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Your Paycheck and Your Lifespan

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Why the middle class will have eight fewer years of healthy life than the rich, and what that means for you.

Growing number of Americans are retiring outside the U.S.

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A foreign resident teaches local children how to draw at the Cultural Arts Center in Ajijic June 9, 2012. For decades, American and Canadian expats have flocked to the shores of Chapala, seeking refuge in the spring-like climate of Mexico's largest natural lake, where English author D.H. Lawrence once came for inspiration. But the calm of the clustered lakeside retreats was shattered in May 2012 when suspected drug-gang hitmen kidnapped a group of Mexican locals and dumped 18 decapitated bodies in two vehicles just miles (kilometres) from the lakeside tourist enclave of Ajijic. Picture taken June 9, 2012. REUTERS/Alejandro Acosta (MEXICO - Tags: CIVIL UNREST CRIME LAW DRUGS SOCIETY EDUCATION TRAVEL) - RTR33SO3

A foreign resident teaches local children how to draw at the Cultural Arts Center in Ajijic June 9, 2012. For decades, American and Canadian expats have flocked to the shores of Chapala, seeking refuge in the spring-like climate of Mexico’s largest natural lake, where English author D.H. Lawrence once came for inspiration. Photo by Alejandro Acosta/Reuters

Newly widowed, Kay McCowen quit her job, sold her house, applied for Social Security and retired to Mexico. It was a move she and her husband, Mel, had discussed before he passed away in 2012.

“I wanted to find a place where I could afford to live off my Social Security,” she said. “The weather here is so perfect, and it’s a beautiful place.”

“I wanted to find a place where I could afford to live off my Social Security.”

She is among a growing number of Americans who are retiring outside the United States. The number grew 17 percent between 2010 and 2015 and is expected to increase over the next 10 years as more baby boomers retire.

Just under 400,000 American retirees are now living abroad, according to the Social Security Administration. The countries they have chosen most often: Canada, Japan, Mexico, Germany and the United Kingdom.

Retirees most often cite the cost of living as the reason for moving elsewhere, said Olivia S. Mitchell, director of the Pension Research Council at the University of Pennsylvania’s Wharton School.

“I think that many people retire when they are in good health and they are interested in stretching their dollars and seeing the world,” Mitchell said.

McCowen’s rent in Ajijic, a community outside Guadalajara near Mexico’s Lake Chapala, is half of what she was paying in Texas. And since the weather is moderate, utility bills are inexpensive.

In some countries, Mitchell said, retirees also may find it less expensive to hire someone to do their laundry, clean, cook and even provide long-term care than in the United States.

McCowen has a community of other American retirees nearby and has adjusted well.

But for others there are hurdles to overcome to adjust to life in a different country.

Viviana Rojas, an associate professor at the University of Texas at San Antonio, says the biggest obstacle is not speaking the language or knowing the culture.

“Many of the people we interviewed said they spoke Spanish, but they actually spoke very little Spanish,” said Rojas, who is writing a book about retirees in Mexico. “They didn’t have the capacity of speaking enough Spanish to meet their basic needs like going to the doctor or to the store.”

Access to health care also can be a challenge. While retirees still can receive Social Security benefits, Medicare is not available to those living abroad, Mitchell said.

Joseph Roginski, 71, says that while the cost of living is higher in Japan, access to health care is not. “Things are very expensive here. It is impossible to live off Social Security alone,” said Roginski, who was stationed in Japan in 1968. “But health insurance is a major factor in staying here.”

The former military language and intelligence specialist said he pays $350 annually to be part of Japan’s national health insurance. His policy covers 70 percent of his costs. The rest is covered by a secondary insurance program for retired military personnel.

Japan experienced the biggest growth of American retirees — at 42 percent — and more than any other country between 2010 and 2014, according to data from the Social Security Administration. The large U.S. military presence in the country may be a factor.

There are more than 50,000 U.S. military servicemen and -women stationed in Japan. The presence is so large that in the island of Okinawa, the U.S. military occupies about 19 percent of the area, according to Ellis S. Krauss, professor emeritus of Japanese politics and policy-making at the University of California, San Diego.

Roginski, who volunteers for the Misawa Air Base Retiree Activities Office, said he helps connect more than 450 retirees and their families living in Northern Japan with resources. He said he would never move back to the United States.

“We have a real strong sense of security here,” he said. “I can leave my door unlocked and no one will take anything. When I go to another country I feel nervous, but when I come back I feel like I’m home.”

Mexico has become home for retired firefighter, Dan Williams, 72, and his wife, Donna, 68. The couple has been living near the same retirement community in Lake Chapala for 14 years.

“The climate and the medical services are very good,” Williams said.

Williams teaches painting to adults and children and puts together a monthly magazine for the local American Legion. He is also a member of the Lake Chapala Society, which offers daily activities for American retirees.

It was those same services that attracted McCowen to the region.

“Before moving, I found out how many widowed and divorced women lived here,” she said. “There is comfort in numbers.”

She says she loves being in a lively community.

“I see older people walking year round. I see them all over the place, even in their wheelchairs. If they were in the U.S., they would probably be in a nursing home,” she said. “I don’t think I could move back.”

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EDITOR’S NOTE — Maria Ines Zamudio is studying aging and workforce issues as part of a 10-month fellowship at The Associated Press-NORC Center for Public Affairs Research, which joins NORC’s independent research and AP journalism. The fellowship is funded by the Alfred P. Sloan Foundation.

The post Growing number of Americans are retiring outside the U.S. appeared first on PBS NewsHour.

Can Keeping Our Cells Healthy Lead to a Longer Life?

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Dr. Elizabeth Blackburn, who won the Nobel Prize in Physiology/Medicine in 2009, and Dr. Elissa Epel, a health psychologist who studies stress, aging, and obesity, discuss their book, The Telomere Effect: A Revolutionary Approach to Living Younger, Healthier, Longer. Blackburn discovered a biological indicator called telomerase, the enzyme that replenishes telomeres, which protects our genetic heritage. They explain how we age at a cellular level and how we can make simple changes to keep our chromosomes and cells healthy, allowing us to stay disease-free longer and live more vital lives.

Column: Social Security will reduce paper statements in 2017. Here’s why it shouldn’t

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Mature adult looking at Social Security documents Photo by Jim McGuire/Getty Images

Mature adult looking at Social Security documents Photo by Jim McGuire/Getty Images

Editor’s Note: Journalist Philip Moeller, who writes widely on aging and retirement, is here to provide the answers you need. 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.


The Social Security Administration just announced it would curtail sending paper statements to many people in order to save money. This is as bad an idea now as it was the last time the agency did this several years ago. After that move, public pressure caused it to reverse course. Let’s hope something similar happens this time around. I would like to believe the agency is smarter than this, and I’m cynical enough to even wonder if it might have planned this action to draw attention to its continued funding shortfall.

And that certainly is the bigger story here. Congress has continued to refuse to properly fund the agency, causing it to cut back on its services at just the time when record numbers of baby boomers are aging into the program and badly need all the information they can get.

The Social Security Administration just announced it would curtail sending paper statements to many people in order to save money. This is as bad an idea now as it was the last time the agency did this several years ago.

The agency has far fewer employees to serve the public than it did a few years ago. And while online information services can be a great way to save money without compromising customer service, Social Security is too complex and too important to be trusted to a smartphone app.

Social Security statements are the primary status reports that consumers receive from the agency. They show a person’s official wage history, which is the basis for their retirement benefits. They also provide estimates of key Social Security benefits to which a person will be entitled at different claiming agencies. The Social Security Administration provides online versions of these statements, and these certainly are useful to many people. But the paper statement is better, and it’s relatively cheap to provide.

Here’s what the agency said earlier this week: “Paper statements will only be sent to people age 60 and over, who are not getting benefits and don’t have a my Social Security account. This will bring down the costs of processing and mailing paper statements by $11.3 million in FY 2017.”

This is not even a rounding error for an agency that forks over roughly $900 billion a year in benefits and covers more than 170 million workers in this country. Millions of those workers are not able to save nearly enough money to afford even barely adequate retirements. They will depend almost entirely on Social Security benefits for their retirement spending, and they need all the help they can get to understand these benefits and make informed decisions.

Before reading this week’s reader questions, please consider protesting this decision to your U.S. representative and senators.


Mark – Calif.: What was the rationale behind the Windfall Elimination Provision that reduces Social Security pension amounts if one is receiving other public pensions? I’m a school teacher, have worked for a railroad and have enough quarters for Social Security. I worked for all those pensions, yet my Social Security and the railroad pensions are being reduced. My teacher pension isn’t. The total of all these pensions amounts to about half of my full-time pay. I’m grateful I’m getting an income for retirement, yet I don’t believe I’m getting all the benefits that I have earned.

Phil Moeller: No one likes the Windfall Elimination Provision, or WEP. But there is a rationale for it. Here is an abbreviated explanation (a fuller take can be found in our Social Security book, “Get What’s Yours”).

Social Security is, in economic terms, a very progressive program. This means its benefits are skewed to be very generous to low-earning folks. They get a much higher percentage of their wages back in benefits than do people who make more money.

READ MORE: Column: What can we do to protect Medicare and Social Security?

This form of income redistribution is a fundamental part of Social Security. It is accomplished by splitting up a person’s earnings record into three tiers. People get 90 percent of the first tier in their Social Security payment and smaller percentages of the second and third tiers. People with low earnings often don’t even make enough to reach the second or third tier.

No one likes the Windfall Elimination Provision … But there is a rationale for it.

The thinking was that a person with a public pension who has paid some Social Security taxes could be quite well positioned for retirement, but would be seen as a low-wage earner in terms of Social Security’s records. When they applied for Social Security, therefore, they’d get 90 percent of their earnings back in the form of Social Security payments. A person whose entire lifetime wages had been subject to Social Security payroll taxes might also be entitled to a private pension, but their Social Security payments would be fair and fully supported by the payroll taxes they had put into the system.

To deal with this, the WEP takes that 90 percent first-tier benefit calculation and reduces it to 40 percent for people with public pensions that are not tied to Social Security payroll taxes. This penalty begins disappearing when a person has been paying payroll taxes for 30 years and totally disappears at 40 years.

Whether you think it’s fair or foul, that’s the rationale.


Helen – Tex.: I’m so worried about Medicare Part B going up and how I’m going to manage every month. I’m 70. All I have to live on is my Social Security of $862 and a part-time job that brings in less than $400 a month. I’m still paying a mortgage, my vehicle is 10 years old, and I’m just barely able to make it each month after utilities and food. If I start my retirement, which I’m required to do now, how will that affect my Social Security and Medicare? If I quit the part-time job would that keep me from losing any of my Social Security? I don’t know what to do. I lie awake at night worrying about all this.

Social Security and Medicare do protect seniors from poverty, but there often is not much extra to go around.

Phil Moeller: Millions of older Americans are struggling to get by just like you. I know this doesn’t make it any easier to pay the bills, but your problems help explain why these benefits are so important. Social Security and Medicare do protect seniors from poverty, but there often is not much extra to go around.

Medicare has programs to help lower-income people. You can get free Medicare counseling from the State Health Insurance Assistance Program. Call them, and see if they can help. They may ask you about your income and financial situation, so make sure you have those records with you when you call.

READ MORE: Column: Social Security needs to be reformed, not have its funding cut

At your age, your Social Security will not be reduced or, most likely, affected at all by whether you are still working and earning wage income.


Tammy – Calif.: Can Republicans cut Social Security and medical benefits for the disabled? I have a severe condition which doesn’t allow me to ever work again, and I’ve been very stressed and concerned thinking my benefits are going to be cut or privatized. I have been reading online articles that Republicans want to “gut” Social Security and “end Medicare as we know it.” How realistic are these claims?

“Can Republicans cut Social Security and medical benefits for the disabled?”

Phil Moeller: Yes, Congress can change these programs, and I have seen the same stories you have about Social Security, Medicare and Medicaid being on the cutting block, along with the Affordable Care Act.

I can’t tell you not to worry. I can tell you that proposals to change any of these programs will trigger a major congressional battle. The GOP majorities in the House and Senate have a lot of power, but Democrats have promised to resist changes to these programs, and enough Republican senators have voiced reservations to jeopardize the GOP’s 52-48 Senate majority. Further, it’s not yet clear where President-elect Trump actually will stand when rhetoric yields to action. So far, he has only said he supports Social Security and Medicare and doesn’t want to change the programs. He has, of course, promised to end Obamacare. And many of his key appointees support changes to these programs as well.

READ MORE: How plans to repeal the Affordable Care Act could affect Medicare

Once the new president, his appointees and the new Congress take office, we will see if these claims come to pass. I can understand that you are stressed, and you have every right to be. You also have the right to complain to your congressman and senators. People need to stand up and be heard on these matters.


GW – N.C.: I am a vet and have medical coverage, but pay for copays and medicine. Do I have to enroll in Medicare, or is there a different coverage for vets?

Phil Moeller: There is different coverage for vets, but you may still need to enroll in Medicare. I am not clear whether you’re still working or are already retired. You say you already have medical coverage. Do you know who is providing this coverage? If it’s from an employer, and you’re going to keep working, you probably don’t need to change coverage just because you’ve turned 65.

If you already are retired, the major coverage for retired military personnel is called Tricare For Life. And you may also be eligible for Veterans Affairs coverage at its facilities.

Once you’ve determined your eligibility for either or both of these programs, I suggest you speak with their representatives about what they cover and how they work with Medicare. Some vets find VA is fine, and some supplement it with Tricare, which includes a Medicare component. It depends on their health care needs and often on their financial situation.

After you’ve looked into this, please feel free to get back to me with detailed questions.


Kevin: I have read “cover to cover” “Get What’s Yours” and have browsed the internet and attended some seminars that offer cocktails, dinner or whatever to get you into a meeting with a financial adviser. We do have wealth managers helping with investments; they are good at the investing, but weak in knowledge of Social Security. I think we have formulated a plan using the “restricted application” filing. We originally wanted to use “file and suspend,” but that window was closed to us as of last May.

My birthdate is Jan. 27, 1951, and my wife was born April 6, 1952, so we meet the 1954 birthdate test. Our plan:

I will file and suspend Social Security in January 2017, allowing me to reach the maximum payout in January of 2021. My wife will wait until April 2018 and also file and suspend until she turns 69 in 2021 or 70 in 2022. We want her to claim spousal benefits during my wait for 2021. We believe they would total about half of what I would get at my full retirement age of 66. When I start taking my full benefit she can either take her age-69 benefit or wait another year to get the full benefit.

READ MORE: Column: Under a President Trump, Medicare reforms are a matter of when, not if

Does she need to wait until she is 66 to file for spousal benefits? She would still file and suspend at full retirement age. Could she get a spousal benefit when I file and suspend? Is this a solid plan? Do we understand correctly how this could work for us?

Phil Moeller: Your note correctly notes that “file and suspend” is no longer possible for you. But then you later say your plan includes both you and your wife filing and suspending. So I hope you can understand that I am confused about your plans!

The fact is that anyone who had not turned 66 before the end of last April can’t file and suspend.

Therefore, your options are limited. Both of you can wait until age 70 to each receive your respective maximum retirement benefits. Or, one of you can file before this time and thus make the other spouse eligible to file a spousal benefit. In that situation, the second spouse would be able to file a restricted application when they reach full retirement age at 66. They would receive only a spousal benefit and defer their own retirement benefit to age 70, earning four years of delayed retirement credits.

If a restricted filing made sense to you, it would normally be better for the lower-earning spouse to file for their retirement on or after reaching full retirement age. The higher-earning spouse then would file the restricted application, preserving their maximum benefit.

This can be especially important if the higher-earning spouse dies first. In this event, the lower-earning spouse would get a survivor benefit equal to the higher-earning spouse’s age-70 benefit.

Figuring out the best strategy often requires more computational power than I have. My co-author Larry Kotlikoff offers Maximize My Social Security software that will let you run all the scenarios and figure out your best option. You will need to know details of all relevant Social Security benefit projections to get the most from the software.


Jane – Mo.: Once you become eligible for Medicare, it covers 80 percent of the medical bill, and my existing employer plan drops to 20 percent coverage. Why wouldn’t they each pay half? This wouldn’t cost Medicare so much and would not let my private insurer off the hook for paying its fair share of claims. As a retired federal employee, my private insurer premiums didn’t go down when I retired, and now I have to pay Medicare premiums as well. Why are the insurance companies getting away with paying only 20 percent of covered claims?

