Social Security announced last week that its annual cost of living adjustment would be a paltry three-tenths of 1 percent in 2017. This small increase is not only unfair to Social Security recipients, but will also trigger an absolute mess with Part B Medicare premiums for the second straight year, writes Making Sen$e columnist Phil Moeller. 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 in “Ask Phil.” 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.

Social Security announced last week that its annual cost of living adjustment, or COLA, for 2017 would be a paltry three-tenths of 1 percent. That’ s 0.003 percent for readers who are more numerically literate than me. As I explained then, this small increase is unfair to Social Security recipients and will also trigger an absolute mess with Part B Medicare premiums for the second straight year.

READ MORE: Average senior’s Social Security check to increase a measly $4 in 2017

Melinda, from California, wrote me a heartfelt rant and lament about this situation. Because it channels what I think many older Americans are thinking, I want to share it with you and ask you to share it with others, including the you-know-whos in Washington. Melinda asks me in her note about my views of what should be done about this situation. My cup of vitriol certainly does runneth over here. But I’d rather hear from you first about what you think should be done. So please fire up you emails and let me know!

Hi, Mr. Moeller. I read your article, and this is why I am bloody mad.

This same thing happened last year. Now I have to worry about this year. I am past full retirement age, but am stalling to collect my Social Security, because it is the only “savings” that is paying 8 percent a year, or so they tell me.

The longer I wait, the bigger the amount of my monthly payment. Since I am facing so many inflationary expenses (property taxes, homeowner’s dues/condo assessments, etc.), I thought I should try to hold out.

The problem is that this darn Medicare Part B is rising, and it’s NOT RIGHT — especially for only 30 percent of the beneficiaries (I’m one of them) STUCK paying for everyone else with ridiculous out-of-control increases. THIS CANNOT STAND and must be fixed, not only for 2017, BUT ENTIRELY.

Last year, I called everyone in WASHINGTON who I thought would get on this right away, and of course, there was NO RESPONSE, other than congresspeople telling me don’t worry, eventually they’ll get to it. That is outrageous. Unacceptable. Things have to change.

What is your opinion on my waiting to collect Social Security (which I was planning on doing 12 to 15 months from now? (I would get about $1,500 to $1,600 extra a year). Right now, I have NO income. I am only living off of some savings that are at almost 0 percent interest.

This whole situation is KILLING SENIORS. I can’t believe that no one in the government is doing anything to help seniors other than make their lives miserable and actually try to kill them off. It’s disgraceful.

I would love your thoughts on this situation and anything you can tell me about it. Why do they take so long to decide until the last day of the year, making it impossible for people to plan their lives, budgets and financial plans?

Please let me know how you feel about Melinda’s take on the COLA and how it is affecting Medicare premiums.

As long as we’re in the neighborhood of dubious government rules, I’ve got another one to share. This doozy is about Medicare and involves an ill-named program called “seamless conversion.” Under this program, the government has the option of empowering private Medicare Advantage insurers to automatically enroll you in one of their plans, possibly without your knowledge and certainly without your approval. Fortunately, this program does not appear to be heavily used these days. But a bad idea is still a bad idea, and I wrote words to this effect last June.

READ MORE: Beware of being automatically enrolled in a Medicare plan you don’t want

Well, Medicare rarely comes right out and says it goofed. But late last Friday — the preferred time for organizations to issue unfavorable, embarrassing news — Medicare said it would temporarily suspend allowing any new insurers to use the program. Further, in a belated transparency move, it released information identifying the 29 Medicare Advantage insurers and their 59 different insurance plans that have been approved to engage in such conversions. Please review this list if you believe you’ve been subjected to this tactic.

“CMS is reviewing its policies for the optional seamless enrollment mechanism in light of recent inquiries regarding the mechanism, its use by [Medicare Advantage] organizations, and the beneficiary protections currently in place,” the agency said in its public announcement. It also noted that it doesn’t know how many such conversations have actually occurred! Lacking this information, the decision to suspend new participants reflects at least some ugly optics surrounding the program if not outright consumer abuses.

