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What does this little-understood rule of Social Security mean for me?

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 “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.


Theresa – Conn.: Has there been any change in the six-month lookback rule for Medicare and Social Security benefits? And what is the benefit of this rule, anyway? I will have been covered by my employer health insurance during the lookback period, so I won’t have outstanding bills for Medicare to pay. Will Social Security send me a check for six months of retroactive Social Security? What was the “good intention” of this rule?

Phil Moeller: I am not aware of any change to this rule, which is not well understood.

If a person has not filed for Social Security by the time they reach their full retirement age (FRA), they are entitled to up to six months of retroactive benefits when they do file. While this may seem like a nice benefit, I disagree.

Between their FRA and age 70, Social Security benefits increase at the rate of 8 percent a year for people who wait to claim. If a person whose FRA was 66, for example, waited to file until they were 66 and a half, they could get a six-month retroactive payment. However, by doing so, their effective claiming date would be 66, not 66 and a half, and they would be accepting a 4 percent reduction in their monthly benefit for the rest of their life.

There is also a lookback period for Part A of Medicare but not for Part B. I have not seen any examples of people going back in time and asking Medicare to honor Part A claims incurred during this period, but perhaps there are some. The main reason for the lookback as it applies to Medicare is that anyone taking Social Security who is 65 or older must enroll in Part A, thus triggering the lookback period for some enrollees.


Anonymous –Mass.: My husband just turned 65 and he is retired. I am younger and will be in the workforce for at least another 10 years. He is covered by my employer’s health plan, but it has a $3,000 deductible. He takes an expensive eye medication that costs $175 a month. Should he purchase Medicare Part D in addition to his Part A?

Phil Moeller: Part D can help pay for his drugs and these funds can be applied to his employer plan deductible. A Medicare spokesman confirms that he can get Part D without first having to get and pay for Part B. Because he is covered on your plan, he will not face late-enrollment penalties later when he does need Part B. Before enrolling, he should review stand-alone Part D plans using Medicare’s Plan Finder. I’d also suggest speaking with a benefits manager at your employer plan and finding out details on how the plan would work with a Part D plan. Medicare warns people that they could lose their employer coverage if they get Part D, so make sure this will not happen to you. If you encounter any problems, please let me know. I suspect lots of Medicare-eligible folks will be interested in your strategy as a way of coping with high-deductible employer plans.


Sarah – Calif.: I’m 69. I started receiving Social Security benefits at age 66 under my husband’s work history, because I worked very little outside the home. My husband died two months ago. I was previously married for 15 years to my first husband. Since my first husband earned a lot more, can I now collect Social Security benefits under his work history instead?

Phil Moeller: Yes. You are eligible for these benefits because you are now single following the death of your second husband. You can’t collect two benefits at the same time, of course, but only the larger of the two — either a survivor benefit from your second husband or a survivor or ex-spousal benefit from your first husband. Your note did not say whether your first husband was still alive.

If he is, even though he earned more money, the spousal benefit is much less generous than the survivor benefit. The spousal benefit at most will be half of what your ex-husband was entitled to receive at his full retirement age. The survivor benefit is all of what your late husband was receiving when he died, or would have been entitled to receive if he died before claiming his benefits.

Social Security should be able to help you with this matter. You will need details on both husbands, including marriage, divorce, and death records.


Mary – Minn.: I just found out I will be losing my Medicaid. My Social Security is only about $550 a month. I am 67, and have been on Medicare since 2015. I haven’t an idea of what I should do. I’m Medicare illiterate.

Phil Moeller: You say that you learned in July that you’d be losing your Medicaid. I am assuming this means that the Medicaid subsidies that were helping to pay for your Medicare were eliminated. Is that correct?

If so, can you tell me the reason(s) why this happened? Some state budgets are being cut back, leading to reductions in Medicaid funding. Did Minnesota change its Medicaid rules? Did your income increase or was there some other change in your financial situation that explains why you lost your Medicaid benefits?

If your Social Security is your only income, I would think you would still qualify for government help in paying for Medicare. The State Health Insurance Assistance Program (SHIP) provides free Medicare counseling and should be able to help you with this.

Generally, if you are strapped for funds, getting a Medicare Advantage plan with a Part D plan bundled into it would be the cheapest form of Medicare coverage. SHIP should be able to help you evaluate your Medicare options as well.


Margaret – Fla.: Can a person retire at 62 if born in 1955, and continue earning a salary?

Phil Moeller: When you say retire, I assume you mean apply for Social Security benefits.

Yes, a person who claims Social Security at 62 can continue to work. However, under the terms of Social Security’s earnings test, if that person’s wages were high enough, their Social Security benefits would be reduced temporarily and, possibly, eliminated entirely. The earnings test does not apply to benefits received by people at or past their full retirement age.


Steve – Calif.: I will be 65 in three months. I will enroll in Social Security. I will also sign up for original Medicare. I have asthma and do need certain drugs on a regular basis and also need to see doctors and outpatient procedures on a regular basis. Should I get Medicare Advantage or a Medigap supplement plan plus a Part D drug plan?

Phil Moeller: Making this decision depends on how much money you want to spend, how complete you want your protection to be, and whether you can find a Medicare Advantage plan that includes all the doctors you want to see.

Generally, Medicare Advantage (MA) plans are less expensive than a package including basic Medicare, a Part D plan, and a Medigap supplemental plan. They must cover everything covered by original Medicare (Parts A and B). Many MA plans also provide limited coverage of dental, vision, and other things that basic Medicare does not cover. The trade-off is that MA plans limit you to using only doctors and hospitals in the plan’s provider network, and also usually restrict coverage to near where you live.

These are decisions that you are in the best position to make, not me! I would use Medicare’s Plan Finder and its Medigap Policy Search online tools to gather information about your medication costs and Medigap choices.


Enrique – N.Y.: Is it true that Social Security will run out of money sometime in the near future?

Phil Moeller: My most recent update on the financial condition of Social Security is here. If you read it and have any further questions, let me know.


Phil Moeller is the author of “Get What’s Yours for Medicare: Maximize Your Coverage, Minimize Your Costs” and the co-author of the updated edition of The New York Times bestseller “How to Get What’s Yours: The Revised Secrets to Maxing Out Your Social Security,” with Making Sen$e’s Paul Solman and Larry Kotlikoff. On Twitter @PhilMoeller or via e-mail: medicarephil@gmail.com.

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