Phil Moeller: I have heard complaints from other federal retirees who think their federal premium should decline when this insurance moves from being primary to secondary. There also are some federal insurance plans where the person does not have to get Medicare, but can stay fully on their federal plan. I assume this was not possible for your plan.

Part B of Medicare pays only 80 percent of covered expenses when it is the primary insurer. Because of this “hole” in coverage, many people get either a Medigap private insurance policy or a Medicare Advantage plan. These policies can plug that hole.

In cases such as yours, where Medicare becomes the primary insurer and the employer plan moves from being primary to secondary, it’s the employer plan that steps up to fill that 20 percent hole. I do not know if anyone at Medicare has ever considered or proposed a 50-50 split in such situations.


Christopher: Are Part B excess charges the same as balance billing charges, or are these separate phenomena?

Phil Moeller: These terms are related. They often are used interchangeably, but this can be misleading. According to Medicare experts at Aetna, balance billing refers to the amount by which charges by health care providers exceed Medicare-approved payment amounts.

Nearly all providers accept Medicare assignment, meaning they have agreed to accept Medicare-approved charges as payment in full. In this case, balance billing is prohibited by federal law.

However, health care providers who do not accept Medicare assignment but agree to treat Medicare enrollees may engage in balance billing. If they do, these amounts are called excess charges. Here is how Aetna describes them:

While non-participating providers are allowed to balance bill, there is a limit on how much they can balance bill. Federal law sets the limit (known as the ‘limiting charge’) on the amount that the provider may balance bill (some states prohibit or limit balance billing as well). The limiting charge is based upon a percentage of the Medicare approved charge. In most cases, non-participating providers may not charge or balance bill more than 115 percent of the Medicare approved charge.

These excess charges are not covered by basic Medicare, but are covered by two types of Medigap, or Medicare supplement plans: letter F or G plans.

I also have seen balance billing described as the practice of billing patients the difference between what an insurance company would pay for a health procedure and the “retail price” that an uninsured patient would pay for the procedure.

The post Column: Social Security will reduce paper statements in 2017. Here’s why it shouldn’t appeared first on PBS NewsHour.

Care provider directories wrong nearly half the time in Medicare Advantage plan lists

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John and Mary Benbow, 67, and 68, respectively, of La Jolla, shown holding his finger over his social security number on his Medicare card, work hard to protect themselves from the scourge of identiy theft. They took their first names off their checks, they black out personal information and shred financial documents before putting them in the trash. There's just one area where they feel vulnerable and there's little that they can do about it. They must carry around their Medicare cards, which are emblazoned with their Social Security numbers, which experts say are a skeleton key to an individual's financial life. (Photo by Allen J. Schaben/Los Angeles Times via Getty Images)

Photo by Allen J. Schaben/Los Angeles Times via Getty Images

Editor’s Note: Journalist Philip Moeller, who writes widely on aging and retirement, is here to provide the answers you need. 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.


As Congress continues to move toward repealing part or even all of Obamacare, it’s not surprising that other health care news has fallen off our radar. Last week, however, the Centers for Medicare & Medicaid Services, the agency that oversees Medicare, released some very upsetting results of a study that reviewed the accuracy of the directories of health care providers in the networks used by Medicare Advantage plans.

These networks are a central component of Medicare Advantage plans, and the accuracy of network details clearly is significant for people who enroll in the plans. Most Medicare Advantage plans either prevent people from using providers not in their networks or charge them higher rates for out-of-network care. It’s thus very important that people review a plan’s network directory and make sure it meets their needs before enrolling in the plan. Are their doctors, hospitals and other providers in the network? If not, the plan might not be their best Medicare option.

There was at least one mistake in nearly 47 percent of the provider reviews and nearly that many among all locations.

There have been widespread reports of inaccuracies in these directories. But the study nevertheless comes as a shocker. It found that nearly half of directory entries were inaccurate in the plans it reviewed. The Centers for Medicare & Medicaid Services reviewed more than 5,800 health care providers offering care at more than 11,600 locations. The directories were provided by 54 Medicare Advantage Organizations that represented about a third of all Medicare Advantage providers. The study reviewed entries for four widely used doctors — cardiologists, oncologists, ophthalmologists and primary care physicians.

Each provider’s office was called to verify that their name and contact information was correct, they saw patients at the address contacted, accepted the Medicare Advantage plan that listed them in its directory and if the directory was accurate in describing whether the practice was now seeing new Medicare Advantage patients.

There was at least one mistake in nearly 47 percent of the provider reviews and nearly that many among all locations. They were widespread and not concentrated among a few providers. And they were not clerical errors.

The Centers for Medicare & Medicaid Services said 85 percent of the deficiencies it found “were of the highest weighted, most egregious errors” that were “most likely to affect access to care.” Here’s an extended comment about providers who were not located at the listed address or perhaps not even in a plan’s network at all:

We found that providers were not located at about 31 percent of the locations listed in the provider directory. This finding means that if a member were to look up a provider/location in an MAO directory, he/she would be unable to make an appointment with that provider because the provider did not work at that location. In about 1,162 of these cases, the provider associated with these locations did not work at any of the locations identified in the online directory. For example, if a provider were listed at three locations in the directory, CMS’s review found that the provider was not at any of the three locations identified. Given that the provider was not at any location listed in the directory, this finding raises concerns about whether these providers are even part of the network.

The report did not identify specific Medicare Advantage insurers, but the problems were so widespread that perhaps this doesn’t matter. Of the 54 Medicare Advantage Organizations whose networks were reviewed, the Centers for Medicare & Medicaid Services issued 31 notices of non-compliance, 18 warning letters and three warning letters that asked that the agency be provided with a business plan.

Medicare enrollees need to do their own due diligence here. Do not assume that a plan’s provider directory is accurate. Call the offices of your primary physician and any specialists you see. Make sure the hospitals they prefer are also in your plan’s directory.

And now, on to this week’s reader questions.


Debra – N.M.: I’ll turn 62 shortly and understand that I will not be eligible under the new Social Security law to file and suspend. I also know the severe downside of claiming before reaching my full retirement age. Therefore, I plan to wait until I’m 66 and two months to file, but I may not be able to wait that long, as I’m currently unemployed. I divorced over 10 years ago and do not have contact with my ex-spouse, who will turn 70 in July 2017. I believe he earned substantially more than me. My questions are: A) What is the most timely way for me to accurately determine when he dies? B) Without actually filing a claim for my benefit, will the Social Security Administration tell me when he filed? c) Will the Social Security Administration give me an accurate estimate of my spousal benefit (which I believe is 50 percent of his full retirement age benefit before his death and 100 percent after he’s deceased)?

Phil Moeller: This is a great question, and I only wish I had a great answer. Unfortunately, personal privacy considerations can make getting this information from Social Security very difficult. Without filing a claim, you really can’t demand this information from Social Security, although I think it would be nice if you could.

One approach I’d suggest is to call Social Security and tell them you’re thinking of filing a claim for your own retirement benefit. Tell them you understand that making this filing, even after you’ve reached your full retirement age, will also subject you to the new deeming rules enacted last year. Tell them you think your former husband has already filed for his retirement benefit, and you thus wonder whether deeming will provide you an excess spousal benefit in addition to your own retirement benefit. This will only happen if your ex-spousal benefit is higher than your own retirement benefit.

Make it clear that this is only an informational call and that you can’t make the decision about whether to actually file for benefits until you know if you’re entitled to an ex-spousal benefit and if they tell you how much that would be.

This information, of course, will also give you a clue as to what your ex-spousal survivor benefit would be. However, your ex-spousal survivor benefit is not 100 percent of his full retirement age benefit, but up to 100 percent of what he was actually collecting, or the amount he was entitled to collect at the time of his death. If he filed for retirement before his full retirement age, your survivor benefit will be reduced; likewise, if he deferred filing until after his full retirement age, your survivor benefit will be greater than his full retirement age entitlement.

Do not expect Social Security to let you know when a former spouse has died. If you’re collecting ex-spousal benefits off of his earnings record, they should alert you to his death and to the possibility of getting an additional survivor benefit. However, there may be a long lag time between his death and this communication. And if you’re not collecting a benefit based his earnings record, the agency would have no basis for even knowing that you used to be married and that his death thus might affect your own benefits.

I know this information can be confusing, and the process is difficult to navigate. You have learned a lot about how Social Security benefits work, and I urge you to keep working to get all the benefits to which you’re entitled.


Ed: I suspended my Social Security until I turned 70 last November. I was paying $121.80 in monthly Medicare premiums, since I was not on Social Security and was not held harmless. Now that I am, my Social Security statement says I will be paying $132 for 2017. I thought once I received Social I would be “held harmless” and drop back to the $109 for 2017 like my spouse, who has been receiving Social Security since she was 65. Am I wrong? Also, why is my monthly premium not $134, which is what Medicare says it should be?

Phil Moeller: My crystal ball for divining Social Security decisions has been cracked beyond repair by the nutty hold harmless rules for 2017.

While people are being held harmless for 2017, this does not mean their Part B premiums won’t increase. It just means they can’t increase by more than the measly 2017 COLA of 0.3 percent. So, for example, if your benefit was $2,000 a month, the cost of living adjustment, or COLA, would raise it by $6 a month, and this is the maximum amount that your Part B premium would rise in 2017.

It seems unlikely that this math would explain why your premium would rise from $121.80 to $132. That’s $11.20 more. Your monthly benefit would need to be nearly $4,000 a month to explain such an increase in terms of the 2017 COLA. And this would be larger than the current ceiling on benefits. So I assume something else is going on. Only I don’t know what!

Under Social Security rules, the fact that you had Part B deducted from your December Social Security payment means that you should be in the hold harmless group for 2017. If your income was higher enough to trigger the high-income premium surcharge, which you say was not the case, the surcharge would be much larger than the increase you are being charged.

So I would think your 2017 Part B premium should be $121.80 plus 0.3 percent of your expected 2017 monthly Social Security payment. I’d calculate this amount and then get in touch with Social Security to try and change the amount of your Part B deduction. And, as you note, if you were mistakenly not held harmless, your monthly Part B premium for 2017 should be $134.

Please let me know how things turn out. If there is a logical reason for the agency’s decision, I’d like to know what it is.


Catherine: I now receive a Social Security spousal benefit and applied for Medicare in December. This has permitted me to be held harmless and shielded from those big Part B premium increases. However, when I switch to my own retirement benefit at age 70, will I be considered a new applicant and thus no longer in the hold harmless group? One person at Social Security told me that I would be subject to a higher premium and would be considered a new applicant filing under my own Social Security number and not my husband’s number. Another representative said no, that the premium would just come out of my new Social Security claim. I tried to answer this question by calling Medicare, but they referred me back to Social Security.

Phil Moeller: Your “hold harmless” status is determined by your initial Social Security benefits claim. If you later file for another benefit, you should not be considered a new applicant. You will not be held harmless for 2017, however. It takes Social Security a month to begin withholding Part B premiums from your benefits. So, even though you may have filed for Part B last December, your first withholding payment shouldn’t have occurred until January, thus preventing you from being held harmless this year.


Roberto – Calif.: My wife started receiving Social Security when she turned 62 last October. I am 60 years old now. My problem is that the Social Security office told me that I need about four more quarterly work credits to be eligible to receive Social Security, and I don’t think I will be able to work enough to earn them. Can I apply for spousal benefits when I turn 62 in 2018? Her monthly Social Security is $954. Would I be eligible to receive half of that amount, or $477, when I turn 62 years old?

Phil Moeller: It’s unfortunate you won’t have enough credits to qualify for your own benefits. You can file for a spousal benefit based on your wife’s benefits, but it will be different than half of her age-62 benefit.

There are two sets of calculations you need to understand or at least ask Social Security about. The first involves the basis on which your spousal benefit is calculated. It’s not what your wife is actually receiving, but what she would have been entitled to receive if she filed for retirement benefits at the age of 66, which is called her full retirement age. There’s a reduction for filing before this age, so the good news for you is that this figure is as much as a third larger than what she is actually collecting. The precise difference depends on how old she was when she filed.

The maximum amount of your spousal benefit will be, as you noted, half of this figure. In order to collect this large of a benefit, however, you would have to wait to file for it until you reached your full retirement age. The full retirement age is getting later for anyone born after 1954, and this includes you. The crucial thing to note here is that if you file for a spousal benefit before reaching full retirement age, you will be hit with an early spousal reduction that could exceed 30 percent.

I understand that you might need the money right away. But the longer you can wait to file past the age of 62, the higher this benefit will be for the rest of your life.


Beth – Ga.: I have two questions about Medicare’s high-income surcharges. First, are these surcharges applied to Medicare Advantage plans, specifically a Medicare Advantage plan with drug coverage, or does this option exclude a surcharge? Second, if my employer offers a retirement package that includes a drug benefit equal to or better than a Part D drug plan, will there be a surcharge for the employer’s coverage?

Phil Moeller: If your Medicare Advantage plan includes Part D drug coverage, and most Medicare Advantage plans do, you would have to pay an IRMAA surcharge. You didn’t ask, but you’d also have to pay an IRMAA surcharge on Part B premiums. You have to have Part B to even sign up for a Medicare Advantage plan and must pay those premiums.

If your employer offers retiree drug coverage, and you pay for it separately and apart from any Medicare coverage or charges, you would not pay IRMAA surcharges on that drug plan.


Terry – British Columbia: I have Part A of Medicare, and I receive Social Security payments. I’ve lived permanently in Canada since 2003. My question is: When I am traveling in the U.S., am I covered by Medicare (Part A) for hospital care should it become necessary? I have been buying supplemental insurance to make up the difference in costs between the Canadian and U.S. systems (which is huge).

Phil Moeller: Welcome to my world! I get uninterpretable answers from Medicare all the time. And this is when they answer me at all. According to the Social Security Administration, which handles a lot of Medicare administrative work, your Part A will cover you for hospital expenses received in the United States. The last time I looked, however, it was impossible to be hospitalized without being treated by health care providers!

Unless you have Part B coverage, either directly or in a Medicare Advantage plan, the expenses of healthcare providers who treat you in the U.S. would not be covered. I am not sure what kind of supplemental insurance you have purchased, but unless it specifically addressed this situation, you would be exposed to big health care bills.

The post Care provider directories wrong nearly half the time in Medicare Advantage plan lists appeared first on PBS NewsHour.

Column: Why aren’t my chiropractic appointments covered by Medicare?

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Chiropractor treating shoulder joint problem of a female patient lying on table in the medical office. related words: chiropractic, physical therapy. Photo by Dean Mitchell/Getty Images

Phil Moeller is here to provide the answers you need on aging and retirement. Photo by Dean Mitchell/Getty Images

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.


Michael: We were stunned to learn from my chiropractor that upon retiring and moving from my workplace health insurance to Medicare, the monthly chiropractic adjustments that I’ve viewed as a “medical necessity” for keeping crippling sciatica at bay over the last decade will no longer be covered. My chiropractor’s office gave me details on why coverage was denied. But a friend tells me that his chiropractor deals with this issue by performing an “evaluation” at the beginning of each year (that my friend pays for), which results in a treatment plan for periodic, monthly visits (much like mine) that Medicare covers. What should I do?

READ MORE: Column: Social Security will reduce paper statements in 2017. Here’s why it shouldn’t

Phil Moeller: I wish I had a clear answer for you or could recommend a specific course of action.

Medicare pays for billions of dollars in uncovered medical services every year. Medicare also fails to pay for billions of dollars in covered medical services every year.

In theory, these things do not happen. But of course they do. “Medical necessity” is a governing concept of what Medicare will and won’t cover, but it hardly lends itself to a universally agreed-upon definition or application. And this concept can be especially difficult to apply consistently in therapeutic situations.

From reading the materials you provided, my takeaway is that your chiropractor’s office certainly appears to have based its position on a thorough review of relevant regulations. I do not know about the other chiropractor. However, even if that other office was wrong in its understanding, it’s quite possible that Medicare would honor your friend’s medical claim. If your chiropractor does not feel it’s appropriate to file such a claim, it seems to me you are stuck with either doing the workaround the office suggests, paying for these treatments yourself, perhaps reducing the frequency of care or finding another chiropractor willing to file this claim with Medicare.

“Medical necessity” is a governing concept of what Medicare will and won’t cover, but it hardly lends itself to a universally agreed-upon definition or application.

If you can convince your chiropractor to file a claim on your behalf and it is rejected, there is a well-established appeal process. However, the “win” rate for claimants is low, and the time frame for resolving appeals is measured in years, not months.