And now, what would an Ask Phil be like without some actual Ask Phil items?

Susan: My husband (age 73) has Humana Advantage coverage in the U.S. We will be residing in Hong Kong for a number of months, and he will need to have follow-up testing to monitor for kidney function (kidney recently removed) and cancer screening. Hopefully, these are only tests (not treatment). Please advise if there is a Medicare plan that will work for him as it is now time to reevaluate his options.

Phil Moeller: Medicare generally does not cover medical care outside the U.S. There are some Medigap policies that cover foreign care outside the U.S., but they cover only emergency treatment and not the kind of medical testing you mention in your note.

READ MORE: Are you prepared for Medicare open enrollment?

I am not sure how expensive these tests will be or what other health expenses both of you might incur. If it were me, I’d explore getting in-country health coverage and just continue to pay the Humana premiums while I was away.

I realize this is hardly a low-cost solution, and I’ve railed against Medicare’s non-coverage of care outside the U.S. In many cases, people can get superior and cheaper medical care outside the U.S., and doing so would save money for the Medicare program. As you can imagine, however, U.S. health care providers and insurers are hardly big fans of this!

Julie: I just finished the Medicare book. It is an excellent resource just like “Get What’s Yours” for Social Security. Thank you! My parents are both on Medicare Advantage plans (Kaiser Senior Advantage). It is my understanding that they cannot purchase Medigap policies to help defray additional out-of-pocket costs. If that is the case, what options do they have to help defray additional costs? They won’t qualify for long-term care insurance policies due to preexisting conditions. Any advice you can provide would be greatly appreciated.

Phil Moeller: Thanks for reading our books and for your kind words.

Yes, it is against the law for someone to have both a Medicare Advantage plan and a Medigap plan. Normally, Medigap plans do a better job of protecting a person from out-of-pocket costs than does Medicare Advantage. But it depends on the specific policies involved. Generally, each of them has out-of-pocket safeguards.

READ MORE: What Clinton and Trump propose for Social Security and Medicare

However, neither policy insures against long-term care expenses. Until and unless Congress tackles this problem, the only protection is for your folks to sock away more money in savings against the day when one or both of them will need long-term care. As you may know, if they run out of money, they can go onto Medicaid, which does cover long-term care. However, this is not an outcome anyone should look forward to.

In terms of defraying additional costs, I don’t have any easy fixes. They could explore group living arrangements to lower their current housing costs and also benefit from a broader support structure. They could move in with you (or vice versa) to lower expenses and also provide on-site help. These choices boil down to some form of downsizing that reduces current living expenses and builds up savings. Best of luck.

George: I read your article in the paper on Part A. I will turn 65 in February 2017 and will continue to work for a very large employer with whom I have health coverage. I will not collect Social Security. Am I allowed to sign up for Medicare Part A? Would it be considered supplemental? My wife will turn 68 in January 2017 and is covered under my work plan and does not collect Social Security. Is she allowed to sign up for Part A? Would it be supplemental?

Phil Moeller: You can elect to receive Part A when you turn 65. Because you qualify for Social Security, you don’t need to pay a premium for Part A.

I am not sure what you mean by Part A being supplemental. It can be what’s called “secondary” coverage, helping to pay covered hospital expenses that are not fully paid by your employer insurance. In this case, you would most likely need to pay any of your private insurance deductibles before Part A coverage is available.

Getting Part A makes sense to me unless you have a high deductible health plan with a health savings account. Tax-free contributions to HSAs are not allowed if you are on Medicare, and having Part A is considered being on Medicare.

Lastly, as your spouse, your wife is also eligible for premium-free Part A even if she has not worked enough to qualify for her own retirement benefits from Social Security.

Julie – Minn.: I’m 64 with a high deductible health insurance plan ($3,500 out of pocket plus $600 premiums — plus employer contribution — annually) through my employer and will begin Social Security at age 66 (my full retirement age). Is there a Medicare plan(s) that can mirror my existing coverage for the same amount of money? I’m going to live on a fixed income in retirement and planning for medical costs is a primary concern. Thanks for your help!

