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What vital questions should seniors consider before November?

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.

As Labor Day nears, so does the time to put away idle pursuits and focus on the very serious work of Medicare’s annual open enrollment season and the nation’s midterm congressional elections. Medicare, Medicaid, Social Security, and other programs of vital interest to older Americans will certainly be on the line this fall, so over the next few months I will be tackling some of the realities confronting older Americans and their families.

I will be looking deeply at open enrollment, which begins Oct. 15 and extends through Dec. 7. During this period, people have broad rights to change their Medicare coverage. Historically, nearly everyone has preferred to stick to the coverage they have, despite overwhelming evidence they could save money and get better care if they switched to other Medicare plans. Undeterred, I will keep pounding away on ways you can find superior Medicare solutions for 2019.

I also will be assessing the many challenges – financial, regulatory, and political – facing Medicare and Social Security.

I’m laying all this out now because I want to hear your ideas about these issues. What concerns and thoughts are on your mind? What would you like to know more about to help you make informed decisions? Please let me know in the coming weeks.


Here are this week’s reader questions.

Judy – Va.: I am fairly healthy and am not on any medications. I rarely get sick enough to go to the doctor and have no ongoing conditions. Is there any reason I should have other Medicare except Parts A and B?

Phil Moeller: I think Judy has lots of company among healthy seniors. No one likes to pay for insurance if they can avoid it.

In Judy’s case, she will face late-enrollment penalties for Part D drug coverage if she later needs it. These are permanent penalties and equal about 30 cents a month tacked on to the Part D premium for each month she is eligible for Part D but does not have coverage.

Otherwise, the big risk health seniors face is a surprise and expensive medical need — think cancer, a bad accident, etc. Part B covers only 80 percent of outpatient and doctors’ expenses, so people with only original Medicare are on the hook for 20 percent of a potentially large number.

If it was me, I’d get a cheap Medicare Advantage plan. It won’t cost much beyond Part B and will include protection against catastrophic medical expenses.


Lynn – S.C.: I will be 62 this October. My husband of 32 years passed away in 2008. I work full-time and plan to keep working for at least another five or six years. The cost of my health care is $450 a month and is a big part of my take-home pay. Can I draw on my late husband’s SS now so that in 2 years — isn’t there a two-year waiting period? — I can qualify for Medicare? Or, do I have to be 65 to qualify for Medicare regardless? Also, by drawing on his Social Security now, will this hurt me when I do quit work and then draw on mine, maybe at age 70?

Phil Moeller: You may me mixing up Social Security disability and retirement benefits. If a person is found eligible for disability benefits, they normally become entitled to Medicare after two years, regardless of their age. However, claiming a survivor Social Security benefit has no relationship to Medicare eligibility. If you are not disabled yourself, you will need to wait until 65 to enroll in Medicare.

As far as Social Security is concerned, you are eligible right now to draw a survivor’s benefit from your late husband. However, this benefit will grow if you can wait to file, and will reach its lifetime maximum if you wait to file until you’ve reached your full retirement age (FRA).

Taking a survivor benefit will not affect your own retirement benefit. The key here is that you can only receive the larger of the two benefits, not both of them.

So, you need to figure out whether your own retirement benefit at age 70 will be bigger than your survivor benefit at your FRA. If so, you will come out ahead by filing for a reduced survivor benefit right away and then switching to your larger retirement benefit when you turn 70.

However, if your survivor benefit at your FRA will be the larger of the two, then you should file for your own reduced retirement benefit this October when you turn 62. You would continue receiving it until your FRA, and then file for the larger survivor benefit.

You can estimate your own retirement benefit by opening an online My Social Security account. It will show you benefits at different claiming ages.

You will probably need to call Social Security or schedule an in-person meeting at your local Social Security office to determine what your survivor benefit would be. You may need a copy of your marriage certificate and your late husband’s death notice, although if you have his Social Security number, the agency should be able to confirm that he passed away.


Saundra – Alaska: After I have enrolled in a Medicare supplement plan (Medigap) during my initial enrollment period, and have been in the plan past this point, can my insurance provider increase my premiums due to my increasing poor health? I was told it could.