The American Physical Therapy Association may be able to help you with this matter. I often refer people to three consumer nonprofits that specialize in providing free assistance to people with Medicare problems: the State Health Insurance Assistance Program, the Medicare Rights Center and the Center for Medicare Advocacy.

Generally, the State Health Insurance Assistance Program is best at general consumer questions, while the Medicare Rights Center and Center for Medicare Advocacy are more appropriate for addressing the kind of complicated situation you face.


Laura: My husband was not collecting Social Security when he began getting Medicare, and his Part B premiums were $121.80 a month. I understand that this is the rate for people who are not collecting Social Security and having their premiums deducted from their Social Security payments. I’m told it has something to do with the agency’s “hold harmless” rule, which limits Medicare premium increases so that net Social Security payments don’t decline from one year to the next. I understand this. But when he began collecting Social Security last summer, didn’t he join the hold harmless group? I thought his Part B premiums should have dropped to $104.90 a month then.

READ MORE: Column: Why is my Medicare Part B premium more than my husband’s?

We got a letter from Medicare that his 2017 premiums would be $109 a month after this year’s 0.3 percent cost of living adjustment went into effect. This confirmed that my thinking was correct about the $104.90 rate. However, we later got a statement from Social Security that it will be deducting $132 a month for Part B! We next went to our local Social Security office in person where the rep shockingly hadn’t heard about the “hold harmless” rule and instead told us that the $132 was correct without being able to explain why. At this point, I don’t know who else to ask since we’ve already contacted both Medicare and Social Security and haven’t gotten consistent answers.

Phil Moeller: Your understandable confusion is a major reason why I think Medicare and Social Security need to get their heads together, scrap the hold harmless rule and come up with a better way for setting Medicare premiums. I applaud the notion of holding people harmless so that their Social Security payments don’t decline from one year to the next. But the hold harmless rule as it presently exists is simply not equipped to deal with a world of persistently low inflation rates.

First off, simply being held harmless does not mean your husband’s Medicare premiums should have declined to $104.90 a month. That was the hold harmless rate that most enrollees had to pay in 2016, due to there being a zero cost of living adjustment last year.

His hold harmless “set” point is not $104.90 but $121.80, which is what he was paying when he began Social Security. Assuming your income does not trigger high-income surcharges, he will be held harmless for 2017. You can find more gruesome details here.

But the hold harmless rule as it presently exists is simply not equipped to deal with a world of persistently low inflation rates.

This means that his Part B premium should be $121.80 plus the amount of his 2017 cost of living adjustment, or COLA. Because the COLA for this year is only 0.3 percent, this means his Part B premium should be no more than $121.80 plus 0.3 percent of his 2016 Social Security benefit. For this to equal $10.20 – the difference between $132 and $121.80, his monthly Social Security benefit in 2016 would need to have been $3,400 a month! This nearly equals the maximum possible Social Security benefit of someone who began claiming benefits last year.

The $109 figure included in your letter from Medicare described the 2017 Part B premium that would be typically paid by a person who was held harmless last year and had been paying $104.90 a month. Again, this group would not include your husband.

I have no idea how Social Security came up with the $132 figure in the statement it sent you. I am guessing this is the Part B premium in 2017 for people who are not held harmless this year. However, Medicare says the number should be $134.

Whatever you wind up paying this year, you are not due any refund for 2016 payments as a result of your husband’s enrollment in Social Security. Part B premiums are set for the entire year each January, and your husband’s premium was accurate as of January of last year.

By now, you may already have passed out on the floor through a combination of shock, confusion and possibly outrage. You have my sympathy. Maybe you can turn to the uninformed Social Security representative for your smelling salts. Good luck with that!


Ron – Wisc.: I turn 65 in April 2017 and have no health issues and take no medications. I plan to enroll in a local health maintenance organization (HMO) Medicare Advantage plan without taking the drug coverage option. My only cost will be the Part B premium required. In the future, would I be able to add the drug coverage option for this same Medicare Advantage plan during annual open enrollment for plan changes? What penalties or restrictions might apply if I choose to add the drug plan option?

Phil Moeller: Most Medicare Advantage HMO plans include bundled-in drug coverage, so you should use the Medicare Plan Finder to see if there is a plan available where you live that will let you add a stand-alone Part D drug plan at a later date. You might need to get a separate stand-alone plan at first, and then you can find an acceptable MAPD (shorthand for Medicare Advantage Prescription Drug) plan and switch to it during your first available Medicare open enrollment period.

There will be a late-enrollment premium penalty for the Part D plan that equals 1 percent a month for each month you are late. With Part D plans averaging about $40 a month, this penalty would cost you slightly less than $5 a month for each year you are late. These are lifetime penalties, so you should do some sample calculations to decide on your best strategy.


Carol – Mass.: My husband died in 1986 at age 34, leaving me with a 4-year-old son. I collected benefits for my son and continued working full time. My son died in 1998. I immediately notified Social Security, and this benefit stopped. Unfortunately, I did not know for quite some time that I had over-collected for my son, because I was making too much money. I had no idea my salary affected this, and it was never explained to me when I went to the Social Security office to begin benefits for him. When the agency told me I owed it several thousand dollars, I contested, and they refused to reconsider the matter — quite rudely I might add. When I turned 66, they began deducting this money from my Social Security payments and said they would last for 10 years. Is it better for me to continue these deductions or to pay what I owe them in full?

Phil Moeller: I am sorry to hear about the tough road you have had to travel.

READ MORE: Column: Social Security needs to be reformed, not have its funding cut

In terms of economic theory, I think most experts would say that it would be better to let Social Security continue deducting $72 a month from your benefit payment than to pay them back in full right now. Under the concept known as “present value,” a dollar is worth much more today than it would be in the future, because you could invest this dollar, and inflation will make it worth less in the future. Therefore, saving your current dollars would be the way to go.

Having said this, if for any reason your financial situation today is much better than it will be in the future, it could be better to pay the lump sum and then receive that $72 back every month when times might be leaner.


Melinda – Costa Rica: My husband and I live abroad and are residents of Costa Rica but are U.S. citizens. We receive health coverage through Costa Rica’s national insurance. My husband will be 65 in July 2017 and receives Social Security benefits now. We realize that we are not covered by Medicare while we live outside the U.S., but that he must purchase Part B coverage or face late enrollment penalties. Can my husband delay in applying for either Part A or B Medicare when he is eligible at 65 until, or if, he returns to the U.S. and avoid Part B penalties?

Phil Moeller: I assume your husband is retired. If so, the clock will start ticking on his Medicare enrollment obligations when he turns 65. His initial enrollment period will be seven months long, beginning three months before his 65th birthday month and ending three months after. That will be the longest he can delay getting Part B without incurring lifetime late-enrollment penalties.

If you plan to continue living outside the U.S. for several or more years, you should balance the savings of not paying Part B premiums against the cumulative expense of paying higher Part B premiums when you return to the U.S.

Having said this, if you plan to continue living outside the U.S. for several or more years, you should balance the savings of not paying Part B premiums against the cumulative expense of paying higher Part B premiums when you return to the U.S.

The late-enrollment penalty for Part B is 10 percent of your Part B premium for every complete year he is late in enrolling. The Part B premium this year for new enrollees is $134 month for most people, although higher-income enrollees will pay more.

To get a rough idea of the trade-off, let’s assume he gets Part B with a five-year penalty. This would add 50 percent to his Part B premiums. He would be saving five years of premiums by not enrolling, so it would take him 10 years back in the U.S. before the penalty exceeded his premium savings.

Should Congress raise the Medicare and Social Security retirement age? Phil explores that question in his latest piece.

The post Column: Why aren’t my chiropractic appointments covered by Medicare? appeared first on PBS NewsHour.

My employer health insurance is unaffordable. Should I get Medicare?

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Nearly 10 million people have signed up and paid for health insurance under the Obama Administration's healthcare law, the Associated Press reported Tuesday. That means the administration is on track for year-end goals. Credit: Ariel Skelley/Blend Images via Getty Images.

Journalist Philip Moeller answers your questions on aging and retirement. Photo by Ariel Skelley/Blend Images via Getty Images.

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.


Maria – Florida: I will be 70 in December, at which time I would like to retire. I am now covered by my employer’s health insurance, but it has a $1,500 deductible in network. I needed some physical therapy, but I first had to cover my deductible, and I couldn’t afford it. My sister has suggested that I drop my employer’s insurance and enroll in Medicare. A Medicare Advantage plan that my husband has is very good. Employer insurance is really getting very expensive!

While you do not have to get Medicare, because you’re covered by an employer plan, you always are free to drop your employer plan and get Medicare instead.

Phil Moeller: While you do not have to get Medicare, because you’re covered by an employer plan, you always are free to drop your employer plan and get Medicare instead.

In an ideal world, your employer would pay at least some of your Medicare premium, because leaving the employer plan would save money. In practice, this seldom happens. But, hey, I’d go ahead and ask your employee benefits office about it. From what you say, you might save money even if your employer provides no assistance for the move.

If you do leave the employer plan, be aware that you might not be able to rejoin it later if you changed your mind. This is also something you should check out ahead of time.

READ MORE: Should you stay on your employer health insurance or get Medicare?

Also, I wonder why your husband has Medicare and is not covered on your health plan? If he’s eligible, you could save his Medicare premiums, and perhaps afford to pay your insurance plan’s deductible.


Richard – New York: I am moving my aging mother from New York state to Naples, Florida, so she can spend her last years in a warm climate. She was a school teacher for more than 38 years and she gets full health care coverage from a third party administrator for a low monthly premium. When I called her group plan administrator, I was informed that since my mother is leaving the state, her monthly cost would be seven times more than what she’s paying now. She can’t afford this. She is 79 and has Medicare Parts A and B coverage. Do I need to find a health maintenance organization to supplement her Medicare coverage in Florida, or is this not necessary? She’s very healthy and takes no medications.

Phil Moeller: Finding a low-cost HMO plan in Florida is the prudent way to go. In effect, you would be buying a catastrophic health plan that can cap out-of-pocket expenses should your mom have a medical emergency. And despite her current good health, a medical emergency is exactly what you need to plan for in her case.

Rather than buying a plan to complement her retiree package, you might consider helping her determine whether it would be better to junk that soon-to-be-costly coverage altogether. With the dollars she’d save, for example, she might be able to afford basic Medicare, a Part D drug plan and a Medigap supplemental insurance plan. I don’t know if her retiree plan also provides dental, vision or hearing coverage — things basic Medicare does not cover.

Focusing on a Medicare Advantage plan would be my first choice. Some of these plans do cover dental, vision and hearing needs. They provide out-of-pocket spending caps as well. Plus, Florida has plenty of low-cost Medicare Advantage plans. You can use the Medicare Plan Finder tool to find the best deals in the Florida ZIP code where she intends to live. Keep in mind that usually these plans would cover her only in the plan’s local coverage area and may not be of much help when she is outside the state.

READ MORE: Don’t make this Medicare mistake: COBRA is not like employer health insurance

Also, you should carefully review the plan’s directory of health care providers to make sure your mom can receive care from providers both of you like. HMOs usually deny coverage from non-network providers or charge you higher out-of-network rates. This is homework you need to do before getting a plan.

If she is going to travel a lot outside Florida, you should consider getting a Medigap plan to plug the coverage gaps in basic Medicare. Medigap plans, like basic Medicare, may be used at any provider in the U.S. who accepts Medicare and is seeing new patients. These policies will, however, cost you more than an HMO.

If her health worsens, you could help her switch into more comprehensive Medicare plans during the program’s annual open enrollment season, which runs from Oct. 15 through Dec. 7 every year. Be aware that finding a Medigap plan at her age might be expensive.


Jane – Oregon: I’m planning to move abroad because of the unaffordability of living costs in the U.S. Right now, my Medicare Part B premium is paid for by a low-income program. I also pay the full cost for a letter F Medigap policy. If I maintain a state mailing address, can I still receive the Part B premium benefit? Otherwise, that and Medigap would eat up a third of my Social Security benefit, which is my only source of income.

Phil Moeller: You do not need a U.S. mailing address to maintain Part B or, as far as I know, a low-income support benefit. These are federal programs, not state-related. The premiums will continue to be deducted from your Social Security payments, and you can be covered by Part B anywhere in the U.S. if you decide to return here for medical care.

However, if you are receiving a Medicaid benefit and thus are dually eligible for Medicare and Medicaid, you would need to check with your state’s Medicaid office about this. I wouldn’t want you to unintentionally lose a state Medicaid benefit.

READ MORE: Beware this Medicare gotcha when you file for Social Security

As for Part F, it strikes me you should do some “what if” analyses and decide if you should continue paying for this supplemental coverage or self-insure against gaps in Part B coverage. You also might want to check up on the availability of health insurance in the nation where you wish to relocate.


Scott – California: I recently got a letter saying that the state of California will no longer pay my Medicare Part B medical insurance premium. Is this a blanket statement for all Medicare beneficiaries in the state of California? I believe it was paid through Medi-Cal.

Phil Moeller: Experts at the State Health Insurance Assistance Program (SHIP) say that they think you have been in a Medicare Savings Program that is managed in California by Medi-Cal. Eligibility for these programs can be affected by changes in a person’s personal income and asset totals, as this is a means-tested program. There also is a periodic recertification process that can trip up people. The California arm of SHIP is called HICAP and can be reached at 800-434-0222. Someone there should be able to help you. There is no cost for this counseling.


Susan – Nova Scotia: I live in Nova Scotia and received a Medicare card at my address here when I turned 65. I travel to New York state and California every year to visit family.  If I required medical attention while I’m in the United States, would I qualify for anything from Medicare? I am a U.S. citizen but have lived in Nova Scotia for 17 years. I don’t take out extra medical insurance when I’m visiting the United States, as I assumed I would receive some coverage if anything did happen.

Phil Moeller: That Medicare card was most likely providing you Part A of Medicare, which covers hospital expenses. It charges no premiums if you have worked enough years in the U.S. at jobs where you paid Social Security payroll taxes.

If that card included Part B, you would have had to sign up for it, and you would be paying monthly premiums or having them deducted from your Social Security payments. Your note doesn’t say whether you’ve applied for Social Security, but I assume you qualify.

Part B covers doctors, medical equipment and other outpatient expenses. If you don’t have Part B, you would be exposed to big uncovered medical bills in the U.S. And even Part A has a hefty $1,316 deductible before your coverage begins paying.


Pete – Indiana: If I am on Social Security Disability Income, can I use the remaining balance in my health savings account?

Phil Moeller: Yes. Acceptance of Social Security benefits invalidates continued tax-exempt contributions to an HSA. But you are still free to use any existing balances in your HSA to pay for eligible health care expenses.


Julie: My husband and I are separated, and we’re both on disability. We’ve been separated for almost a year now, and my husband has been living off of his parents and borrowing money from credit cards. The divorce is finally going to go through. Are there any back-pay awards from Social Security for the year that we have been separated?

Phil Moeller: I’m sorry, but Social Security does not pay divorce benefits unless there is a legally binding divorce in place. Being separated is not a basis for paying benefits. Your note doesn’t say whether one or both of you have qualified for Social Security Disability Income payments. If you are, you both should be receiving payments each month. If so, getting a divorce would not boost your Social Security unless one of you earned a great deal less than the other. If this is the case and the lower-earning person qualifies for ex-spousal benefits, they could file once the divorce is final, and they should receive an added payment.


John – Massachusetts: I will turn 66 next month. My wife is four years older and collects Social Security. Can I, and should I, file for spousal benefits next month and defer my own benefits until age 70? When I do file for retirement, can my wife then file for a spousal benefit? Also, must I keep working and earning my current income to reap the higher benefit in four years?

Phil Moeller: Because you had turned 62 before the beginning of last year, you are grandfathered under the 2016 changes to Social Security laws. Because your wife has already filed for her retirement benefit, once you reach your full retirement age, you can file what’s called a restricted application for just your spousal benefit while deferring your own retirement benefit up to age 70, during which time it will receive delayed retirement credits that will increase your retirement benefit by 8 percent a year.

READ MORE: Column: Why is my Medicare Part B premium more than my husband’s?

Once you have filed for your own retirement benefit at age 70, your wife can file for a spousal benefit based on your earnings record. If this benefit is larger than the retirement benefit she is receiving, she would receive what’s called an excess spousal benefit that equals the amount by which her spousal benefit exceeds her retirement benefit.