Phil Moeller: Great question!

Other than paying $4,100, I don’t really know how your insurance policy pays after that for covered expenses. Does it pay all of them or have a co-pay? Do you have a hard cap on your annual out-of-pocket expenses?

Looking only at the $4,100, I’d think you can find comparable Medicare coverage (but I’d stress again that it depends on details of your current coverage).

READ MORE: Signing up for Medicare? Read this cautionary tale first

The premiums for basic Medicare are $0 for Part A and, for most people, $104.90 a month now for Part B. Your Part B will be more expensive – at least $121.80 a month and possibly as high as $149. Each also has its own annual deductibles and, for Part B, copay requirements. Average premiums for Part D drug plans will be about $42, but that may require a $400 annual deductible and several thousand in potential out-of-pocket costs depending on the drugs you take. You then could get a Medigap plan to plug holes in basic Medicare. These policies easily can cost $200 or more a month, depending on the type of plan you get.

Alternatively, you could get a Medicare Advantage plan that includes basic Medicare, Part D coverage and out-of-pocket protection that can be comparable to a Medigap plan. Again, it will depend on the specifics of the policies. You normally have to pay the Part B premium in addition to a Medicare Advantage premium. Still, these plans usually are less expensive than having basic Medicare, Part D and Medigap.

There can be downsides to Medicare Advantage. These plans usually require enrollees to use doctors and hospitals in the plan’s provider network. These limitations can make it hard to get care from preferred docs and hospitals, especially if you have a serious health condition where seeing specialists becomes a priority.

The best advice I can provide is to read past Ask Phil Medicare columns that explain these matters in more detail. You can also find these answers in my new book, “Get What’s Yours for Medicare: Maximize Your Coverage, Minimize Your Costs.”

The post Column: Questionable Social Security and Medicare policies put seniors in a bind appeared first on PBS NewsHour.

The annual Medicare open enrollment period is underway, having begun on Oct. 15 and extending through Dec. 7. For 2017 plans, active shopping may yield the greatest benefits in Medicare Part D prescription drug plans, writes Phil Moeller. Photo by Heidi de Marco/KHN

Editor’s Note: Journalist Philip Moeller, who writes widely on aging and retirement, is here to provide the answers you need in “Ask Phil.” 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 annual Medicare open enrollment period is underway, having begun on Oct. 15 and extending through Dec. 7. During this period, you can shop for new Medicare policies and even switch from Original Medicare (Parts A and B) to a Medicare Advantage plan or vice versa. Most people don’t change plans, despite studies that repeatedly find they could save money and improve their coverage by doing so. Doing nothing here means you actually are doing something — automatically re-enrolling in your current plan.

For 2017 plans, active shopping may yield the greatest benefits in Medicare Part D prescription drug plans. Every day seems to bring another horror story of some pharmaceutical company cynically jacking up prices, not because of underlying business conditions, but simply because they can. Medicare officials, who are legally barred from negotiating drug prices, can do little here but continue approving claims for what often are outrageously overpriced drugs.

Part D premiums will be 9 percent higher in 2017 than in 2016, the Kaiser Family Foundation reported, and will average more than $42 a month. This is on top of the 13 percent jump in average premiums this year. These figures are for stand-alone Part D plans, which are the choice of about 60 percent of roughly 41 million Part D enrollees. The other 40 percent have Part D plans as part of their Medicare Advantage plans. I’ll be covering those plans in a couple of weeks.

(Geek alert: Kaiser’s averages and those in other Part D analyses are weighted to reflect the numbers of enrollees in different plans. So a plan with 2 million people has double the weight as one with 1 million participants.)

READ MORE: Signing up for Medicare? Read this cautionary tale first

There also will be fewer plans than in past years, continuing a consolidation trend that I think is healthy. There simply have been too many plans for consumers to feel at all capable of making informed decisions. CMS is encouraging plans to consolidate or even leave the market and is trying to focus attention on quality plans that receive the agency’s highest star ratings.

