What do you think? Leave a respectful comment.

Proposed fixes to Social Security and the effects the tax cuts could have on Medicare and Medcaid are two issues voters sh...

Opinion: Vote like Social Security and Medicare are at stake

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.

I do not know for sure if the futures of Social Security, Medicare and Medicaid are at stake in next week’s elections. But behaving as though they are would not be a bad idea.

Let’s start with Social Security, whose challenges are well-documented. Protecting benefits for younger generations should be a cornerstone of national government policy. Improving benefits for people in or close to retirement should also be considered if it can be done in a fiscally responsible way.

One relatively modest change stands out to me. The program’s annual cost of living adjustment is based on a measure of consumer price inflation that fails to adequately weight the share of household budgets of older people spent on health care. Each year, the COLA falls short of increases in their living expenses, and while the annual gap is small, its cumulative effect is large.

Fixing this problem by raising Social Security taxes on wealthier workers is an attractive approach in paying for long-term changes to the program. However, a better approach would be one where all beneficiaries should share some of the pain.

As an older American myself, a far more compelling election issue is the state of my Medicare. As someone who has spent a lifetime pursuing and believing in the facts, I don’t think there’s any doubt that the Democrats have more Medicare facts on their side than do Republicans.

Recently, Republicans have tried to focus the conversation on what they call radical “Medicare for All” proposals that they say would destroy our health care system and which they link to Democrats. This is mostly election-time hot air, epitomized by the embarrassingly partisan and clumsy report by the president’s Council of Economic Advisers on the purported evils of socialism.

The greater threat to Medicare and Medicaid, by far, is the enormous tax cut pushed through by Republicans. Putting aside its tilt toward wealthier taxpayers, this big cut in federal revenues puts tremendous pressure on government supports for health care. Pushing for even more tax cuts, which President Trump has proposed doing after the midterms, seems more like a craven attempt to win votes than a serious effort to govern.

The Republicans have long maintained that lowering taxes will more than pay for itself by boosting economic growth. So far, the evidence is not there. Current deficits are up, which is not so surprising. But so are projections of future deficits. Nearly all economic experts disagree with Republican growth projections. So do the stock and bond markets.

I do believe Republicans when they say that rising deficits will make it increasingly hard for the government to afford paying the bills for Social Security, Medicare and Medicaid. This is a fact that worries me a lot. It’s also one largely of the Republicans’ own making.

And now for this week’s reader questions.

Mike – Alabama: I am 65 and trying to find an insurance plan that mainly covers dental and hearing, including hearing aids. I found one, but it only covers $1,000 a year and the hearing aids are approximately $5,500. This doesn’t sound like a very viable plan considering the premium is about $400 a year.

Marilyn – Missouri: I have a Medicare Advantage plan. I need hearing aids and have only one molar left. Our yearly income is around $44,000. Do you have any suggestions?

Phil Moeller: As Mike and Marilyn have discovered, dental and hearing insurance plans are skimpy. The underlying reason is that nearly everyone with these policies needs dental and hearing help. If the insurance paid a high percentage of expenses, the insurers would go out of business. They, of course, would like to make a profit, so they price their products accordingly.

Marilyn should compare 2019 Medicare Advantage plans sold in her area and see if any have better coverage than the plan she now has. Open enrollment for 2019 plans extends through Dec. 7.

The only way older Americans will get better dental, hearing and vision protection is if Congress decides that this benefit should be provided and largely funded by taxpayers through Medicare and Medicaid subsidies. In the meantime, good quality, and much cheaper, over-the-counter hearing aids are increasingly available.

Nancy – Hawaii: My husband and I were born in 1953. I have worked part-time through the years and am retired. My husband is planning on working at least three more years before he retires. Taking a spousal benefit on his earnings would produce a higher benefit than I would collect on my own earnings. He would like to defer his benefit until 70. Can I take half of his at 66, and can he continue to wait until 70?

Phil Moeller: I advise high-earning spouses to delay taking Social Security until 70 if at all possible. This guarantees them their largest-possible monthly payment, and with many people living into their 90s, having that larger payment can really come in handy. Waiting until 70 also means that the high-earner’s spouse is also guaranteed of receiving the highest possible survivor benefit should the high earner be the first person to die.

You cannot file for a spousal benefit until your husband has filed for his own retirement benefit.

Given this, you should consider filing for your own retirement benefit when you turn 66. When you’ve filed and your husband is at least 66, he can file what’s called a restricted application for a spousal benefit, while allowing his own retirement benefit to grow until he files for it at age 70. When he does file for his benefit, you can file for a spousal benefit and will receive an extra payment equal to the amount by which your spousal benefit exceeds your own retirement benefit.

Louisa – New Jersey: I need help finding the best Medigap supplement plans for me and my brother. I will need Medigap soon. He already has Medigap, but while he loves his policy, it seems to be much more expensive than what other insurers are charging for the same coverage. However, we’ve heard it can be hard to change Medigap insurers and would appreciate your thoughts.

Phil Moeller: Your brother is right to be concerned that he may not be able to easily switch to a new Medigap plan on terms nearly so favorable as those that governed his initial enrollment period. So, it’s essential to shop carefully for new coverage and not to exit one plan before locking up coverage in the new one.

While the benefits of all same-letter plans (“A”, “B”, “C”, etc.) must be the same, there is widespread variation in Medigap premiums. Plans are regulated at the state level and insurers are free to set their own rates. However, there also are different approaches to underwriting Medigap plans that can make some plans more desirable than others.

Medicare publishes a useful annual guide to Medigap that explains these underwriting approaches as well as providing a useful rundown of what each different letter plan covers. I wish Medicare would update this guide, but it is still well worth the time to become familiar with these matters.

Olga – New York: I have been in and out of the work force, and I am relying on my husband’s Medicare plan with his employer. This makes me nervous. What should I be doing or watching out for?

Phil Moeller: You should be nervous. I do not know the details of your husband’s Medicare plan. However, Medicare covers only individuals, not couples or families. If your husband is actively employed and not yet 65, he should be covered by regular employer insurance. If he does have Medicare, however, it will not cover you. If you are younger than 65, you’d need to get your own coverage on New York’s Affordable Care Act insurance exchange. If you have turned 65, you’d need your own Medicare coverage.