You do not need to keep working after age 66 to receive delayed retirement credits.


Michael – Kansas: I am turning 65 in six months. I have health coverage from my employer, but we have less than 20 employees. Do I have to sign up for Medicare even though I am not going to draw Social Security until I am 66 or 70?

Whether you need to sign up for Medicare has nothing to do with Social Security. Under the Medicare rules, people with health insurance through what are called small-employer plans must sign up for Medicare at 65.

Phil Moeller: Whether you need to sign up for Medicare has nothing to do with Social Security. Under the Medicare rules, people with health insurance through what are called small-employer plans must sign up for Medicare at 65. At that age, their employer coverage automatically becomes their secondary insurance plan, and Medicare becomes the primary payer of covered insurance claims. Failure to get Medicare can thus expose someone to huge medical bills.

The threshold for a small employer plan is, as you indicated, 20 employees. Some companies with fewer than 20 employees can, however, skirt this rule by becoming part of a multi-employer health insurance plan. You should check with your employer to see if this is the case. If not, you will need Medicare.


D – Illinois: I have Medicare and am planning to get married to a same-sex partner. Would my partner be covered with my Medicare after we marry?

Phil Moeller: No, they wouldn’t. Medicare covers only the individual, not their spouse or family members. If your partner is 65, they would need to get their own Medicare coverage. If they are younger than 65, they would need commercial health insurance from a state Obamacare insurance exchange, a private insurance plan or, if they’re employed, their employer’s group insurance plan.

People approved as disabled by Social Security qualify for Medicare at any age, but enrollment in Medicare takes upwards of two and half years after Social Security Disability Insurance payments begin.


Barbara: I am 58. My husband died two years ago. I am told I can start collecting survivor benefits at age 60. Once I start collecting benefits at age 60, will those benefits be effective if I remarry after that?

Phil Moeller: You will not lose these survivor benefits should you remarry. While you can begin survivor benefits as early as age 60, they will be 30 percent less each month than if you wait until 66 to file. Of course, you would also forego these benefits entirely for six years, so if your own retirement benefits are going to larger when you file for them in the future, it might well be better to begin taking the survivor benefit as soon as possible.


Robert – Texas: I will start Medicare at 65 this July and understand that being on Medicare will mean that I will no longer be eligible to contribute to a health savings account. My wife won’t turn 65 for another 18 months. Our existing health insurance premiums have doubled to the point of being unaffordable. So we have decided to buy a very low-premium plan. My strategy is to put our premium savings into an HSA and then pay medical bills from this account. Can you point me to non-employer based HSA sources or references?

Phil Moeller: Unfortunately, HSAs are only available through an employer health plan. They don’t exist as stand-alone private accounts. Sorry!

The post My employer health insurance is unaffordable. Should I get Medicare? appeared first on PBS NewsHour.

Column: Need to unload family heirlooms? Prepare for disappointment

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British retiree Peter Harrison, 74, and his wife Anne, who have been living in Spain for 9 years, watch the television as they drink a cup of tea in their mobile home at Saydo Park in the outskirts of Mollina, southern Spain, May 18, 2016. REUTERS/Jon Nazca - RTX2EXEH

Richard Eisenberg of Next Avenue has advice for boomers desperate to unload family heirlooms. Photo by Jon Nazca/Reuters

Editor’s Note: Next Avenue columnist Richard Eisenberg has advice for boomers desperate to unload family heirlooms. You can read the original post here.


After my father died at 94 in September, leaving my sister and me to empty his one-bedroom, independent-living New Jersey apartment, we learned the hard truth that others in their 50s and 60s need to know: Nobody wants the prized possessions of your parents — not even you or your kids.

Admittedly, that’s an exaggeration. But it’s not far off, due to changing tastes and homes. I’ll explain why and what you can do as a result, shortly.

The stuff of nightmares

So please forgive the morbidity, but if you’re lucky enough to still have one or more parents or stepparents alive, it would be wise to start figuring out what you’ll do with their furniture, china, crystal, flatware, jewelry, artwork and tchotchkes when the mournful time comes. (I wish I had. My sister and I, forced to act quickly to avoid owing an extra months’ rent on our dad’s apartment, hired a hauler to cart away nearly everything we didn’t want or wouldn’t be donating, some of which he said he’d give to charity.)

Nobody wants the prized possessions of your parents — not even you or your kids.

Many boomers and Gen X’ers charged with disposing the family heirlooms, it seems, are unprepared for the reality and unwilling to face it.

“It’s the biggest challenge our members have and it’s getting worse,” says Mary Kay Buysse, executive director of the National Association of Senior Move Managers.

“At least a half dozen times a year, families come to me and say: ‘What do we do with all this stuff?’” says financial adviser Holly Kylen of Kylen Financials in Lititz, Pennslyvania. The answer: lots of luck.

Heirloom today, foregone tomorrow

Dining room tables and chairs, end tables and armoires (“brown” pieces) have become furniture non grata. Antiques are antiquated. “Old mahogany stuff from my great aunt’s house is basically worthless,” says Chris Fultz, co-owner of Nova Liquidation, in Luray, Virginia.

On PBS’s “Antiques Roadshow,” prices for certain types of period furniture have dropped so much that some episode reruns note current, lower estimated appraisals.

READ MORE: Column: Broke baby boomers, it’s time to face reality

And if you’re thinking your grown children will gladly accept your parents’ items, if only for sentimental reasons, you’re likely in for an unpleasant surprise.

“Young couples starting out don’t want the same things people used to have,” says Susan Devaney, president of National Association of Senior Move Managers and owner of The Mavins Group, a senior move manager in Westfield, New Jersey. “They’re not picking out formal china patterns anymore. I have three sons. They don’t want anything of mine. I totally get it.”

The Ikea generation

Buysse agrees. “This is an Ikea and Target generation. They live minimally, much more so than the boomers. They don’t have the emotional connection to things that earlier generations did,” she notes. “And they’re more mobile. So they don’t want a lot of heavy stuff dragging down a move across country for a new opportunity.”

“This is an Ikea and Target generation. They live minimally, much more so than the boomers.”

And you can pretty much forget about interesting your grown kids in the books that lined their grandparents’ shelves for decades. If you’re lucky, you might find buyers for some books by throwing a garage sale, or you could offer to donate them to your public library — if the books are in good condition.

Most antiques dealers (if you can even find one!) and auction houses have little appetite for your parents’ stuff either. That’s because their customers generally aren’t interested. Carol Eppel, an antique dealer and director of the Minnesota Antiques Dealers Association in Stillwater, Minnesota, says her customers are far more intrigued by Fisher Price toy people and Arby’s glasses with cartoon figures than sideboards and credenzas.

Even charities like Salvation Army and Goodwill frequently reject donations of home furnishings, I can sadly say from personal experience.

Midcentury, yes; Depression-era, no

A few kinds of home furnishings and possessions can still attract interest from buyers and collectors though. For instance, Midcentury Modern furniture — think Eames chairs and Knoll tables — is pretty trendy. And “very high-end pieces of furniture, good jewelry, good artwork and good Oriental rugs — I can generally help find a buyer for those,” says Eppel.

“The problem most of us have,” Eppel adds, “is our parents bought things that were mass-produced. They don’t hold value and are so out of style. I don’t think you’ll ever find a good place to liquidate them.”

Getting liquid with a liquidator

Unless, that is, you find a business like Nova Liquidation, which calls itself “the fastest way to cash in and clean out your estate” in the metropolitan areas of Washington, D.C., and Charlottesville and Richmond, Virginia. Rather than holding an estate sale, Nova performs a “buyout” — someone from the firm shows up, makes an assessment, writes a check and takes everything away (including the trash), generally within two days.

READ MORE: America’s boomers and undocumented immigrants need each other

If a client has a spectacular piece of art, Fultz says, his company brokers it through an auction house. Otherwise, Nova takes to its retail shop anything the company thinks it can sell and discounts the price continuously (perhaps down to 75 percent off) as needed. Nova also donates some items.

Another possibility: Hiring a senior move manager (even if the job isn’t exactly a “move”). In a Next Avenue article about these pros, Leah Ingram said most National Association of Senior Move Managers members charge an hourly rate ($40 to $100 an hour isn’t unusual) and a typical move costs between $2,500 and $3,000. Other senior move managers specializing in selling items at estate sales get paid through sales commissions of 35 percent or so.

“Most of the people in our business do a free consultation, so we can see what services are needed,” says Devaney.

8 tips for home unfurnishing

What else can you do to avoid finding yourself forlorn in your late parents’ home, broken up about the breakfront that’s going begging? Some suggestions:

  1. Start mobilizing while your parents are around.“Every single person, if their parents are still alive, needs to go back and collect the stories of their stuff,” says Kylen. “That will help sell the stuff.” Or it might help you decide to hold onto it. One of Kylen’s clients inherited a set of beautiful gold-trimmed teacups, saucers and plates. Her mother had told her she’d received them as a gift from the DuPonts because she had nursed for the legendary wealthy family. Turns out, the plates were made for the DuPonts. The client decided to keep them due to the fantastic story.
  2. Give yourself plenty of time to find takers, if you can.“We tell people: The longer you have to sell something, the more money you’re going to make,” says Fultz. Of course, this could mean cluttering up your basement, attic or living room with tables, lamps and the like until you finally locate interested parties.
  3. Do an online search to see whether there’s a market for your parents’ art, furniture, china or crystal. If there is, see if an auction house might be interested in trying to sell things for you on consignment. “It’s a little bit of a wing and a prayer,” says Buysse. That’s true. But you might get lucky. I did. My sister and I were pleasantly surprised — no, flabbergasted — when the auctioneer we hired sold our parents’ enormous, turn-of-the-20th-century portrait of an unknown woman by an obscure painter to a Florida art dealer for a tidy sum. (We expected to get a dim sum, if anything.) Apparently, the Newcomb-Macklin frame was part of the attraction. Go figure. Our parents’ tabletop marble bust went bust at the auction, however, and now sits in my den, owing to the kindness of my wife.
  1. Get the jewelry appraised. It’s possible that a necklace, ring or brooch has value and could be sold.
  2. Look for a nearby consignment shop that might take some items. Or, perhaps, a liquidation firm.
  3. See if someone locally could use what you inherited. “My dad had some tools that looked interesting. I live in Amish country and a farmer gave me $25 for them,” says Kylen. She also picked out five shelters and gave them a list of all the kitchen items she wound up with. “By the fifth one, everything was gone. That kind of thing makes your heart feel good,” Kylen says.
  4. Download the free “Rightsizing and Relocation Guide” from the National Association of Senior Move Managers. This helpful booklet is on the group’s site.
  5. But perhaps the best advice is: Prepare for disappointment. “For the first time in history of the world, two generations are downsizing simultaneously,” says Buysse, talking about the boomers’ parents (sometimes, the final downsizing) and the boomers themselves. “I have a 90-year-old parent who wants to give me stuff, or if she passes away, my siblings and I will have to clean up the house. And my siblings and I are 60 to 70, and we’re downsizing.”

This, it seems, is 21st century life — and death. “I don’t think there is a future” for the possessions of our parents’ generation, says Eppel. “It’s a different world.”

The post Column: Need to unload family heirlooms? Prepare for disappointment appeared first on PBS NewsHour.


Want to live past 100? These centenarians share their secrets

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100-year-old Marge Jetton lifts weights every morning.  "I'm for anything that has to do with health" Jetton says.  Photo by Getty.

100-year-old Marge Jetton lifts weights every morning. “I’m for anything that has to do with health” Jetton says. Photo by Getty.

Gertrude Siegel is 101 and hears it all the time. “Everyone says ‘I want to be just like you.’ I tell them to get in line,” she said.

John and Charlotte Henderson, 104 and 102, often field questions from wannabes eager to learn their secrets.

“Living in moderation,” he said. “We never overdo anything. Eat well. Sleep well. Don’t overdrink. Don’t overeat. And exercise regularly.”

Mac Miller, who is 102, has a standard reply.

“People ask me ‘What is the secret?’ The answer is simple. Choose the right grandparents. They were in their 80s. My mother was 89, and my father was 93,” he said.

John Henderson and his wife of 77 years, Charlotte, live in Austin in the independent living section of Longhorn Village, a community of more than 360 seniors. They were the first people to move into the retirement community when it opened. (Sharon Jayson for KHN)

John Henderson and his wife of 77 years, Charlotte, live in Austin in the independent living section of Longhorn Village, a community of more than 360 seniors. They were the first people to move into the retirement community when it opened. (Sharon Jayson for KHN)

Genetics and behaviors do play roles in determining why some people live to be 100 or older while others don’t, but they aren’t guarantees. And now, as increasing numbers are reaching triple digits, figuring out the mysteries of longevity has taken on new importance among researchers.

Although those 100 and older make up a tiny segment of America’s population, U.S. Census reports show that centenarian ranks are growing. Between 1980 and 2010, the numbers rose from 32,194 to 53,364, an increase of almost 66 percent. The latest population estimate, released in July 2015, reflects 76,974 centenarians.

“The number of centenarians in the U.S. and other countries has been doubling roughly every eight years,” said James Vaupel, founding director of the Max Planck Institute for Demographic Research in Rostock, Germany.

“When the baby boomers hit, there’s going to be acceleration, and it might be doubling every five or six years,” he said.

Henderson and his wife of 77 years live in Austin in the independent living section of Longhorn Village, a community of more than 360 seniors, many of whom have ties to the University of Texas at Austin. Henderson is UT’s oldest-living former football player, arriving in 1932 as a freshman. They’re the only centenarians in the complex and are a rare breed: married centenarians.

Charlotte Henderson said she believes being married may have helped them reach these 100-plus years.

“We had such a good time when John retired. We traveled a lot,” she said. “We just stay busy all the time, and I’m sure that helps.”

John Henderson’s secret to a long life? “Living in moderation,” he said. “We never overdo anything. Eat well. Sleep well. Don’t overdrink. Don’t overeat. And exercise regularly.” (Sharon Jayson for KHN)

Bernard Hirsh, 100, of Dallas agrees. His wife, Bee, is 102. They married in 1978 when both were in their early 60s and each had been widowed, she for the second time.

“I think it’s been such a wonderful marriage, and we’ve contributed to each other’s benefit,” he said.

Little research exists on the effects of marriage on longevity. One 2015 Belgian study of centenarians born between 1893 and 1903 did focus on their living arrangements during ages 60 and 100 and found “in very old age, living with a spouse is beneficial for men but not for women, for whom living alone is more advantageous than living with a spouse.” The study explained that “living with one’s spouse at the oldest ages does not provide the same level of protection as it does at younger ages. This may be explained by the decline of the caregiver’s own health as the needs of his or her spouse increase. Caregiving could also have negative consequences for the health and economic condition of the spouse who is the primary caregiver, especially for older women.”

“Especially if you’re quite old, it’s very helpful have a spouse. If you’re very old and don’t have a spouse, the chance of death is higher,” he said.

Siegel, who lives in a senior living community in Boca Raton, Fla., outlived two husbands. She never smoked and occasionally has a glass of dry, red wine.

“I am not a big eater. I don’t eat much meat,” said Siegel, who said she weighs 90 pounds and used to be 5 feet tall but is shrinking.

She stays active by walking inside the building about a half-hour each day, playing bridge twice a week and exercising.

“I feel that’s what really kept my body pretty good. It wasn’t sports. It was exercises,” she said of the routine she does daily twice a day for about 20 minutes.

Miller, of Pensacola, Fla., also outlived two wives.

He was a fighter pilot in the Marine Corps during World War II and spent eight years in active duty, which Miller said “was not so good for me because I sat in the cockpit of a plane for 5,000 hours.”

But, he was active as a youth — running track, playing football and spending hours surfing while living in Honolulu.

Charlotte and John Henderson, now 102 and 104 years old respectively, have been married for 77 years. Charlotte said she believes being married may have helped them reach these 100-plus years. (Courtesy of the Henderson family)

Miller is gluten-free because of allergies and doesn’t eat many carbohydrates. He also never smoked. And, he still enjoys a scotch in the evening.

The Hendersons usually have wine or a cocktail before dinner. She never smoked. He quit in 1950.

Hirsh, of Dallas, another non-smoker, attributes his long life to “good luck.”

“I was very active in my business and did a lot of walking during the day. I was not sedentary,” he said.

Now, exercise is limited to “some knee bends every morning to keep my legs stronger.”

“My father died of a heart attack in his early 50s, and my mother died in her early 60s of a stroke, so I don’t think my genes were very good,” Hirsh said.

