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If I’m healthy, do I really need a Medigap or Medicare Advantage plan?

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.


Christian – Virginia: Do I really need a Medicare supplement or Medicare Advantage plan if I’m very healthy and take no prescription medicines? There’s a chance I may someday need a hip replacement, but fortunately, I do have the capital to pay my coinsurance and copayments. I’m just wondering if staying “self insured” this way is better than paying monthly premium for a benefit I’ll likely not use much.

Phil Moeller: It’s all a matter of your own risk-reward calculation.

First off, there is no law that says you have to get any part of Medicare when you turn 65. You can totally self-insure.

The downside to this is that if you later decide you do need Medicare, you will get socked with lifetime late-enrollment penalties for Part B and Part D. You also might have trouble even getting a Medicare supplement plan. And you undoubtedly will face a gap of up to six months or even more between when you want Medicare and when coverage becomes effective. So, if you wait until you get sick to apply, it might be too late to avoid really big bills.

And don’t kid yourself, health care is incredibly expensive. My wife went in last year for a one-day “outpatient” treatment and was in the hospital something like 30 hours. The bill from the hospital was nearly $110,000! I kid you not. Insurance covered all but $1,000.

Lastly, while you are healthy now, Medicare is about insuring a “future” you who is not going to be nearly so healthy. Even very healthy people face substantial medical bills in their later years.

Having said all this, it remains your choice.


Donna: I am 64 years old and have been divorced for eight and a half years after a 31-year marriage. I understand that I can’t get my full benefits until 66. Can you tell me what is the best thing to do, and how much do I get if I wait until 66? Also, can I collect on both of our benefits? For instance, if I get $1,000 for myself, will I be able to get an additional $500 from him?

Phil Moeller: As you noted, you will need to wait until age 66 to get full divorce benefits. Their exact amount will depend on how much money in benefits your former husband would have been entitled to at age 66 (whether or not he had actually filed for them by then). This figure is determined by the record of wages on which he paid Social Security payroll taxes.

Whatever that amount is, it will be reduced by 7 to 8 percent for each year you claim it prior to age 66.

You cannot claim both your full retirement benefit and your full ex-spousal benefit at the same time. Social Security will look at the size of each benefit and pay you an amount that is roughly equal to the greater of the two.

You can find out your own benefit entitlement by opening an online account with Social Security. It will show you the agency’s records for your lifetime wage earnings and provide you a rough calculation of how much money you would get in retirement at different claiming ages.

Armed with this knowledge, you can then contact Social Security and ask them to calculate what your ex-spousal benefit would be. This can take a while, and you need to be patient. Unless you are friendly with your ex and he agrees to provide you access to his Social Security records, you are dependent on the agency to gather this information for you. If your local Social Security office is like most of them, it is understaffed and overworked, and the people you deal with may not even understand the rules as well as they should.

READ MORE: Can I work and still collect my late husband’s Social Security benefits?

Once you know the size of both benefits, you can begin to fashion a good claiming strategy.

If your ex-spousal benefit at age 66 is always going to be greater than your own retirement benefit, then you should just file for it and not worry about your own retirement benefit.

However, perhaps your retirement benefit already is the larger of the two, or maybe it would be if you delayed filing for it until age 70, when it reached its maximum amount. In this situation, you should consider taking advantage of another Social Security claiming rule.

Under the terms of a major change in Social Security laws enacted in 2015, anyone who turned 62 on or before the beginning of 2016 is allowed to file what’s called a “restricted” application. This applies to you. What it means is that at age 66 you can file a restricted application for just your ex-spousal benefit, while delaying the filing for your own retirement benefit.

If you did this, you could get the full value of your ex-spousal benefit for up to four years. Then, as late as age 70, you could file for your own retirement benefits. If you did this, you would get an additional payment roughly equal to the amount by which your retirement benefit exceeded your ex-spousal benefit.


Nancy – Virginia: I am currently 64 and am planning to quit my job on my birthday next year when I turn 65. Although I do not plan to collect Social Security until I am 66, I will file for Medicare before I turn 65 so that I am not penalized. My husband is five years younger than me. I was planning to drop my employer’s insurance when I resign at 65 and get added to my husband’s health insurance. Do you advise this move? To be added, it will cost approximately $100 a month.

Phil Moeller: If you like your husband’s coverage, I’d suggest you skip Medicare for now and simply have him add you to his plan. So long as you are covered by an employer plan — as the employee or the spouse — you can avoid late-enrollment penalties when you later enroll in Medicare.

If being added to your husband’s plan would cost only $100 more a month, I wonder if it makes sense to do this right away and not wait until you’re 65?


Lee: My wife filed before her full retirement age for her own benefit based on her work record. Since I have not applied for benefits, Social Security is saying that I must apply for benefits before they can make a determination on her application. Since I have not applied, do deeming rules apply in that she must apply for all the benefits she is “eligible” for, including spousal benefits? She may be eligible for spousal benefits, but since I didn’t apply, they are not available to her. I planned to apply for spousal benefits on her record and let mine benefit grow until I’m 70.

Phil Moeller: Your wife’s entitlement to her own retirement benefits is not dependent on you first filing for yours, so I am at a loss why Social Security would tell you this.

READ MORE: Should we raise the retirement age for Social Security and Medicare?

If you have not filed, she cannot be deemed, because she is only eligible for her own retirement benefit and not for her spousal benefit.

Assuming you turned 62 before the beginning of 2016, you are grandfathered under Social Security’s new rules and may file a restricted application for just a spousal benefit when you reach your full retirement age. This will permit you to delay your own retirement benefit until as late as age 70.

If you revisit this issue with Social Security, I would love to know the official source for their position that you must file before your wife can file.

Why does drawing Social Security benefits prevent seniors from making HSA contributions? Phil Moeller reports on the issue in his latest column.

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