Even with fewer plans, most consumers will continue to have plenty of plans to choose from.  While there are lots of plans, there are not lots of insurers. Kaiser says four insurers control 80 percent of this market: Humana and United Healthcare, 24 percent each; Aetna, 22 percent; and WellCare, 10 percent.

Many Part D beneficiaries qualify for low-income subsidy benchmark plans that charge zero monthly premiums. The numbers of such plans offered by insurers is also decreasing. This means that millions of Plan D enrollees will need to find new plans for 2017.

There are great variations within this $42 average premium, so it’s essential to look at actual premiums for plans available in the ZIP code where you live. Beyond premiums, of course, you will also need to understand other key costs in Part D plans.

Rising prices have caused Medicare to raise the maximum allowable deductible for Part D plans to $400 from $360 this year (and $320 last year). This is the amount of money you must pay before you get any insurance coverage at all. In past years, lots of plans charged annual deductibles that were lower than the allowed maximum. Fewer and fewer are doing so now.

Once you have paid your drug plan’s annual deductible, Part D rules will cover you until you and your plan have spent $3,700 on covered drugs in 2017. Then, a so-called coverage gap kicks in and strips you of all insurance until total out-of-pocket spending hits $4,950. While in the gap, also known as the donut hole, you will pay 40 percent of the cost of brand-name drugs and 51 percent of the cost of generic drugs. However, 95 percent of the costs of brand name drugs will apply to the total spending in determining when you reach the end of the gap. For generics, it’s only the 51 percent of the cost that you paid.

READ MORE: Column: Questionable Social Security and Medicare policies put seniors in a bind

Under terms of the Affordable Care Act, the donut hole will disappear by the year 2020, at which time your copay for all drugs — branded and generics — will never be more than 25 percent. However, don’t assume this means you will be paying 25 percent as your share for each and every drug you take. This figure is what’s called, in Medicare-speak, an actuarial average. Some plans may charge you 40 or even 50 percent of the cost of a drug. However, they must also provide a commensurate offering of drugs with little or no co-pays. They can do this so long as their actuarial average is about 25 percent.

When total costs have reached $4,950, you will enter the catastrophic phase of plan coverage and will pay only a few dollars for each prescription or 5 percent of the cost, whichever is greater.

How to shop for a Part D plan

As I said in an earlier column, you should already have received annual documents from your Medicare drug insurer explaining any important changes in your plan for 2017. Here’s what to look for:

How will your overall costs change next year?

Go online to Medicare’s Plan Finder, put in your ZIP code and see what drug plans are offered where you live. Many of these plans will be included in Medicare Advantage plans. For now, just look at the drug part of those Medicare Advantage plans.

READ MORE: Get ready for big changes in Medicare drug pricing

You can get a rough idea of comparative plan costs for next year by looking at Plan Finder summaries for each drug plan. However, these summaries do not reflect your specific prescription drug needs and costs. Enter your drugs in the Plan Finder formulary section. This will take a little time, and most likely you will need to round up your prescription bottles and refer to them. The good news is that once you have completed your personal formulary, you don’t need to do it again. It will be stored at Plan Finder and accessible via a password, allowing you to easily compare different plans.

Doing this detailed comparison should give you a good idea of your annual out-of-pocket costs for different plans. This is the number you need to know to really compare plans. Just looking at monthly premiums is not enough and could lead you to make the wrong decision.

Are all your prescription drugs still included in your plan formulary (the list of prescription medicines covered by the plan)?

It’s essential to find out if your drugs are still in your current plan’s formulary in 2017. Insurers and pharmacy benefit managers are permitted to negotiate with drug companies on prices, so a drug may not have the same cost to you in different plans. Another way to combat high prices is to simply drop an expensive drug. This is also more likely to happen in 2017 plans. Medicare rules require plans to offer therapeutically equivalent drugs in key categories, so plans may argue that they can drop your drug and move you to a cheaper equivalent. Your prescribing physician has a strong voice here, so make sure your doctors accept any such changes. If not, you may be able to continue to get your preferred medication.

If you take any expensive medications, how will they be treated?