There are certain commonalities among those who reach 100: few smoke, nearly all of the men are lean, and centenarians have high levels of the “good cholesterol.”

Geriatrician Thomas Perls, director of the New England Centenarian Study at Boston Medical Center, said research shows that behaviors have a greater influence on survival up until the late 80s, since he said most people have the right genes to get there as long as their behaviors aren’t harmful. But once people reach the 90s and beyond, genetics play a more significant role.

“To get to these very oldest ages, you really have to have the right genes in your corner,” he said.

As an international leader in the field, Perls’ focus is on finding the right mix of behavior, environment and genetics to produce long lives. His work includes a National Institute on Aging study called the Long Life Family Study.

“There are always questions about environment versus genes,” said endocrinologist Nir Barzilai, founding director of the Institute for Aging Research at the Albert Einstein College of Medicine in Bronx, N.Y. “We are with our genes in this environment. It’s really 50-50, no matter how you look at it.”

Barzilai’s studies include centenarians and their children, as well as efforts to slow the process of aging.

Among those who reach the 100-year-old milestone, Perls’ said his research and that of Barzilai and others has found certain commonalities: few smoke, nearly all of the men are lean, and centenarians have high levels of the “good cholesterol.” Studies show that whatever their stress level, they manage its well. And they’re related to other centenarians or have a parent or grandparent who lived past 80.

These lessons of long life are playing well with the public, who have made changes for the better in the 21st century, Vaupel said.

“We don’t smoke or drink so much, and we’re better at exercise. People are taking better care of themselves. People are better educated, and the more educated know when to go to the doctor and follow the doctor’s advice,” he said, adding that people now tend to have higher income and can spend more on health care and improved diet.

“The most important thing is we’re living longer and living longer healthy,” Vaupel said.

KHN’s coverage related to aging & improving care of older adults is supported by The John A. Hartford Foundation and its coverage of aging and long-term care issues is supported by The SCAN Foundation.

The post Want to live past 100? These centenarians share their secrets appeared first on PBS NewsHour.

Many seniors who qualify for home-based care under Medicare aren’t receiving it. Why?

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A worrisome and growing number of Medicare enrollees have said that they have been denied home-based care even though they are qualified to receive it and it is covered by Medicare, Phil Moeller reports. Photo by Jim Young/Reuters

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.


One of the greatest gaps in Medicare coverage is that it does not help to pay for home-based care unless such care is requested by a physician as medically necessary. Medicaid will cover such long-term custodial care for people with little to no income or assets. But Medicaid covers fewer than one in five of the roughly 55 million people on Medicare, leaving the rest to fend for themselves or, for a small group of mostly better-off folks, purchase private long-term care insurance.

Now, it appears that even Medicare’s limited home-based coverage benefits for those with medical needs are also not possible for many people.

Now, it appears that even Medicare’s limited home-based coverage benefits for those with medical needs are also not possible for many people. The nonprofit Center for Medicare Advocacy says it been researching the availability of Medicare-covered home-based care in response to a worrisome and growing volume of complaints from Medicare enrollees that they are being denied home-based care even though they are qualified to receive it and it is covered by Medicare.

Like nearly everything about Medicare, this is a complex topic. But it appears that Medicare is not keen to encourage use of allowable home care benefits. Home care providers don’t much like this benefit either. They don’t make much money on it, and under new Medicare rules, they can actually lose money providing such care.

Let’s begin with the benefit itself. According to the Center for Medicare Advocacy, Medicare will pay for up to 35 hours a week of home-based care to people who are housebound and for whom such care is prescribed as medically necessary by their doctor or another authorized caregiver. This care can be for any one of three therapies — physical, occupational or speech-language — and for what Medicare classifies as “intermittent” and “part-time” skilled nursing care.

READ MORE: Does Medicare pay for a home health care provider?

According to Center for Medicare Advocacy, the benefit also includes the provision of home-based medical social services and for home health aides, who are allowed to perform certain personal services that stem from the patient’s underlying medical needs, but which are not the same as custodial care, which is not covered by Medicare.

These two coverage categories, while part of Medicare’s benefits, merit only a footnote on the Medicare website. And when Medicare updated its home health care brochure last March, it was full of errors about the nature of available coverage, according to Center for Medicare Advocacy associate director Kathleen Holt.

Holt says the allowable benefits are thus broader than people realize. However, she adds, it looks like it doesn’t matter what’s actually covered, because home health agencies routinely decline to provide even the skimpier services that Medicare publicizes to Medicare enrollees who request them.

Home health agencies routinely decline to provide even the skimpier services that Medicare publicizes to Medicare enrollees who request them.

Significantly, Medicare will only pay insurance claims to home health agencies who are registered and approved by Medicare. Ostensibly to help consumers, it has developed an extensive quality rating system, so consumers can find the most qualified agency. However, there apparently is no requirement that an agency actually provide home health services when Medicare enrollees request them.

The reasons why these agencies turn away business, Holt claims, stem partly from Medicare’s increasing emphasis on paying for health care that actually helps patients get better. This is an admirable goal, but what it means is that home health agencies are rewarded for treating patients who are likely to get better.

Supporting care that cures people, while understandable, is not a requirement Medicare insists on for covering most health care. Therapy that maintains a person’s ability to function, or even that slows the pace of decline, is a perfectly good goal for treatment and one that many older Americans and their families embrace.

However, Medicare and Congress have supported the shift from fee-for-service health care to fee-for-results care. In this situation, home health agencies face a carrot-and-stick financial incentive system based on measurable patient improvement. That’s all fine and dandy, but what this means is that agencies are effectively discouraged from treating people with long-term chronic conditions who may be qualified for services, but are unlikely to get better.

READ MORE: Does my mother qualify for home health care?

This latter group, of course, is filled with growing numbers of older Medicare beneficiaries. Overwhelmingly, such people would like to stay in their homes, and getting home-based care would help make this possible. It’s also well-established by research that home-based care is cheaper than being parked in a nursing home or other institutionalized care facility. On paper at least, Medicare’s home care benefit should be perfect for many of these folks.

While Medicare stresses that the benefit should be considered a short-term solution, Holt notes that it can be renewed for consecutive 60-day episodes of care. So long as a doctor prescribes continuation of such care, Medicare is supposed to cover it.

However, Medicare has been stepping up its surveillance of fraud in home health care services, Holt says, and this has added to home health agencies’ reluctance to accept such Medicare patients. Care lasting beyond 60 days has become a red flag that triggers a fraud investigation by the outside fraud contractors hired by Medicare, she says. Needless to say, home health agencies are not eager to have their Medicare licenses threatened by having a fraud bullseye painted on their backs.

The common response to all of these forces is for home health agencies to either physically or figuratively just not come to the phone when Medicare enrollees come calling looking for care. And this, the Center for Medicare Advocacy has found, is exactly what has happened. In a white paper published last October, the Center for Medicare Advocacy concluded:

Medicare and Medicare Advantage plans are stating that beneficiaries are able to receive up to 8 hours a day and 35 hours a week of home health coverage, however this is not occurring in practice at the home health agencies. Only 8.1% of the home health agencies telephoned were willing to offer, and stated Medicare would cover, [even] 20 hours a week of home health aide services. Although many home health agencies said the number of hours they would provide depended on their assessment of the individual, 52.1% offered 3 or less visits a week, despite contradicting doctor’s orders. Some home health agencies indicated staffing concerns to meet the requested home health aide hours, but many stated a lack of Medicare coverage was the reason for the limited amount of visits a week.

In one specific case in Oklahoma, the Center for Medicare Advocacy found, a person with ALS (Amyotrophic Lateral Sclerosis) theoretically could choose from among 48 Medicare-licensed home health agencies for care where they lived. A patient’s representative got through to 42 of the 48 agencies and was told that only three of the 42 would even consider evaluating the person for care. Further, none of the agencies would consider providing the person more than three hours of home health aide services a week, even though the person’s doctor had prescribed 20 to 28 hours of care a week as medically necessary.

I reached out to Medicare for comment on this situation. The agency’s public information office had not responded after several days.

READ MORE: How to hire in-home help when your aging parents don’t want to move

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How older adults can recover from loneliness

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Photo by Jose Luis Pelaez Inc/Getty Images

It’s widely believed that older age is darkened by persistent loneliness. But a considerable body of research confirms this isn’t the case.

In fact, loneliness is the exception rather than the rule in later life. And when it occurs, it can be alleviated: It’s a mutable psychological state.

Only 30 percent of older adults feel lonely fairly frequently, according to data from the National Social Life, Health and Aging Project, the most definitive study of seniors’ social circumstances and their health in the U.S.

The remaining 70 percent have enough fulfilling interactions with other people to meet their fundamental social and emotional needs

“If anything, the intensity of loneliness decreases from young adulthood through middle age and doesn’t become intense again until the oldest old age,” said Louise Hawkley, an internationally recognized authority on the topic and senior research scientist at the National Opinion Research Center (NORC) at the University of Chicago.

Understanding the extent of loneliness is important, insofar as this condition has been linked to elevated stress, impaired immune system function, inflammation, high blood pressure, depression, cognitive dysfunction and an earlier-than-expected death in older adults.

A new study, co-authored by Hawkley, highlights another underappreciated feature of this affliction: Loneliness is often transient, not permanent.

That study examined more than 2,200 Americans ages 57 to 85 in 2005 and again in 2010. Of the group who reported being lonely in 2005 (just under one-third of the sample), 40 percent had recovered from that state five years later while 60 percent were still lonely.

What helped older adults who had been lonely recover? Two factors: spending time with other people and eliminating discord and disturbances in family relationships.

Hawkley explains the result by noting that loneliness is a signal that an essential need — a desire for belonging — isn’t being met. Like hunger or thirst, it motivates people to act, and it’s likely that seniors reached out to the people they were closest to more often.

Her study also looked at protective factors that kept seniors from becoming lonely. What made a difference? Lots of support from family members and fewer physical problems that interfere with an individual’s independence and ability to get out and about.

What helped older adults who had been lonely recover? Two factors: spending time with other people and eliminating discord and disturbances in family relationships.

To alleviate loneliness, one must first recognize the perceptions underlying the emotion, Hawkley and other experts said.

The fundamental perception is one of inadequacy. People who are lonely tend to feel that others aren’t meeting their expectations and that something essential is missing. And there’s usually a significant gap between the relationships these people want and those they actually have.

This isn’t the same as social isolation — a lack of contact with other people — although the two can be linked. People can be “lonely in a marriage” that’s characterized by conflict or “lonely in a crowd” when they’re surrounded by other people with whom they can’t connect.

Interventions to address loneliness have received heightened attention since 2011, when the Campaign to End Loneliness launched in Britain.

Here are two essential ways to mitigate this distressing sentiment:

Alter perceptions. Loneliness perpetuates itself through a gloomy feedback cycle. We think people don’t like us, so we convey negativity in their presence, which causes them to withdraw from us, which reinforces our perception that we’re not valued.

Changing the perceptions that underlie this cycle is the most effective way to relieve loneliness, according to a comprehensive evaluation of loneliness interventions published in 2011.

Heidi Grant, associate director of the Motivation Science Center at Columbia University, described this dynamic in an article published in 2010. “If co-worker Bob seems more quiet and distant than usual lately, a lonely person is likely to assume that he’s done something to offend Bob, or that Bob is intentionally giving him the cold shoulder,” she wrote.

With help, people can learn to examine the assumptions underlying their thoughts and ask questions such as “Am I sure Bob doesn’t like me? Could there be other, more likely reasons for his quiet, reserved behavior at work?”

This kind of “cognitive restructuring” is an essential component of LISTEN, a promising intervention to treat loneliness developed by Laurie Theeke, an associate professor in the school of nursing at West Virginia University. In five two-hour sessions, small groups of lonely people probe their expectations of relationships, their needs, their thought patterns and their behaviors while telling their stories and listening to others.

Joining a group can be effective if there’s an educational component and people are actively engaged, experts said.

Invest in relationships. With loneliness, it’s not the quantity of relationships that counts most. It’s the quality.

If you’re married, your relationship with your spouse is critically important in sustaining a feeling of belonging and preventing loneliness, Hawkley said.

If you haven’t been getting along, it’s time to try to turn things around. Remember when you felt most connected to your spouse? How did that feel? Can you emphasize the positive and minimize the negative? If you’re badly stuck, seek professional help.

Investing in relationships with family members and friends is similarly important. This is the time to move beyond old grievances.

Invest in relationships. With loneliness, it’s not the quantity of relationships that counts most. It’s the quality.

“If you want to recover from loneliness, try to deal with difficulties that are disrupting relationships,” Hawkley said.

Also, it’s a good idea to diversify your relationships so you’re not depending exclusively on a few people, according to Jenny de Jong Gierveld and Tineke Fokkema, loneliness researchers from the Netherlands.

Training in social skills can help lonely people deal with problems such as not knowing how to renew contact with an old friend or initiate conversation with a distant relative. And learning coping strategies can enlarge their arsenal of adaptive responses.

Both of these strategies are part of a six-week “friendship enrichment program” developed in the Netherlands. The goal is to help people become aware of their social needs, reflect on their expectations, analyze and improve the quality of existing relationships and develop new friendships.

One simple strategy can make a difference. “If you have good news, share it,” Hawkley said, “because that tends to bring people closer together.”

KHN’s coverage related to aging & improving care of older adults is supported by The John A. Hartford Foundation.

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente. You can view the original report on its website.

The post How older adults can recover from loneliness appeared first on PBS NewsHour.

If I’m healthy, do I really need a Medigap or Medicare Advantage plan?

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The Social Security Administration has no idea who’s in your family unless you tell them. That information can affect the benefits you collect. Photo by Siri Stafford/Getty Images.

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.


Christian – Virginia: Do I really need a Medicare supplement or Medicare Advantage plan if I’m very healthy and take no prescription medicines? There’s a chance I may someday need a hip replacement, but fortunately, I do have the capital to pay my coinsurance and copayments. I’m just wondering if staying “self insured” this way is better than paying monthly premium for a benefit I’ll likely not use much.

Phil Moeller: It’s all a matter of your own risk-reward calculation.

First off, there is no law that says you have to get any part of Medicare when you turn 65. You can totally self-insure.

While you are healthy now, Medicare is about insuring a “future” you who is not going to be nearly so healthy.

The downside to this is that if you later decide you do need Medicare, you will get socked with lifetime late-enrollment penalties for Part B and Part D. You also might have trouble even getting a Medicare supplement plan. And you undoubtedly will face a gap of up to six months or even more between when you want Medicare and when coverage becomes effective. So, if you wait until you get sick to apply, it might be too late to avoid really big bills.

And don’t kid yourself, health care is incredibly expensive. My wife went in last year for a one-day “outpatient” treatment and was in the hospital something like 30 hours. The bill from the hospital was nearly $110,000! I kid you not. Insurance covered all but $1,000.

Lastly, while you are healthy now, Medicare is about insuring a “future” you who is not going to be nearly so healthy. Even very healthy people face substantial medical bills in their later years.

Having said all this, it remains your choice.


Donna: I am 64 years old and have been divorced for eight and a half years after a 31-year marriage. I understand that I can’t get my full benefits until 66. Can you tell me what is the best thing to do, and how much do I get if I wait until 66? Also, can I collect on both of our benefits? For instance, if I get $1,000 for myself, will I be able to get an additional $500 from him?

Phil Moeller: As you noted, you will need to wait until age 66 to get full divorce benefits. Their exact amount will depend on how much money in benefits your former husband would have been entitled to at age 66 (whether or not he had actually filed for them by then). This figure is determined by the record of wages on which he paid Social Security payroll taxes.

Whatever that amount is, it will be reduced by 7 to 8 percent for each year you claim it prior to age 66.

You cannot claim both your full retirement benefit and your full ex-spousal benefit at the same time. Social Security will look at the size of each benefit and pay you an amount that is roughly equal to the greater of the two.

You can find out your own benefit entitlement by opening an online account with Social Security. It will show you the agency’s records for your lifetime wage earnings and provide you a rough calculation of how much money you would get in retirement at different claiming ages.

Armed with this knowledge, you can then contact Social Security and ask them to calculate what your ex-spousal benefit would be. This can take a while, and you need to be patient. Unless you are friendly with your ex and he agrees to provide you access to his Social Security records, you are dependent on the agency to gather this information for you. If your local Social Security office is like most of them, it is understaffed and overworked, and the people you deal with may not even understand the rules as well as they should.