Phil Moeller: According to Medicare’s rules, during your initial enrollment period your insurer may not increase your premium for your Medigap supplemental policy due only to your increasing poor health. These rules are known as “guaranteed issue rights” and are explained on pp. 21-23 of Medicare’s annual guide to Medigap plans.

Your rates can later be increased, but not because of any pre-existing health condition. Page 18 of the annual guide explains three different types of Medigap pricing systems used by insurers. You can ask your insurer which approach it uses, and how this may affect your premiums.


Ted – Texas: In order to pay rent and have food to eat, I need the money that’s now being taken from my Social Security to pay for Medicare. How can I drop Medicare and get those funds restored to my Social Security?

Phil Moeller: If your income is really low, you might qualify in Texas for Medicaid. If so, it would pay your Medicare premiums. Otherwise, you are free to disenroll from Medicare. You can call Social Security to do that, but of course it would mean you’d have no health insurance, and if you wanted Medicare in the future, you might face large re-enrollment penalties that would be permanent.

If you want to look into Medicaid rules in Texas, you can contact the State Health Insurance Assistance Program (SHIP). It provides free Medicare counseling.


Elizabeth – W.Va.: I am still working and will turn 65 in October. I have health insurance through my employer. The cost to me is reasonable, about $100 a month, but comes with an annual deductible of $1,000, which I never meet! I know that to sign up for Part A and Part B would cost me only $34 more dollars a month and lower my deductible dramatically. Also, I would likely do a Medicare Advantage plan to get some dental and vision coverage which I now lack. I don’t currently take any prescription meds. It seems to me that Medicare is the way to go. My employer’s initial response when I broached the subject was that he “would not allow” me to waive the company insurance. The insurance is not part of a union contract and the employer doesn’t pay 100 percent of my premium, so it seems to me that waiving it is my right. Thoughts?

Phil Moeller: I am not an expert on the many, many versions of private employer health policies. I have heard that some employers stipulate that employment is conditioned on accepting employer insurance as mandatory. If that’s the case, you should have been informed as part of the hiring process and, of course, the employer should be able to provide you this policy in writing.

I can’t really advise you on how hard you should push. Do you think doing so would cause long-term damage in your relationship with your employer? If so, how big a problem might that be?

Also, I’d advise you to get at least a low-cost Part D Medicare prescription drug plan wrapped into your Medicare Advantage plan. At some point, you will need such coverage and Medicare then would hit you with permanent late-enrollment penalties.


Dale – Pa.: My wife retired in 2013 and received insurance benefits (which included me) until she turns 65 in two months. Since I did not need Part B, I did not sign up when I turned 65. I am now being told that I will have to wait until the 2019 Medicare open enrollment period to sign up for Part B. I was not notified that this would happen. Is there any possible way for me to enroll now?

Phil Moeller: From what you write, the key variable seems to be whether your Medicare enrollment period began under your wife’s plan when you turned 65 or when she did. If you were entitled to a Medicare enrollment period, you should have been able to apply and have your coverage take effect before next year. The fact that you are being told otherwise indicates that Medicare does not believe you either were entitled to a special enrollment period or, if so, that you failed to enroll in a timely manner.

Unfortunately, waiting for Medicare or your wife’s employer plan to inform you of your options is a losing strategy. My in-basket is full of emails from people who say they were never told what to do.


Coleen – N.Y.: I’m a U.S. citizen who has spent the majority of my working life in the U.K. I moved back to New York City five years ago for a job that was later eliminated after a year and a half. My 65th birthday was last week, and I discovered I don’t have enough quarterly credits to qualify for premium-free Part A of Medicare. I only have 20 and I need 40. I’ve launched myself as a freelance publicist and I’m living off my savings at the moment. I can’t really afford $300 to $500 a month for Medicare. Do you have any suggestions?

Phil Moeller: I don’t have any great advice. I doubt this is practical, but you could find a friend willing to marry you! After a year, you could qualify for Medicare on their Social Security record. Like I said, not so practical! I’m sorry I don’t have something more helpful to offer.

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