This information should be included in plan formularies as well. Look to see whether the plan is charging you significantly more for these drugs in 2017 than 2016 — either through direct increases or by moving the drug from one plan pricing group, or tier, into a more expensive one. Most plans have five tiers — preferred and other generics, preferred and other brand drugs and specialty medications (aka the ones that break your bank if not your financial back).

READ MORE: Are you prepared for Medicare open enrollment?

Even if you see an out-of-pocket total for a drug plan, this is probably not your worst-case financial hit. Under Part D rules, as explained above, you are still on the hook for up to 5 percent of the cost of a drug in the so-called catastrophic section of plan coverage rules. With some drugs costing $100,000 a year or even more, 5 percent can still be a lot of money.

Can you still get your prescriptions filled at your local pharmacy, and at what price?

Nearly all Part D plans now have preferred pharmacy networks. Filling your prescriptions with your plan’s preferred pharmacy provider will save you money, especially on mail-order prescriptions. Even if you can fill a prescription at a non-preferred pharmacy, you may end up paying a higher price. While the plans do publish enormous pharmacy directories, the easiest thing for you to do is call your preferred pharmacy and make sure it is still in the preferred network of your current plan for whichever plans you might be considering switching to during open enrollment.

Are your prescriptions written by a Medicare-enrolled provider?

A new Medicare rule took effect this year that denies Part D coverage for prescriptions that are not written by a provider who is enrolled in Medicare (most are) or has a formal exception from the agency. While this is not likely to trip you up with a physician’s prescription, dentists and other professionals can write prescriptions, and they also need to be enrolled. This is a preventable surprise you don’t want to get!

READ MORE: Lower drug prices: Does any candidate have an Rx?

Is your income low enough to qualify for Medicare’s Extra Help program?

Millions of Medicare beneficiaries receive financial assistance from Medicare to pay for their Part D drugs and even their insurance premiums. The Extra Help program can be complicated, so I recommend you get free help by calling a counselor in your state with the State Health Insurance Assistance Program.

Finally, here’s a look at 2017 premium changes in the nation’s most popular stand-alone prescription drug programs (PDP), courtesy of Kaiser. These 10 plans enroll more than 80 percent of all Medicare buyers of stand-alone plans:

*Cigna is banned from selling Part D and Medicare Advantage policies to new customers in 2017 because of Medicare rules violations. Existing customers can renew their Cigna policies.

Lastly, remember that these are averages and that the premiums offered by these plans where you live may differ a lot.

READ MORE: Is there any relief for astronomical drug costs?

Kaiser also has a very useful table in a recent report showing how much money major insurers charge enrollees for drugs in the five tiers of the their plans. You will find it on page 10.

I’ll be shifting to other aspects of open enrollment next week, as well as getting back to answering your questions. Send your questions to me here.

The post Here’s how to find the Medicare Part D drug plan right for you appeared first on PBS NewsHour.

Tens of millions of adults are chronically lonely, which has deleterious impacts on aging. Photo by brunella fratini/via Adobe

A new national campaign rolling out on Wednesday aims to raise awareness of a hidden but devastating complication of aging: loneliness.

Tens of millions of adults are chronically lonely. And a growing body of research has linked that isolation to disability, cognitive decline, and early death.

The first-of-its kind campaign, organized by the AARP Foundation and the National Association of Area Agencies on Aging, aims to help seniors assess their social connectedness and suggest practical ways they can forge bonds with other people.

“This is a public health issue of growing concern,” said Lisa Marsh Ryerson, president of the AARP Foundation.

Addressing stigma will be a priority. “Who wants to admit that, ‘I’m isolated and I’m lonely?’” said Dallas Jamison, a spokeswoman for the National Association of Area Agencies on Aging. “It’s a source of shame and embarrassment.”

Her organization represents 622 agencies across the country that provide meals, transportation, in-home help, and other support to seniors. They’ll take the lead in identifying older adults who are isolated and linking them to resources, in part through the federal government’s Eldercare Locator. The campaign will also encourage families to talk about these issues during the holidays.

READ MORE: Paging Miss Lonelyhearts: Social isolation boosts risk of cardiac disease

These efforts come as research highlights the physical and emotional toll of isolation in later life.

