I can’t afford Medicare Part B. How do I prepare for tomorrow’s health problems?

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.

Suzanne – N.M.: I enrolled in Medicare Part A in 2011. I receive $776 a month from Social Security, so I cannot afford Part B. I continue to work as an independent consultant. By the time I pay my expenses, my income is negative. So far, I have been healthy, do not go to the doctor, and don’t take prescriptions.

However, I realize that I should prepare for more challenging times. My question is, what should I do in case I can’t continue working until I die? I own my home, and I’m wondering how this would affect my Medicare and Social Security? Should I sign the property over to one of my children now, before I get too decrepit?

What Medicare and Social Security rules and laws should I be aware of in order to make an informed decision? I’m 72 now.

Phil Moeller: Suzanne, you are this week’s poster child for the kind of responsible decisions that people need to be thinking about as they near the end of their working lives. Please take a bow for being a great role model!

Unfortunately, I have some sobering news. At your age, I fear that signing up for Medicare Part B would expose you to big late-enrollment penalties. Unless you have had active employer health insurance, you needed to get Medicare at age 65 to avoid such penalties.

They add 10 percent to your Part B premiums (which are now $134 a month) for each year you are late. They tack on another 1 percent a month to Part D premiums, using the national average for Part D of about $33 a month.

Having Part A provides you hospital insurance but you need Part B for doctors, outpatient and durable medical equipment expenses. Without Part B, you are dangerously exposed to ruinous health care bills that you so far have avoided. I have become a scold if not a scourge for healthy people like you. While you have dodged a health care bullet so far, the odds are you will need substantial health care in your later years. My mantra, boring to regular Ask Phil visitors, is that health insurance is for the “future” you, not the “present” you.

The Part B penalty alone would raise your Part B premium from $134 a month to nearly $228 (using a 70 percent penalty). These penalties last the rest of your life, so they are a big stone in the road for you.

Your Social Security payments would not be affected by owning your home. Neither would your Medicare, at least not directly.

As you may know, people on Medicare with little income or personal wealth may qualify for Medicaid. It helps pay Medicare expenses and, more importantly for you, will pay for long-term care expenses should you need such care and are unable to afford it.

Given that Medicare is not such a great deal for you now, I think you should give a lot of thought to how you would spend down your assets and qualify for Medicaid. Medicaid is managed at the state level, and I am clearly no expert on Medicaid rules in New Mexico.

However, most states use what’s called a five-year “lookback” period in evaluating asset disposals intended to qualify a person for Medicaid. In other words, asset sales must be more than five years old for a person’s remaining assets to qualify for Medicaid.

My advice, for what it’s worth, is to work with your children to find an attorney who can advise you on how to qualify for Medicaid. Unfortunately, with your modest means and history of not having Medicare, this may be your most practical strategy for getting health care in your later years.

Marjie – Wash.: I am turning 65 in 2018. I am retired, currently drawing my Social Security, and am covered through my husband’s employer health insurance. I was told Social Security will deduct approximately $100 a month from my Social Security payments, yet I also read Medicare Part A is premium-free. I am learning as I go, so could you please tell me if I can prevent that $100 monthly deduction if I show Social Security that I’m insured through my spouse’s employer? Also, do I need to pursue Medicare health care since I’m currently covered through my spouse’s plan? If so, can I simply add it to that insurance plan?

Phil Moeller: The deduction you’re referring to occurs when you sign up for Part B of Medicare, which now charges a monthly premium of $134.

Social Security handles Medicare enrollment. If Social Security sends you a Medicare card showing it has enrolled you in Part B, you need to return that card and reject Part B at this time. Because you are covered through your husband’s employer plan, you can stay on that plan when you turn 65 (assuming the plan has at least 20 employees) and you do not need to get Medicare.

If you happened not to like the employer plan, you would be free to drop it and get Medicare. As I recently wrote, some people with high-deductible health plans who are eligible for Medicare can save money by keeping the employer plan and also getting Medicare.

Once your husband’s plan stops covering you, you will have a special enrollment period in which to get Medicare.

If Medicare improperly charges you a Part B premium, you can appeal this. Here’s a form Medicare may require to confirm that you have employer insurance.

The best approach here is to be proactive. Call Medicare and make sure it’s not enrolling you in Part B. As with much else in life, undoing a mistake is much, much harder than avoiding one in the first place.

Linda – Okla.: I am on Medicare and I have a Part D drug plan.  Without the Part D plan, my meds would cost me $44 a month. With the plan, it is $33, but if you add the Part D insurance, I am paying $60 a month for insurance and copays. Can I cancel my Part D plan for a year and pick it back up later?

Phil Moeller: It sounds like you have a lousy Part D plan, or at least one that does not fit the mix of medications you are taking.

I suggest you shop for a new plan for 2018 during Medicare’s annual open enrollment period, which runs through Dec. 7.

If you cancel your Part D plan, you will face re-enrollment penalties when you again buy a plan. These penalties, which last for the rest of your life, add 1 percent to your Part D premium for each month you are without coverage.

Beth: My husband passed away; he was receiving Social Security disability benefits when he died. I am only 59 years old now, but plan on getting married after I turn 60. I want to wait that long to qualify for a survivor benefit. How can I find out how much I would be able to receive based on how old I am when I file for this benefit? My late husband collected $2,400 a month, and his children also collected a Social Security check each month. They have since turned 18. Would I be able to collect 100 percent of what he received if I wait until I’m 62? I truly am not sure about my options, and really do not trust the Social Security office to give me correct information.

Phil Moeller: The benefits that your children collected from your late husband (or ex-, as the case may be) usually will not reduce your own survivor benefits. If any of the children are disabled, there might be an impact, but I’m not positive about that, so if that’s the case, please let me know and I’ll do some additional research.

If your husband collected a $2,400 disability benefit, that normally is what you would receive if you waited until your full retirement age (FRA) to file for this benefit. If you file earlier, these benefits will be reduced according to this schedule. You can open an online My Social Account if you also want to see your wage history, and projections of what your own retirement benefit would be at different claiming ages.

If your survivor benefit is always going to be larger than your own retirement benefit, you could file for only your retirement benefit at age 62 and then also file for your survivor benefit at your FRA. That way, you can get some benefits fairly soon, and also defer your survivor benefit until it has reached its maximum level.

Debra – N.C.: My brother is in the late stages of Alzheimer’s.  He has Medicare Part A and Part B.  Can we get in-home care paid through Medicare, and, if so what agencies can we locate to do this?

Phil Moeller: I am sorry to hear about your brother. Unfortunately, Medicare does not cover the kind of custodial care that people with Alzheimer’s normally require. It only covers medically necessary care that must be prescribed by a physician, and which is normally only short-term in duration.

If his doctor prescribes such care as medically necessary, this would be covered under Medicare’s home-care benefit. This program has been beset with lots of problems. Here’s the latest piece I wrote about this topic. It includes links to additional resources.

I wish I had more helpful news. Many people mistakenly think Medicare covers long-term care, but it does not. With more seniors approaching the age when they need such care, the lack of affordable options will become yet another crisis in health care. Like many such problems, this is one we’ve seen coming for decades.

Correction: An earlier version of this post incorrectly told Beth that she did not need to wait until age 60 to remarry in order to maintain her eligibility for a survivor benefit. She does.