35 year raises benefits, the higher payment will be retroactive. It could, however, take Social Security some time to make this automatic adjustment.