READ MORE: Can I work and still collect my late husband’s Social Security benefits?

Once you know the size of both benefits, you can begin to fashion a good claiming strategy.

If your ex-spousal benefit at age 66 is always going to be greater than your own retirement benefit, then you should just file for it and not worry about your own retirement benefit.

However, perhaps your retirement benefit already is the larger of the two, or maybe it would be if you delayed filing for it until age 70, when it reached its maximum amount. In this situation, you should consider taking advantage of another Social Security claiming rule.

Under the terms of a major change in Social Security laws enacted in 2015, anyone who turned 62 on or before the beginning of 2016 is allowed to file what’s called a “restricted” application. This applies to you. What it means is that at age 66 you can file a restricted application for just your ex-spousal benefit, while delaying the filing for your own retirement benefit.

If you did this, you could get the full value of your ex-spousal benefit for up to four years. Then, as late as age 70, you could file for your own retirement benefits. If you did this, you would get an additional payment roughly equal to the amount by which your retirement benefit exceeded your ex-spousal benefit.


Nancy – Virginia: I am currently 64 and am planning to quit my job on my birthday next year when I turn 65. Although I do not plan to collect Social Security until I am 66, I will file for Medicare before I turn 65 so that I am not penalized. My husband is five years younger than me. I was planning to drop my employer’s insurance when I resign at 65 and get added to my husband’s health insurance. Do you advise this move? To be added, it will cost approximately $100 a month.

Phil Moeller: If you like your husband’s coverage, I’d suggest you skip Medicare for now and simply have him add you to his plan. So long as you are covered by an employer plan — as the employee or the spouse — you can avoid late-enrollment penalties when you later enroll in Medicare.

If being added to your husband’s plan would cost only $100 more a month, I wonder if it makes sense to do this right away and not wait until you’re 65?


Lee: My wife filed before her full retirement age for her own benefit based on her work record. Since I have not applied for benefits, Social Security is saying that I must apply for benefits before they can make a determination on her application. Since I have not applied, do deeming rules apply in that she must apply for all the benefits she is “eligible” for, including spousal benefits? She may be eligible for spousal benefits, but since I didn’t apply, they are not available to her. I planned to apply for spousal benefits on her record and let mine benefit grow until I’m 70.

Phil Moeller: Your wife’s entitlement to her own retirement benefits is not dependent on you first filing for yours, so I am at a loss why Social Security would tell you this.

READ MORE: Should we raise the retirement age for Social Security and Medicare?

If you have not filed, she cannot be deemed, because she is only eligible for her own retirement benefit and not for her spousal benefit.

Assuming you turned 62 before the beginning of 2016, you are grandfathered under Social Security’s new rules and may file a restricted application for just a spousal benefit when you reach your full retirement age. This will permit you to delay your own retirement benefit until as late as age 70.

If you revisit this issue with Social Security, I would love to know the official source for their position that you must file before your wife can file.

Why does drawing Social Security benefits prevent seniors from making HSA contributions? Phil Moeller reports on the issue in his latest column.

The post If I’m healthy, do I really need a Medigap or Medicare Advantage plan? appeared first on PBS NewsHour.

What do you need to know about successful aging and retirement?

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Tens of millions of adults are chronically lonely, which has deleterious impacts on aging. Photo by brunella fratini/via Adobe. related words: seniors, retirement, health care, medicare

Tens of millions of adults are chronically lonely, which has deleterious impacts on aging. Photo by brunella fratini/via Adobe. related words: seniors, retirement, health care, medicare

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.


Medicare and Social Security are of critical importance in enabling older Americans to age in good physical and financial health. To support these broader goals, “Ask Phil” is expanding its mission.

If you have questions about other things that are shaping your own experiences with aging, please send them my way.

Where to start? I am so glad you asked! I have written what seems to be countless stories and received thousands of questions from readers about facets of what I call successful aging. I wish that success meant that we’d all live forever and avoid stormy weather during our journeys. Of course, it does not.

Successful aging means aging with as much physical well-being, financial security and dignity as possible. To this I would add the nebulous but critically important goal of living a life that is satisfying, or at least satisfying enough that the view from your death bed is not one of regret. I co-authored a book about this in 2012 called “How to Live to 100.” While I am not sure I would want to live that long, I am sure that the required elements of a long and successful life are very much worth paying attention to.

Here, then, is a laundry list of aging topics that I hope will help prime your “Ask Phil” pump and prompt questions that you would like addressed.

GOALS

Purposeful time: volunteering, education, giving back and worship
Leisure time: travel, entertainment and hobbies
Family and social relationships
Estate and legacy issues
What does your finish line look like?

ISSUES

Budget deficits and senior safety nets
Technology, self-driving cars and senior independence
Longevity, demographics and implications for aging
Alzheimer’s and dementia
Long-term care
Who will take care of us?

MONEY

Investments
Budgets and spending
Financial fraud and abuse
Taxes

WORK

Retirement, non-retirement and pre-retirement
Working forever
Encore careers
Workplace issues for older employees

HOME

Aging in place at home
Age-friendly homes and communities
Reverse mortgages, home equity and other housing issues
Downsizing
Retirement communities

This list is not meant to be complete or exclusive. If you have questions about other things that are shaping your own experiences with aging, please send them my way.

And now, here are this week’s reader questions.


Cynthia – Texas: Where can I get some help with Medicare questions? What is SHIP? I will be 65 in July and need some help. Also, my husband is 66 years old and has been receiving Social Security since he was 62. I am still working. Can I file under his Social Security to receive a spousal benefit?

Phil Moeller: SHIP is shorthand for the State Health Insurance Assistance Program. It provides free Medicare counseling and has local experts in your home state. President Trump’s current budget proposals would eliminate all of SHIP’s annual $52 million in funding, continuing recent Republican efforts to eliminate this source of free help to consumers. While Medicare’s own information services can be very helpful, they do not do a very good job of helping consumers navigate Medicare’s seemingly countless complexities. That $52 million, by the way, supports an enormous volunteer network of thousands of consumer counselors. Medicare would need to spend many times this amount to replace what SHIP does.

READ MORE: Column: Why we need to save Medicare counseling from the federal chopping block

As far as your Social Security question is concerned, you can file for a spousal benefit if you are at least 62. However, these benefits will increase every year until reaching their maximum amount when you reach your full retirement age of 66.

Also — and this is big deal — if you file for a spousal benefit before you turn 66, Social Security will deem you to be simultaneously filing for your own retirement benefit. You would be hit with early claiming reductions on both benefits. Worse, Social Security would not pay you each benefit, but only an amount roughly equal to the greater of the two.

Because you already had turned 62 as of the beginning of 2016, you are grandfathered in under new Social Security laws. Under this provision, if you waited to file for a spousal benefit until you were 66, you could file what’s called a restricted application for just your spousal benefit while deferring your own retirement benefit until as late as age 70, when it would reach its maximum amount.


Richard – Minnesota: I have a disability that forced me to stop working as a registered nurse. My former employer provided me a wonderful benefit to continue my health plan at the same payment rate until I turned 65. However, after I received Social Security disability benefits, I now find that I can no longer use this plan as my primary insurer if I sign up for Medicare. So I will have to go onto my wife’s employer health plan. In either case, the expense is raised by thousands of dollars each year. Why does the government find this a reasonable way to treat disabled persons?

Phil Moeller: I am sorry you are finding out in such a negative way that Medicare is not always reasonable. It is, however, usually logical. Your former employer’s plan apparently is designed so that it ceases to be the primary payer of health claims when you turn 65 or, at least in the plan’s eyes, are retired. Most retiree plans require Medicare to become the primary payer of claims, with the retiree plan becoming the secondary payer. This provision holds down employer expenses and is a major reason why they offer retiree plans at all.

If you get Medicare, even if you had not yet turned 65, this apparently triggers the provision that your former employer’s plan become a secondary payer. I can understand that you feel you have no choice but to be covered under your wife’s plan and that either Medicare or her plan will cost you a lot more money than you were paying.

READ MORE: Should we raise the retirement age for Social Security and Medicare?

In this case, I don’t think your disability is the cause of your problem. Rather, it’s that your former plan would view you as a retiree if you went onto Medicare. You would be treated this way whether or not you were disabled.

By the way, finding a health policy on Minnesota’s state Obamacare insurance exchange might be another option. While these rates have been increasing and Republicans would like to end Obamacare altogether, this could be a less expensive option for you than moving to your wife’s employer health plan.


Eugene: I am reading your Medicare book and think it should have mentioned the U.S. Family Health Plan. This plan works with Tricare and covers former military members in some parts of the country, allowing them to avoid needing to sign up for Medicare after they turn 65.

Phil Moeller: Thanks for mentioning the U.S. Family Health Plan. It’s always hard to know how much detail to go into for situations that are not widespread, and this is one of them.

According to Tricare, there are slightly more than 100,000 members in this health plan, which is the only one of its kind. This is a little more than 1 percent of about 9.4 million Tricare members.

Even though Medicare is not required for people in this plan, its limitation to only six regions of the country prompted Tricare to tell me, “We strongly encourage these beneficiaries to enroll in Part B when they first become eligible. If they disenroll from USFHP, or move to a non-USFHP area, they won’t be eligible for other TRICARE benefits if they don’t have Part B. And, if they don’t enroll in Part B when first eligible, they may be required to pay the Medicare Part B Late Enrollment Penalty.”


Dan – Texas: I have been trying to find home care (unskilled) for my 83-year-old mother. She has Medicare, but also has a Humana policy. It covers 35 hours a week, but every time I try to get assistance, I am denied. I don’t understand why we can’t get her the desperate help we need for her. My mother has Alzheimer’s and dementia and is the widow of a veteran.

Phil Moeller: Sadly, Medicare does not cover most unskilled home care. This is not Humana’s fault, but it is a Medicare rule.

If you don’t have a doctor’s recommendation, I am not surprised you are being rejected for coverage. Might your doctor prescribe such care as medically necessary? Even if he has, and she qualifies for Medicare’s home care benefit, the challenge is to find a home-health agency to provide it.

READ MORE: Many seniors who qualify for home-based care under Medicare aren’t receiving it. Why?

This has become an enormous problem. Even though this is a covered benefit, it seems that many home-health agencies simply do not want to provide these services. There are lots of reasons — other care is more profitable, they have staff shortages, etc. But the bottom line is that it is very, very hard to get this care.

Humana should have a list of recommended home-health agencies. Medicare also maintains an online list of registered agencies and has a rating system to grade their performance. Even so, it can be very hard to find an agency willing to take on a client such as your mother.

The post What do you need to know about successful aging and retirement? appeared first on PBS NewsHour.

Think you’re too old for a bucket list? These 90-somethings disagree

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Mildred “Milly” Reeves, right, flies a Cessna Model 172 with assistance from pilot Pete Lockner, left. (Screengrab of family video/YouTube)

Mildred “Milly” Reeves, right, flies a Cessna Model 172 with assistance from pilot Pete Lockner, left. (Screengrab of family video/YouTube)

It is one thing to have a bucket list at any age. It is something else entirely to have a bucket list that sends you to college for the first time at 92 — or that sends you on your maiden flight at the controls of a single-engine airplane at 97.

These are the bucket list accomplishments of Cecile Tegler (92) and Mildred “Milly” Reeves (97). And neither of them is done yet.

“I never even thought about having a bucket list,” said Reeves, a resident at Mount View Assisted Living in Lockport, N.Y., who became familiar with the insides of airplanes in her 20s, when she was a small-parts inspector for Bell Aircraft during World War II. After the war ended, she stayed home and had seven daughters — so the notion of ever flying a plane solo grew increasingly distant.

Nor had Tegler, her friend and fellow resident at Mount View, ever created a real bucket list. What she did have, however, was an urge to go to college, since her folks — who had to support their own parents — didn’t have the money to pay for college when she was in her late teens. Both of Tegler’s daughters graduated from college, but she never imagined that she could go to college, too.

Within the past year — because of unusual outreach efforts by staff at the assisted living community where they both live — Tegler attended a community college, where she finally learned how to use and operate a computer. And Reeves took the controls of an airplane and flew it, on her own, for about 15 minutes. Whether or not these are actual bucket list items, they are accomplishments that have spurred both women to set even more goals.

It stands to reason that bucket lists — specific life goals to accomplish before dying — are more popular as Americans live longer and find they have more time on their hands.

Such goals don’t have to be about flying airplanes or entering college in your 90s. Sometimes, bucket lists that focus on helping others can be the most effective. That, at least, was the plot line of the 2007 film “The Bucket List,” starring Jack Nicholson as an eccentric billionaire who finds himself sharing a hospital room with a car mechanic played by Morgan Freeman. Both men suffer terminal illnesses but opt to complete their lifetime bucket lists together — only to discover their new friendship tops the list.

“The best bucket lists aren’t usually about skydiving or climbing the Great Wall of China,” said Marc Agronin, a geriatric psychiatrist who is vice president for behavioral health and clinical research at Miami Jewish Health Systems in Miami. “Our bucket lists need to be in line with our core values.” He suggests that people simply look around and see the riches they have and the potential for adventure right in their own communities.

Cecile Tegler, right, stands in the lobby of Niagara County Community College with fellow Mount View Assisted Living residents Sandra Leaming, left, and Marge Reinard, center, before heading to a class on computer applications. (Courtesy of Mount View Assisted Living)

Cecile Tegler, right, stands in the lobby of Niagara County Community College with fellow Mount View Assisted Living residents Sandra Leaming, left, and Marge Reinard, center, before heading to a class on computer applications. (Courtesy of Mount View Assisted Living)

Reeves, whose grandson eagerly came along with her on her maiden flight to capture the moment on video, totally gets that. She said that she took as much — if not more — pleasure in her grandson coming along for the ride as she took in the moment when the captain of the plane handed her the controls. Reeves takes the greatest pride in her seven daughters, 12 grandchildren and 14 great-grandchildren.

Meanwhile, Tegler, who attended computer class three times weekly at Niagara County Community College in Niagara Falls, N.Y., learned how to use Microsoft Word and Excel software. She was among the first at Mount View to enroll at the college and has since inspired others to do the same. Among those now considering a return to college is her friend Reeves.

“The ultimate goal of this is to get them more involved in society and in the belief that they can still do things.”

“I’ve helped many people in my life,” said Tegler, who expressed no fear or hesitation about attending college with a bunch of 20-somethings. Many students in the class helped her learn how to use the computer. When Tegler was younger, she said, she often volunteered at homes for veterans because her husband, father and brothers all served in the Army.

Quietly helping Reeves, Tegler and 266 other residents of two assisted living homes in upstate New York accomplish their bucket list goals is David Tosetto, who owns both Mount View and Cobb’s Hill Manor in Rochester, N.Y. “Young people dream and old people remember,” said Tosetto. “The goal of the bucket list is to give them something to dream about.”

Mount View owner David Tosetto, left, stands with Mildred “Milly” Reeves, right, after her flight in a Cessna Model 172 at the Genesee County Airport. (Courtesy of Mount View Assisted Living)

Mount View owner David Tosetto, left, stands with Mildred “Milly” Reeves, right, after her flight in a Cessna Model 172 at the Genesee County Airport. (Courtesy of Mount View Assisted Living)

The way Tosetto figures it, happy residents make for longer-term residents and happier employees. So, he doesn’t charge them one penny extra for the bucket list outings. Besides the flying school and college opportunities, he’s also putting together a scuba diving class at a local pool and a kayaking adventure this summer.

“The ultimate goal of this is to get them more involved in society and in the belief that they can still do things,” said Tosetto. He puts the programs into motion by posting large “Bucket List” signs around the two assisted living facilities that announce the opportunities and encourage residents to sign up.

Tosetto won’t sponsor some activities, such as skydiving. “I just don’t know how they can land safely,” he explained. “Of course, if they choose to do it on their own, that’s up to them.”

In the end, said Agronin, author of the book “How We Age: A Doctor’s Journey Into the Heart of Growing Old,” your legacy isn’t about how many planes you’ve jumped out of or how many countries you’ve visited. “When the trip of a lifetime ends, you still have the rest of your life to live,” he said. Your real legacy is about the people you touch along the way. “The relationships you create and what you teach your children is how you build your legacy,” he said.

At 97, Reeves is still building hers.

Asked to name the lifetime accomplishment of which she’s most proud, it’s not the plane flight at all. “I’m still a Girl Scout,” she boasted, noting that she earned the Gold Award, scouting’s highest honor. “I still pay my dues.”

