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; and he will answer as many as he can.
Sharlyn – Texas: My hubby and I are going to start full-time RVing. We have basic Medicare and drug coverage but wonder what would happen if we get sick on the road? Do we go to an urgent care clinic, an emergency room, or what? I looked at a lot of RV websites and found nothing to answer these questions.
Phil Moeller: Basic Medicare covers you with any doctor or hospital in the country that accepts Medicare, and nearly all do.
The trick, obviously, is how do you find a good doctor, with no advance notice, who is accepting new Medicare patients and is actually available when an unpredictable emergency occurs? Eliminating global warming might be easier!
For this reason, walk-in clinics are your best bet for routine matters, and hospital emergency rooms might be the first step for serious ones.
I know that you might want to just hit the open road and take it wherever the mood strikes you. But doing some trip planning would be a good idea. This planning should include a contact list of people you know near where you plan to travel. They can be invaluable sources for medical help, including providing names of good doctors.
Best of luck on your adventures. I am jealous!
Steve – Ill.: I got in a bad work accident five years ago and am now disabled. I receive Social Security disability benefits and have Medicare Parts A and B. I will be 57 next year and eligible for my pension, so I plan to retire. I will also be able to keep my work insurance, so I am wondering if I can drop Medicare? I was thinking that it doesn’t make sense paying for two medical insurance programs.
Phil Moeller: You always can drop Medicare. The questions are whether you want to, and whether you’d face late-enrollment penalties when you later re-enroll.
Part A charges no premium, so I’d keep that. It covers hospital expenses and can come in handy as secondary insurance for claims that your BCBS policy does not cover. (Here’s my explanation about Part A for people with health savings accounts.)
Most likely, your work insurance will be your primary health insurer until you turn 65. At that time, most employer retiree plans require people to get Medicare as their primary insurance. The employer program would then become the secondary insurer, and would help pay covered expenses not fully paid by Medicare. You should confirm this with your work insurer.
Even though you now have Medicare, you can drop it and, when you turn 65, you will receive a new Medicare initial enrollment period and will not face any penalties for not having Medicare the previous eight years.
Paul – Calif.: My best friend had Medicare but was recently told that his Medicare is being discontinued because he is making a lot of money from his Social Security disability benefits. He is going to appeal the decision, but what happens if he loses? What would it mean for his health coverage and prescriptions?
Phil Moeller: My guess is that what is being discontinued for your friend is not his Medicare but the Medicaid support he receives that helps pay for his Medicare. One in five people with Medicare have incomes low enough for them to also qualify for Medicaid.
If he loses his appeal, he would have to pay for his Medicare, as do the other 80 percent of people on Medicare. His coverage wouldn’t necessarily change, just the way he pays for it. However, there are some things that Medicaid covers that Medicare does not, so he will need to find out those details about Medicaid benefits in his state.
The State Health Insurance Assistance Program (SHIP) provides free Medicare counseling. Your friend should call SHIP and find out if there are other Medicare support programs that can help pay some of his costs.
Mike – Texas: I am 62, and plan to file soon for Social Security. I understand that my son, who is 12, can get benefits based on my earnings record. My wife would also like to apply for a spousal benefit. Will there be any limits on their benefits?
Phil Moeller: Your son and wife cannot both receive their full Social Security benefits based on your earnings record. That’s because their filings are likely to exceed what’s called the family maximum benefit (FMB). This is the amount of money that can be paid out on based on a single worker’s earnings record. If both of them file, the odds are their benefits would be proportionally reduced to avoid exceeding your FMB.
If you haven’t already done so, open an online My Social Security account. It displays your formal earnings record and includes estimates of your various benefits, including your FMB. You then should be able to approximate the size of their respective benefits, and the extent to which they would be reduced by the FMB.
Brian –Texas: My mother fell and broke her hip, requiring an operation and then 30 days in a retirement facility that was covered by Medicare. Before she could be released from the retirement facility she fell and broke her other hip, which required another operation to fix. Would Medicare pay for another 30 days in the retirement facility, and would she be eligible for in-home health care paid for by Medicare?
Phil Moeller: What are the odds? I am so sorry your mother had such an unfortunate run of bad luck. Medicare covers more than 30 days of institutional care following a hospital stay, so she should be covered for more days in the facility. However, I always advise people to confirm this ahead of time, with the facility and Medicare.
In terms of home health care, Medicare does cover medically necessary care but does not cover so-called custodial care. Her doctor would need to prescribe the home care, and the requirements to qualify can be stringent.
Sandra – Md.: I’ve paid into the Medicare tax system for more than 40 years. Why is that I have to pay for Part B when I retire?
Phil Moeller: Your Medicare taxes pay for Part A of Medicare, which covers hospital expenses. Your Part B premium pays only 25 percent of the cost of that part of Medicare, which covers doctors, outpatient expenses, and durable medical equipment. The government pays the other 75 percent, which means that taxpayers (including you) are paying this tab.
Senior groups and other advocates for senior benefits have long said that people deserve their Medicare because they paid for it. That’s an effective rallying cry, but it’s never been completely true. On the other hand, I would say what we hear from Republicans and the White House about the merits of their new tax law is no less dubious.