A seminal study of more than 1,600 seniors age 60 and older found that lonely people were far more likely have difficulties with walking, bathing, dressing, and climbing stairs than those who were not. They were also 45 percent more likely to die during the six years that researchers tracked them, from 2002 to 2008.

Some 43 percent of seniors interviewed for that study said they were lonely — a subjective feeling of not being meaningfully connected to other people. Based on a separate analysis, AARP estimates that 42.6 million adults age 45 and older are chronically lonely.

That feeling of isolation sounds an “I’m not safe; all is not well” alarm in seniors, raising blood pressure, sparking inflammation, inspiring stress, and interfering with the immune system’s response.

“If you’re lonely, you feel there aren’t adequate people around to support you and that means you have to surveil your environment continuously for every kind of threat,” said Linda Waite, director of the National Social Life, Health, and Aging Project and a professor of sociology at the University of Chicago.

“This consumes cognitive, physical, and psychological resources,” Waite said, “and makes it harder for you to do other things that might be beneficial to your health.”

READ MORE: How old is too old? A debate on toying with the human life span

Social isolation may mean that you rarely get out of the house and lack a support system of people who will notice when you’re feeling sick, bring over chicken soup, go out and get a decongestant, or take you to the doctor. About one in five seniors reports being isolated, Jamison said.

Still another line of research suggests that loneliness and isolation doubles the risk of Alzheimer’s disease in older adults by inducing changes in the brain that are not yet well understood.

“Humans evolved to live in social groups, and we’re most comfortable when we feel part of a group — more relaxed, happier, with lower blood pressure and cortisol levels,” Waite said.

Along with the coming campaign, the AARP Foundation plans an initiative called Connect2Affect that will highlight research on loneliness and innovative attempts to address the issue.

This article is reproduced with permission from STAT. It was first published on Nov. 16, 2016. Find the original story here.

The post Loneliness harms aging health. This new campaign aims to curb isolation appeared first on PBS NewsHour.

This is a rebroadcast of an interview that originally aired on April 13th, 2016.

Before journalist Lesley Stahl joined 60 Minutes, she became the first woman to serve as CBS News' White House Correspondent. Her coverage of news, political leaders and stories has taken her around the globe. Her latest investigation looks into the science of grandparenting. In Becoming Grandma: The Joys and the Science of the New Grandparenting Stahl reflects on her own experiences as a grandmother, and interviews friends and experts to understand how grandmotherhood affects women. 

Journalist Philip Moeller shares tips from his latest book, Get What's Yours for Medicare: Maximize Your Coverage, Minimize Your Costs. "Sporkful" podcast host Dan Pashman gets an inside look at the economics and shady dealings of the truffle business. "Gilmore Girls" star Lauren Graham on her new collection of personal essays, Talking as Fast as I Can: From Gilmore Girls to Gilmore Girls (and Everything in Between). How "Office Christmas Party" directors Josh Gordon and Will Speck mange their dual careers in advertising and filmmaking.

Philip Moeller, who writes the "Making Sen$e" Medicare column for the PBS NewsHour website and reports on aging, health and retirement for Money magazine, shares advice from his latest book, Get What's Yours for Medicare: Maximize Your Coverage, Minimize Your Costs, part of his “Get What’s Yours” series.  Moeller explains how to select the right Medicare plan and offers retirees ways to maximize their health coverage and save money in the process.

Photo by MoMo Productions via Getty Images

Aging is generally associated with improvements in our quality of life: We become more proficient in our work, learn how to manage our finances better and our bonds with loved ones deepen. With time and practice, most of the core domains of our lives improve as we develop skills and strategies to manage our lives with more mastery. An exception to this pattern is the quality of our sex lives, which has consistently been reported to deteriorate with age.

While this fits with the messages we receive from popular culture, which tell us that sex is a young person’s domain, it is somewhat at odds with the fact that older adults continue to explore and enjoy sexuality well into old age. The majority of men and women over 60 in the U.S. are sexually active, most at least two to three times per month (more often than many younger adults). They also rate sex as an important part of life.