KHN’s coverage related to aging & improving care of older adults is supported by The John A. Hartford Foundation.

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente. You can view the original report on its website.

The post Think you’re too old for a bucket list? These 90-somethings disagree appeared first on PBS NewsHour.

What’s the best place to retire? Keep these factors in mind before settling down

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Two elderly people sit on a bench as they look at a parascending during a sunny summer day in Nice, southeastern France, July 28, 2014. REUTERS/Eric Gaillard (FRANCE - Tags: ENVIRONMENT TRAVEL SOCIETY) - RTR40E3K related words: medicare, aging, retirement, travel, retired

Photo by Eric Gaillard/Reuters

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’ve always taken those “Best Places to Retire” lists with a very big grain of salt. Most people think the best place to retire is right where they are, usually staying in their own homes as long as possible. Family concerns are another driver, with people moving to be near grandchildren or perhaps other relatives, especially those who need looking after.

I have become convinced, however, that location will become a more significant variable in later-life decisions. Several factors are shaping this shift.

President Trump and the Republican Congress want to give states a much greater say in how they spend federal health care dollars, particularly in the Medicaid program. Medicare does not cover long-term care, and Medicaid is the primary payer of nursing home care for millions of lower-income, older Americans. Changes in Medicaid thus could produce big differences in the amount and quality of health care provided by different states.

Democrats vow to strongly resist these efforts, and it’s not at all clear that Republicans will be able to agree among themselves that they should even more forward with a version of the American Health Care Act that passed the House of Representatives.

But there is a lot of writing on the wall here that says states will not be able to look to Washington for the kind of funding support they’ve enjoyed.

Federal deficits have not been a widespread concern since the deep recession began roughly 10 years ago. Deficit spending was accepted by even many conservatives as a necessary antidote to a weak economy. With inflation remaining very low, our rising national debt has not produced painful consequences to date.

But the weak recovery has nonetheless been a recovery. The unemployment rate is now at a 16-year low of 4.3 percent. I grant that many people are badly underemployed, working in jobs they dislike for equally disappointing salaries. Millions of other unemployed people are not even counted in the work force.

READ MORE: Analysis: Today’s unemployment number fools us and President Trump, but for different reasons

Still, warts and all, we are approaching — if not already at — full employment. Historically, a steady supply of legal and illegal immigrants would have boosted the supply of labor. But with the immigration spigot turned tighter, rising pressure on wages and price levels would hardly be surprising. Any appreciable uptick in inflation would ratchet up interest costs on the national debt, bringing federal deficits back into the news.

Already, rising numbers of older Americans are driving higher federal government spending on Social Security, Medicare and Medicaid. If the rate of inflation picks up, these programs will become unsustainable even earlier than forecast. Even a sympathetic Washington, which we don’t have today, would have little choice but to reduce its support for senior safety nets. This, in turn, would give the states more effective say in shaping local safety-net supports.

At the same time, lack of consensus in Washington on just about everything has been the norm for several years. Many state governors and legislatures have responded to this federal vacuum by charting either modest or major changes in the courses that their states are taking.

Against this backdrop, three other trends deserve mention:

First, climate change appears to be having an unequal impact on different parts of the United States. As this reality becomes better understood and more pronounced, it can’t help but produce winners and losers among the states.

Second, the rising numbers of older citizens has boosted attention to the quality of life offered to seniors in different cities and states. So-called “age friendly” programs and policies have the potential to create significant differences in the desirability of living in different parts of the country. The Milken Institute, among others, has been assembling a compelling case for this in its annual “Best Cities for Successful Aging” reports.

Third, there already are significant differences in state tax policies. These have long influenced retirement location decisions of wealthier folks. As states wrestle with the consequences of more responsibility for their older citizens’ retirement and health needs, these differences could become even more pronounced.

Now, before you scatter to the retirement hills in whatever state beckons you, here are this week’s reader questions.


John – Massachusetts: My wife is 66 and has a health savings account. She recently was laid off and thus will need to sign up soon for Medicare. We know that doing so will render her ineligible to continue contributions to her HSA, but we are confused about the part of this rule that says the effective date of her signing up for Part A of Medicare could be retroactive to six months prior to her enrollment. If she signs up for Medicare soon, will this six-month retroactivity affect her HSA contributions for last year? Might she be better off waiting until July 1 to sign up? Or could I simply request an HSA distribution for November and December of last year and pay taxes on that amount?

READ MORE: The Social Security and Medicare gotcha that makes contributing to your HSA illegal

Phil Moeller: The six-month retroactivity “gotcha” for HSA eligibility stems from Social Security rules, and it certainly could affect 2016 contributions. But the biggest issue with your timing question is not about possible IRS penalties for making improper contribution. It is, or should be, making sure your wife does not find herself with no health insurance, even for one day. Thus, she should either get Medicare right away or get a COBRA continuation policy through her former employer, but for no more than a couple of months. Her Medicare enrollment period began as soon as her employer coverage ended. Having COBRA does not pause the clock on when she needs to have Medicare and avoid its late-enrollment penalties.

If she waited until July, you would eliminate the need to deal with the IRS on 2016 tax issues. But you will still have to adjust your 2017 tax returns to reverse the benefits of any pre-tax contributions to her HSA this year. Whether you will face IRS penalties is another matter, although it seems to me that making HSA adjustments during 2017 will remove any tax benefit you may have received and thus eliminate the cause for being penalized. However, I have learned never to predict what the IRS might or might not do.


David: My parents are Christian missionaries in Mexico. They have been doing this for more than 40 years. Needless to say, they have not made very much money throughout their life and have no serious post-retirement plans. My mother turns 65 this year and she has no clue what she is supposed to do (my father is a Mexican citizen). They have been getting wages though their sponsoring church, so I assume they have contributed to Social Security and Medicare. My parents plan to remain in Mexico. What would be their best course of action?

Phil Moeller: In terms of Social Security, they (or you) should use their Social Security numbers to open online accounts with the agency that will show them their benefits under some different claiming ages. Our Social Security book goes into all the gory details of how they can evaluate these options.

In terms of Medicare, they probably should do nothing, so long as they are confident they will not live in the U.S. later in their lives. I recently wrote an explanation of Medicare issues for ex-pats that might provide you a good overview.


Gary: Regarding Medigap rating approaches, it appears that community rating is superior to the issue-age or the attained-age rating. I reached this conclusion based on that fact that it is not age related, like the attained-age approach, and not individually health related, like I assume the issue-age rated approach to be. Am I correct here?

Phil Moeller: When a person first becomes eligible for Medicare, they normally have what’s called a guaranteed access period for Medigap. During this period, Medigap insurers are not allowed to discriminate against an applicant based on their health. Having said that, the prices of both issue age and attained age policies may be affected over time by the generally poorer health of pools of older policyholders.

Here are explanations of these approaches that were provided to me for research on my Medicare book. I found them helpful, and hope you do, too:

Attained age rating, when structured properly, reflects the underlying costs for each age. This rating type is used frequently since it is least expensive for younger insureds (e.g., age 65), even though it is most expensive for older insureds. While this structure may provide the lowest rates for someone first eligible for Medicare, rates increase over time for both aging (about 2% to 4% per year up to age 80 or 85) and inflation. At older ages, it may be challenging to pay the higher rates required. For those who want the lowest rates now and who may not expect to live long, attained age rating may provide the best value.

Issue age rating charges a rate that’s a little higher than the cost of benefits during the first few years and invests the excess in a reserve that grows with interest and survivorship. (Survivorship means that the reserve for people who die or terminate their coverage is shared among those who remain.) In later years when the issue age rate is not enough to cover the cost of benefits, the reserve is used to help fund the difference. This structure has a higher initial cost than attained age rating and is not used often except in states that require it (Florida, New Hampshire) or prohibit the use of attained age rating (several states including Idaho). Rates increase for inflation but do not increase due to age. With issue age rating, people enrolling at older ages pay higher rates than people enrolling at younger ages. Issue age rating helps members avoid the higher rate increases associated with attained age rating and can provide excellent value for those who expect to continue their insurance for many years.

With pure community rating, everyone in the community pays the same amount for their plan. (A state may have more than one community, defined by geographic region within the state.) Similar to issue age rating, younger insureds pay more than their average cost of benefits, while older insureds pay less than their average cost of benefits. Unlike issue age rating, there is no reserve build up since today’s younger insureds are subsidizing the extra costs for today’s older insureds. Community rating is required in seven states: Connecticut, Maine, Massachusetts, Minnesota, New York, Vermont and Washington. Pure community rating is not often used in states where it is not required, since community rates are higher for younger insureds than attained age rates and issue age rates. Modified community rating may include rates that vary within the community based on factors other than age. Rates under modified community rating can be competitive with attained age and issue age rates, and can provide excellent value for people of all ages.


Deanna: I know you are the guru on Social Security and Medicare, and I love reading your articles! I’m nearly 64 years old and still working. My husband passed away two years ago. Last year, I started collecting Social Security survivor benefits, but I only get six months’ worth a year, because I’m still working, and the earnings test reduces my benefits. My question concerns Medicare. I will be 65 next year in July 2018, and I’m not sure how long I’ll continue to work. Since I’m collecting Social Security, will I automatically be enrolled in Medicare Parts A and B? I have insurance coverage at work that includes health, vision and dental. It is less expensive than Medicare Part B. I know Medicare Part A will not charge me a premium. Should I enroll, or keep Part A if I’m automatically enrolled? Would my work insurance be my primary coverage even if I have Medicare Part A and/or Part B?  If I decline Medicare when I turn 65, will I be able to enroll once I decide to retire?

Phil Moeller: When you turn 65, you should be automatically enrolled in Part A of Medicare but not Part B. Mistakes do happen, of course, so if Social Security does enroll you in Part B, you need to quickly contact the agency and reject Part B until you retire and lose access to your employer health insurance.

Having Part A invalidates continued participation in a health savings account. But I’m guessing you don’t have an HSA, or you would already have encountered this rule. For people without HSAs, I recommend keeping Part A, which can come in handy as a secondary insurer for covered hospital expenses.

You don’t need to worry about getting Medicare until you lose your employer health coverage. At that time, you will have an enrollment period to get Medicare and will not face any issues for not having done so when you turn 65.

The post What’s the best place to retire? Keep these factors in mind before settling down appeared first on PBS NewsHour.


How the back pain industry is taking patients for an unhealthy ride

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Searching for solutions to back pain can lead sufferers into an expensive and sometimes dangerous maze of ineffectual treatments, procedures and pills, journalist and investigative reporter Cathryn Jakobson Ramin found. Illustration by leremy/via Adobe

Searching for solutions to back pain can lead sufferers into an expensive and sometimes dangerous maze of ineffectual treatments, procedures and pills, journalist and investigative reporter Cathryn Jakobson Ramin found. Illustration by leremy/via Adobe

For the majority of us, it’s not a question of whether we’ll someday experience back pain; it’s a question of when.

‘Study after study after study has shown that long-term visits to chiropractors don’t help patients. They don’t prevent back pain; they don’t solve back pain.’

But searching for solutions can lead sufferers into an expensive and sometimes dangerous maze of ineffectual treatments, procedures and pills, as journalist and investigative reporter Cathryn Jakobson Ramin found. For years, she searched for ways to alleviate her own intractable back pain. Then she began to investigate the entire back pain ecosystem: doctors, chiropractors, surgery centers, pharmaceutical companies, “posture mavens,” collusion between personal injury attorneys and doctors … you name it.

Her new book, “Crooked: Outwitting the Back Pain Industry and Getting On the Road to Recovery,” explores what she found, while also telling the story of how she overcame her chronic suffering. When it comes to people making money on — literally — the backs of other people, “A lot of things didn’t add up,” she says. “That generally means something is wrong.”

Ramin recently spoke about her investigation with Eric Westervelt on KQED’s Forum program. Here is some of what she said.

Beware the One Surgeon Who Says Yes

Ramin, who had ineffective minor surgery for her back pain, said the post-surgical woes of Tiger Woods and Golden State Warriors’ coach Steve Kerr serve as prime examples of what can go wrong with back surgery.

‘Minimally invasive surgery’ is a marketing term. ‘The damage beneath the skin will be exactly the same as it would be in traditional spine surgery.’
She said some athletes do have successful surgery for back pain, but that it’s unlikely their example would apply to the rest of us. “Those athletes are highly, highly trained and in excellent condition,” she says.

Ramin says the fee-for-service payment system in the U.S. incentivizes unnecessary and potentially damaging spine surgery, where in other countries, spine surgery is rare.

And beware the surgeon who agrees to operate on you after other reputable doctors have turned you down. She gave the example of author, physician and marathon runner Jerome Groopman, who, after five surgeons had told him there was nothing they could do for his back injury, found a sixth who claimed he could operate and get him up and running in six weeks.

“He spent the next 19 years in extraordinary pain,” Ramin says.

Beware the surgeon who agrees to operate on you after other reputable doctors have turned you down.

Ramin also warns against taking the description “minimally invasive spine surgery” literally, calling it a marketing term.

“These are sexy buzzwords,” she says. “Perhaps the incision is small — and it isn’t always. If in fact you do have a small incision, good for you, you might look better in a bathing suit. The damage beneath the skin will be exactly the same as it would be in regular, traditional, conventional spine surgery.”

These procedures are often done in outpatient surgery centers , she says. “If anything goes wrong afterward, you’re not in a hospital environment.”

Chiropractors: A Very Mixed Bag

Ramin says some chiropractors are completely ineffectual while some are treating patients the right way. Of the latter, “They have stopped seeking vertebral subluxations [partial dislocations] which don’t actually exist on any X-ray or any type of scan, and have moved onto the very excellent practice of rehabilitation. They may ultimately be a back patient’s best hope because they have studied exercise science and they have worked hard on it.”

Neck adjustments, Ramin said, “are to be avoided at all costs. There is no reason to let a chiropractor anywhere near your neck.” Photo by Microgen/via Adobe

Neck adjustments, Ramin said, “are to be avoided at all costs. There is no reason to let a chiropractor anywhere near your neck.” Photo by Microgen/via Adobe

However, “If you see a chiropractor more than one or two sessions, you are wasting your time if you are being cracked, adjusted or walked over. Study after study after study has shown that long-term visits to chiropractors don’t help patients. They don’t prevent back pain; they don’t solve back pain.”

She said the World Health Organization has come up with a long list of all the diagnoses for which chiropractic is contra-indicated.( See page 20 here.) “And it’s probably anything that would take you to a chiropractor.”

Neck adjustments, she said, “are to be avoided at all costs. There is no reason to let a chiropractor anywhere near your neck.”

Pharmaceutical Companies: Painkilling Pill Pushers

In the 1990s, Ramin says, pharmaecutical companies embarked on a well-funded campaign to get primary care doctors to ask all their patients if they were experiencing any pain.

‘There is no reason to let a chiropractor anywhere near your neck.’
Oftentimes they were experiencing some back pain, “because it is a human condition,” she says. “The answer to that from the primary care doctor’s perspective, because of the active marketing from pharmaceutical companies, was to say ‘Well, we can take care of that pain.’ ”

Doctors often started out with short-acting pain killers, such as Vicodin, a potent and addictive narcotic. This was often followed by longer-acting, extended-release painkillers, such as the opioid-based Oxycodone — which has led thousands into heroin addiction.

But, Ramin says, opioid painkillers don’t work well for people with back pain.

“They cause those patients to become very unmotivated and very sleepy,” she says.

Plus, a condition called opioid-induced hyperalgesia can arise, in which the brain generates pain independent of the original injury.

Expensive Chairs and Standing Desks

What Ramin calls “posture mavens” rely on “ergonomic smoke and mirrors” to fix back pain, Ramin says.

For instance, many back sufferers will try new office chairs.

“I had a stable of office chairs,” she says. “One after another, expensive office chairs parading through my office, and I found most of them to be not very good.”

These chairs are “often built for 250-pound men,” she says.

Some tremendous benefits can be gained from doing yoga, Ramin says, but there is potential harm, as well.

“I realized you could have a chair from Costco for $25 that could keep you in the right position.”

The standard, erect typing position, she says, is actually a relic from when you had to press hard on typewriter keys to get them to work.

Regarding the use of standing desks, Ramin says those come with their own problems. “It’s a nice variation from sitting. But remember, if you are standing, you are putting tremendous pressure on possibly a different set of ligaments,” she says. “But still you’re asking your ligaments to hold you up for a really extended period of time. We’re seeing all kinds of problems related to standing desks, now. They tend to be knee and hip problems, but those will lead to back problems.”

If you have a standing desk, you still need to move around every so often, she counsels.

The Yoga Trap

Some tremendous benefits can be gained from doing yoga, Ramin says, but there is potential harm, as well.

“One of the risk factors is finding yourself in a very competitive Northern California yoga class where you are pushed to do what you really cannot do. Most of us who are even remotely competitive will experience that.”

She says if you have back pain, there are limitations to what you should do in class, and you need an instructor who can give you variations on postures to suit your condition.

Moving is the key. Our bodies are not built to sit or stand in one place for hours at a time.

“Be very careful about finding yourself in a flow yoga class where things are moving very fast and there’s no way the teacher can keep a close eye on you.”

Two type of yoga she recommends for back sufferers: Iyengar yoga and Viniyoga.

“Both of them have a very powerful orthopedic focus,” Ramin says.

So What Does Work?

Two things: Exercise and changing the way you think about back pain.

“Understanding that hurt does not mean harm,” Ramin says. “You can continue to live an active life. The most dangerous thing you can do for yourself is take to the couch or take to your bed or take to pain management. But of course that is what most people do.“

Ramin recommends finding a “back whisperer”–someone who understands the musculoskeletal system and is able to help people build strength, balance their gaits and move effectively.

Moving is the key. Our bodies are not built to sit or stand in one place for hours at a time, she says. “The best posture is your next posture.”

This report was produced by KQED’s Future of You. You can view the original report on its website.

The post How the back pain industry is taking patients for an unhealthy ride appeared first on PBS NewsHour.

Help! I lost my job and just turned 65. What do I do about health insurance?

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A job seeker walks past a sign at a veterans' job fair in Burbank, Los Angeles, California March 19, 2015. The number of Americans filing new claims for unemployment benefits rose marginally last week, indicating the labor market remained on solid footing despite slowing economic growth. REUTERS/Lucy Nicholson - RTR4U3N5

Phil Moeller answers your aging and retirement questions in his weekly column, “Ask Phil.” Photo by Lucy Nicholson/Reuters

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.


Anonymous — Florida: Help! I am turning 65 next week and was shocked to be let go from my job last week! My company had paid my medical and dental, and I paid these benefits for my husband, who is 17 months younger than me. My company gave me forms to go on COBRA and said it will make my COBRA payments for a year and continue to deduct from my severance what I pay for my husband. What should we do?

Phil Moeller: I’m so sorry that you lost your job. However, in the haze that can accompany such surprises, I urge you not to simply take COBRA and assume you’re done with health insurance concerns for the time being. You’re not done yet.

COBRA does not qualify as employer group insurance for Medicare eligibility. So when you turn 65 next week, you need to sign up for Medicare as soon as possible. There are two adverse consequences if you don’t: You might face late-enrollment penalties from Medicare, and what’s worse, your COBRA coverage might not pay your covered health claims.

You should check with your COBRA insurer, but it’s common for COBRA insurers to not be the primary payer of covered insurance claims for people who are eligible for Medicare.

For the same reason, you need to look into supplemental coverage now as well. I lay out all these choices in my Medicare book, and I hope reading it can take at least some of the deer-in-the-headlights panic out of this process.

As for your husband, he will need to get individual coverage on your state Obamacare exchange. This will be a hassle, but it should not be any more expensive than COBRA and possibly less expensive.

There are some Medicare Advantage policies that include a modest dental benefit. But all dental policies are relatively modest, so you might be better off just buying a separate policy from a private insurer. In any event, I would not let dental concerns be the determining factor in what types of supplemental Medicare coverage is best for you.

Best of luck, and again, I’m so sorry you lost your job and you have to go through this health care stress as well.


Patsy – Pennsylvania: When dying in a nursing home, an oncology unit in a hospital or in a hospice center, why isn’t a patient allowed hydration or food and medicated to the point of being barely conscious? Can a patient who does not want to be starved to death choose to be given minimal medication — just enough to take the edge off, but remain conscious?

Phil Moeller: Either the patient or their legal decision maker should be able to request whatever drugs and nutrition are needed for the patient to be comfortable in their final days. The primary purpose of hospice is to provide palliative care, which by definition, is to be provided with the patient’s comfort as the primary goal.

I can only assume you were involved with treatment of a loved one or friend that failed to meet these objectives. I am so sorry this happened.

There can be many reasonable differences about the kind of care a patient should receive at the end of their life. This is something the patient or their caregiver should learn about ahead of time, including having discussions with their doctors and caregivers at the facility where the patient will receive end-of-life care.

I hope that others reading about your experiences will be prompted to take charge of their own end-of-life care. Advance planning is essential here.

Having said this, I know that real-life situations can be hectic and often do not unfold as planned.


Sal – New Jersey: In your opinion, how much would future Social Security cost of living adjustment (COLA) increases need to be for all Medicare B premiums to be the same for everyone except the higher earners? Charging people different Medicare premiums is not fair and needs to stop.

Phil Moeller: What a great question! I don’t have a precise answer. The impact of the hold-harmless rule, which is what your question concerns, depends not only on future rates of consumer price inflation but also on future Medicare Part B premium increases. These, in turn, will be keyed to future rates of health care inflation that are not known today.

I think I’m on safe ground, however, in saying that it would take several years of at least moderate inflation before Part B premiums would be equalized. While consumer prices have ticked up as of late, it’s not clear to me that we will see even moderate COLAs during the next few years.

If I were running the zoo — one of my not-so-fond names for our national government — I would change the rules to get rid of this situation. This is easier said than done.

For example, ending the hold harmless rule would allow the same Medicare premiums to be paid by everyone except for wealthy enrollees. But it would expose Social Security recipients to declines in benefits if Medicare expenses outstrip the pace of inflation.

If you do not find this exposure acceptable, then we’d need to devise a mechanism that works like the hold harmless rule, but does not produce different payment levels for Medicare enrollees. To do this, we’d need rules that protected Social Security benefits from being eroded by either inflation or higher Medicare premiums and that prevented Medicare health inflation from triggering differential premium impacts.

One solution would be for the government to step up and pay any annual amounts by which Medicare Part B premiums exceeded the annual COLA. This has occurred, at least in part, on an emergency basis the past two years. Making it permanent would require Washington to further subsidize Medicare premiums. I wouldn’t hold my breath for this happening while Republicans control the White House and Congress.

The fiscal conservative in me is also obligated speak up. Such a solution might be “fair” and certainly attractive to Social Security and Medicare recipients. But it wouldn’t be so good for the national debt!


John: If a participant in a high-deductible health plan is reaching 65 shortly, what would happen if he elected to take a Social Security spousal benefit on his wife’s earnings while deferring his own Social Security retirement benefit? Could he still contribute to a health savings account?

Phil Moeller: No. Any type of Social Security benefit, even one taken on a spouse’s earnings record, will automatically enroll a beneficiary in Part A of Medicare. This invalidates continued tax-advantaged contributions to an HSA. The only way to avoid Part A in this situation is to forego Social Security benefits entirely.


Paul: My wife started collecting Social Security in November 2015 and soon will turn 65. I started collecting in February 2017, when I turned 66. We are being told she must start collecting spousal benefits now, because I started collecting. I thought she could wait until she turned 66 and get more out of the spousal benefit.

Phil Moeller: No, she can’t wait. Because she is already collecting her retirement benefit, she is automatically deemed to also be claiming her spousal benefit as soon as she became eligible for it. This eligibility was triggered when you filed for your own benefit.

The ability to avoid deeming was largely eliminated in major changes to Social Security laws enacted in 2015 by Congress. There is a limited exemption from deeming for people who were at least 62 as of the beginning of 2016. When they reach their full retirement age, they can file a restricted application for only one benefit. But because your wife had already filed for her retirement benefit, this option is no longer open to her. Sorry!

The post Help! I lost my job and just turned 65. What do I do about health insurance? appeared first on PBS NewsHour.

Bill Nye Lets Out His Inner Nerd, How To Grow Old Without Getting Old, 'A Life of Adventure and Delight'

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Bill Nye joins us to discuss his new book Everything All at Once: How to Unleash Your Inner Nerd, Tap into Radical Curiosity and Solve Any Problem. Malachy McCourt on his latest book Death Need Not Be Fatal, a collection of personal stories and reflections on how to grow old without acting old, and how to die without regret. Akhil Sharma joins us to discuss his new collection of short stories A Life of Adventure and Delight, eight stories that focus on Indian protagonists at home and abroad. Jim St. Germain talks about his memoir A Stone of Hope, his story of immigrating to the U.S. from Haiti, involvement in gangs and drug dealing, and how he turned his life around.

#100 Is 100 That Exciting?

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In honor of our 100th episode, producer Abigail Keel talks to some centenarians about the good and the bad of 100. To join the conversation, go to www.longestshortesttime.com! This episode is brought to you by Thirdlove, Uniqlo, Olive & Cocoa and Crane & Canopy.

Older people dying on job at higher rate than all workers

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old Hand women on bed patient

Poor women are four times more likely to be jobless by the end of treatment than their better-off peers, according to a study published Monday in Health Affairs. Photo by srisakorn/via Adobe

Older people are dying on the job at a higher rate than workers overall, even as the rate of workplace fatalities decreases, according to an Associated Press analysis of federal statistics.

It’s a trend that’s particularly alarming as baby boomers reject the traditional retirement age of 65 and keep working. The U.S. government estimates that by 2024, older workers will account for 25 percent of the labor market.

Getting old — and the physical changes associated with it — “could potentially make a workplace injury into a much more serious injury or a potentially fatal injury,” said Ken Scott, an epidemiologist with the Denver Public Health Department.

Gerontologists say those changes include gradually worsening vision and hearing impairment, reduced response time, balance issues and chronic medical or muscle or bone problems such as arthritis.

In 2015, about 35 percent of the fatal workplace accidents involved a worker 55 and older — or 1,681 of the 4,836 fatalities reported nationally.

William White, 56, was one of them. White fell 25 feet while working at Testa Produce Inc. on Chicago’s South Side. He later died of his injuries.

“I thought it wouldn’t happen to him,” his son, William White Jr., said in an interview. “Accidents happen. He just made the wrong move.”

READ NEXT: I was successful and recognized. Now, at 64, I can’t get an interview.

The AP analysis showed that the workplace fatality rate for all workers — and for those 55 and older — decreased by 22 percent between 2006 and 2015. But the rate of fatal accidents among older workers during that time period was 50 percent to 65 percent higher than for all workers, depending on the year.

The number of deaths among all workers dropped from 5,480 in 2005 to 4,836 in 2015. By contrast, on-the-job fatalities among older workers increased slightly, from 1,562 to 1,681, the analysis shows.

During that time period, the number of older people in the workplace increased by 37 percent. That compares with a 6 percent rise in the population of workers overall.

The workplace fatality rate for all workers — and for those 55 and older — decreased by 22 percent between 2006 and 2015. But the rate of fatal accidents among older workers during that time period was 50 percent to 65 percent higher than for all workers.

Ruth Finkelstein, co-director of Columbia University’s Aging Center, cautions against stereotyping. She said older people have a range of physical and mental abilities and that it’s dangerous to lump all people in an age group together because it could lead to discrimination.

She said she’s not sure that older workers need much more protection than younger workers, but agreed there is a need for all workers to have more protection. “We are not paying enough attention to occupational safety in this country,” she said.

The AP analysis is based on data from the Bureau of Labor Statistics’ Census for Fatal Occupational Injuries and from one-year estimates from the American Community Survey, which looks at the working population. It excludes cases where the cause of death was from a “natural cause,” including a heart attack or stroke.

AP also examined the number and types of accidents in which older workers died between 2011, when the bureau changed the way it categorized accidents, to 2015:

— Fall-related fatalities rose 20 percent.

— Contact with objects and equipment increased 17 percent.

— Transportation accidents increased 15 percent.

— Fires and explosions decreased by 8 percent.

“We expect that there will be more older workers increasing each year and they will represent a greater share (of the fatalities) over the last couple of decades,” said Scott, the Denver epidemiologist. “This issue of elevated risk is something we should be paying close attention to.”

An Associated Press-NORC Center for Public Affairs Research poll found in 2013 that 44 percent of older Americans said their job required physical effort most or almost all of the time, and 36 percent said it was more difficult to complete the physical requirements of their jobs than it was when they were younger.

William White Jr. said his father had been working in the same Chicago-based warehouse for over a decade and was a manager when he fell to his death on Sept. 24, 2015.

“My dad was the best at what he did. He’s the one who taught me everything I know,” the 26-year-old Chicago resident said. “He went up to get an item for the delivery driver and the next thing you know he made a wrong move and fell. The job is fast-pace and everybody is rushing.”

Thomas Stiede, principal officer for Teamsters Local 703, said White knew the safety procedures and he can’t understand why White didn’t wear a safety harness. “He was a very conscientious employee,” he said, his voice cracking with emotion.

Testa Inc. was fined $12,600 by the U.S. Occupational Safety and Health Administration for failing to provide safety training. The company declined to comment for this story.

The same year White died, the fatal accident rate in Illinois for older workers was 4.5 per 100,000 workers, 60 percent higher than the comparable rate for all workers.

In most states, the fatal accident rates for older workers were consistently higher than comparable rates for all workers.

Nevada, New Jersey and Washington had the greatest percent increase in fatal accident rates for older workers between 2006 and 2015.

The three states with the biggest percent decrease were Hawaii, Oregon and Vermont.

Eight states saw their overall workplace fatality rate drop, even as the rate for older workers increased: Massachusetts, Michigan, Montana, Nevada, New York, Texas, Utah and Washington.

In two states — North Dakota and Wisconsin — the trend was reversed; older worker accident rates decreased while the accident rate overall increased.

In metropolitan areas, Las Vegas ran counter to the national trend.

In 2006, the fatal accident rate among older workers in the Las Vegas metropolitan area was lower than the rate among all workers. But by 2015, the rate of deaths among older workers more than doubled even as the rate among all workers declined.

Transportation accidents account for a large portion of fatal workplace incidents among both older workers and workers in general.

In one such incident, Ruan Qiang Hua, 58, died last Nov. 21 from injuries suffered in a forklift accident at Good View Roofing and Building Supply warehouse, according to the California Occupational Safety and Health Administration. After a bag of mortar fell from the pallet, Qiang backed up and rolled off a ramp. The forklift tipped over and Qian was crushed when he jumped off.

The agency fined the San Francisco-based company $62,320, saying it had failed to ensure that forklift operators were competent and wore seat belts.

The company is appealing the penalties, according to OSHA.

Records show that Hua was not properly trained or certified as a forklift operator. Video of the incident showed he was not wearing his seatbelt. Other video from the worksite showed that other forklift operators also had not used their seat belts and that the employer failed to install a curb along the sides of the ramp to prevent the lifts from running off the ramp. The company declined to comment.

In California, the 2015 rate of fatal accidents was 3.4 per 100,000 workers for older workers, 60 percent higher than the rate for all workers.

The AP analysis showed that older workers were involved in about 1 in 4 fatal workplace accidents related to fires and explosions from 2011 to 2015.

In April 2014, Earle Robinson, 60, and other employees were doing maintenance work at Bryan Texas Utilities Power Plant, about 100 miles north of Houston, when there was a loud explosion. Workers called 911 and pleaded for help.

“He’s in bad shape. He’s got a lot of facial burns,” according to a transcript of the 911 calls. “He’s got some pretty bad burns.”

Robinson was taken to a hospital in Houston and died days later. The company declined to comment for this story.

The year Robinson died, the fatality rate among older workers in Texas was 6.1 per 100,000 workers — 43 percent higher than the accident rate for all workers.

The National Center for Productive Aging and Work is pushing for changes in the workplace to make it safer for older workers. The year-old center is part of the National Institute for Occupational Safety and Health.

“We advocate to make workplaces as age-friendly as possible,” said co-director James Grosch. For example, increased lighting helps older workers whose eyesight has weakened with age.

He said the center is emphasizing productive aging, looking at “how people can be more productive, how their wisdom can be leveraged in a workplace.”

Maria Ines Zamudio is studying aging and workforce issues as part of a 10-month fellowship at The Associated Press-NORC Center for Public Affairs Research, which joins NORC’s independent research and AP journalism. The fellowship is funded by the Alfred P. Sloan Foundation

The post Older people dying on job at higher rate than all workers appeared first on PBS NewsHour.

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