So, if there is no epidemic of age-related frigidity, why would sexual quality of life take a nosedive in later life? A common answer to this question cites declining physical health and sexual functioning with age. Another answer might be: The quality of our sex lives doesn’t decline with age.

Studying sex and aging

There is a key element missing from nearly all studies of sex and aging: studying change over time. If we ask a group of people how satisfied they are with their sex life, and the younger people are more satisfied than the older people, does that mean that aging is responsible for this difference? What if instead the apparent age difference is because people born in the 1930s have different attitudes toward sex than people who grew up after the sexual revolution of the ‘60’s and ‘70’s?

To get to the bottom of how aging affects sexual quality of life, we analyzed patterns in longitudinal data collected from over 6,000 individuals followed over a period of 18 years, spanning ages 20-93. In 1995, 2004 and 2013, the representative sample of English-speaking Americans completed extensive self-administered survey questionnaires in private and returned them by mail.

A key question for our study was: How would you rate the sexual aspects of your life these days, from the worst possible situation (0) to the best possible situation (10)?

The basic trends in the data suggested that – without taking any other factors into account – sexual quality of life declines with age. But as people in the study aged, they placed more emphasis on the quality – not quantity – of sexual encounters. For example, frequency of sex became less important with age, and the amount of thought and effort invested in sex became more important.

These changing priorities were key predictors of sexual quality of life for older adults, and appeared to buffer its decline. When we matched older and younger adults on key characteristics of their sex lives – along with sociodemographic characteristics, and mental and physical health – older adults actually had better sexual quality of life.

For example, if we compared a 40-year-old man and a 50-year-old man with the same levels of perceived control over their sex life, who invest the same amount of thought and effort in their sex life, have sex with the same frequency and had the same number of sexual partners in the past year, we would expect the 50-year-old to report better sexual quality of life.

This is consistent with the improvement we see in other life domains with age, and highlights the benefits of life experience for sexuality as people learn more about their sexual preferences and their partners’ likes and dislikes. The positive relationship between sexual quality of life and aging was strongest in the context of good-quality romantic relationships, where sexual exploration and a focus on partners’ pleasure is more likely to take place.

Life experience related to a better sex life

Together these findings suggest that as we age, our sexual priorities change and we develop knowledge, skills and preferences that protect against aging-related declines in sexual quality of life. Since wisdom is “the quality of having experience, knowledge and good judgment,” our study suggests that life experience is fostering sexual wisdom.

This is great news, as a satisfying sex life has been found to be important for health and well-being, regardless of age. For older adults in particular, being sexually active predicts a longer and healthier life.

We now know that age-related declines in sexual quality of life are largely related to modifiable factors, so we can target sexual skills, beliefs and attitudes in clinical interventions. Given that our life expectancy continues to grow, this research highlights the opportunity to facilitate positive sexual experiences across the lifespan.

Miri Forbes, Postdoctoral Research Fellow in Psychiatry and Psychology, University of Minnesota; Nicholas Eaton, Assistant Professor, Clinical Psychology, Stony Brook University (The State University of New York), and Robert Krueger, Professor of Psychology, University of Minnesota

This article was originally published on The Conversation. Read the original article.

The post Column: Why age doesn’t get in the way of good sex appeared first on PBS NewsHour.

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.”

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.”

___

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.

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.

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 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.

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.

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?

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.

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 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.

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.

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.

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.

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.

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!

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?

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.

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.)

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.”

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.

4. Get the jewelry appraised. It’s possible that a necklace, ring or brooch has value and could be sold.
5. Look for a nearby consignment shop that might take some items. Or, perhaps, a liquidation firm.
6. 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.
7. Download the free “Rightsizing and Relocation Guide” from the National Association of Senior Move Managers. This helpful booklet is on the group’s site.
8. 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.

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)

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.

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.

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. 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.

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

The post Many seniors who qualify for home-based care under Medicare aren’t receiving it. Why? appeared first on PBS NewsHour.

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.

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.

“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.

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.

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.

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.

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.

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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.

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