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Navigating Medicare
By: Elaine Floyd, CFP®
Back in the day, when full retirement age for Social Security was 65 and most people retired and claimed benefits then, Medicare basically took care of itself. Enrollment was automatic along with the Social Security application, and many employers offered retiree health insurance to supplement Medicare. Those who didn’t have retiree insurance could buy a Medigap policy to cover prescription drugs (Part D did not yet exist), and some of the gaps left by Medicare, primarily the Part A deductible and the Part B 20% coinsurance. Medicare Advantage did not yet exist. Once a person was on Medicare with their retiree insurance or supplement, there was very little for them to think about. Medical bills were paid behind the scenes and the occasional bill they did receive was easily paid out of pocket.
Medicare is much more complicated today. If you are not receiving Social Security at age 65 (which, hopefully, you are not), you will not automatically be enrolled in Medicare. If you are working past age 65 and staying on your employer plan, you will have to figure out when and how to make the transition to Medicare, also taking your spouse’s insurance into consideration. With medical costs now so high and fewer employers offering retiree coverage, private insurance plays a much bigger role than it did before. This opens up many more choices and complications, all of which hinge on your individual health status and expected health care usage both now and in the future.
Financial advisors are often called to help with Medicare, even though it is clearly outside their financial wheelhouse. But because HR people who are helping employees with the rest of their retirement don’t really understand Medicare (and how it interacts with COBRA), and because you are being bombarded with marketing messages from private insurers who don’t have your best interests in mind, a little direction from your financial advisor can go a long way. It is not necessary for them to pry into your personal health situation, but by receiving a few tools and resources you should be able to navigate Medicare on your own.
Medicare enrollment periods
There are specific times a person can enroll in Medicare. In fact, the Medicare application asks a series of questions to determine if the person is currently in one of the enrollment periods. If not, they will not be allowed to proceed with the application.
The first is when they turn 65. This is called the initial enrollment period. A person can enroll in Medicare up to three months before their 65th birthday. Coverage will start the first of the month they turn 65. If they’re a little late it’s okay—they can apply up to three months after their 65th birthday. Coverage will start the first of the month after they enroll.
The second is called the special enrollment period and it’s for people who want to stay on an employer plan (based on active employment of self or spouse) after age 65. As long as they maintain continuous coverage under the employer plan, they can switch over to Medicare at any time. Most commonly the transition to Medicare is done when they leave employment. But they can do it anytime after age 65 (i.e., while still working) and up to eight months after termination. There is really no reason to utilize the 8-month grace period, though, because it could result in coverage gaps. COBRA pays secondary to Medicare for anyone age 65 or older, so even if a person takes COBRA (too expensive!), they will have to enroll in Medicare.
The third enrollment period is the general enrollment period, from January 1 to March 31 of each year, with coverage starting the month after enrollment. This is for anyone who missed one of the other Medicare enrollment periods. If there has been a gap in coverage, there may be a late-enrollment penalty: 10% of the Part B premium for every 12-month period they went without health insurance after age 65. This penalty will be assessed every year.
Part A and Part B enrollment is through SSA
The Social Security Administration handles Medicare enrollment. The easiest way to enroll is to do it online. Or people can call the main number: 800-772-1213. They’ll need to provide their Social Security number and place of birth as well as current health insurance information. It will not be necessary to prove insurance if they are enrolling during their initial enrollment period. But if they are enrolling after age 65, during their special enrollment period, in order to avoid penalties they’ll need to have their employer sign CMS Form L-564 attesting to their continuous health insurance coverage. If their initial enrollment period overlaps with their special enrollment period, the initial enrollment period takes precedence.
What Clients Need To Know About Opening and Managing Their Social Security Account
Go to Medicare.gov for private insurance options
Once a person is enrolled in Medicare Parts A and B, they can sign up for: 1) a Medigap policy and Part D drug plan, or 2) a Medicare Advantage Plan. Note that enrollment in these plans cannot take place until they are enrolled in Medicare, but shopping can start earlier. People who want to do it themselves can go to medicare.gov and “find health and drug plans” based on their zip code.
If they have opted for Original Medicare with a Medigap policy, they’ll be shopping for both a Part D drug plan and the Medigap policy. For the drug plan, they’ll want to enter their drugs and dosages in order to see what their out-of-pocket costs would be under each plan. If they don’t take any drugs, they can simply choose the lowest-premium plan. (But they can’t skip Part D; if they go more than 63 days without creditable drug coverage there will be a late enrollment penalty.) Drug plans operate a year at a time. If a person’s drug regimen changes or if the plan changes, they can shop for a new drug plan during the fall open enrollment period (Oct. 15–Dec. 7) and the new plan will start January 1. For Medigap, they’ll want to focus on Plan G, the most popular and comprehensive plan. The Medicare.gov website shows the options from the different carriers. “Issue age” is the better pricing method, otherwise premiums will escalate rapidly as they age. Because benefits are the same for all Plan G policies, they’ll be focusing primarily on monthly premiums. For drug plans they can enroll directly through the Medicare.gov website or, if they have further questions, can call the insurer and have them take the application. For Medigap policies they can call the plan or enroll through the company’s website.
People who opt for a Medicare Advantage plan can pull up all the plans in their area and review benefits and costs. Most Advantage plans have very low (or no) premiums, so it will be a matter of reviewing benefits and out-of-pocket costs for the various services. Medicare Advantage shopping can be a challenge because if there are things that are wrong with the plan—such as a narrow provider network or a propensity to delay or deny care—they won’t be apparent other than indirectly through a low star rating.
Open Medicare account
Once a person has enrolled in Medicare they can establish an account at medicare.gov and keep track of their claims, costs, and other information.
While transitioning to Medicare can be rather time-consuming, once it’s set up it should be easy to manage, especially if the person has Original Medicare and a Medigap policy and drug plan. Virtually all Medicare-approved expenses will be covered and paid behind the scenes. Drug plans will need to be reviewed annually, but the switch to a new plan is easy. (Be sure to note if the preferred pharmacy changes.) Medicare Advantage plans could be easy or difficult to manage depending on your health care experience and whether you face delays or denials in care. If you are dissatisfied, these plans can also be changed once a year.
Source: Horsesmouth, LLC
Horsesmouth, LLC is not affiliated with Lane Hipple or any of its affiliates. -
In Case of Death
Managing Death Records and Addressing Fraud Concerns
SSA’s death master file has been in the news lately, first in connection with DOGE’s “discovery” that there were 120-year-olds in the system who could not possibly still be alive (they weren’t, they were just never marked as deceased because of coding quirks, and were certainly not receiving benefits), and most recently because the Trump administration is reporting certain immigrants as deceased in an attempt to get them to self-deport.
Once a person is listed as deceased in SSA’s master death file, they have no Social Security number and thus can’t get a job, open a bank account or get a loan, and pretty much have no financial life in America. The Administration is hoping people in such a position will voluntarily leave the country, never mind that some of them are here legally or that allowing immigrants to work actually strengthens the Social Security system because many of them pay into the system without ever collecting benefits. And heaven help anyone who gets placed in SSA’s death master file by mistake; they must prove to SSA that they are still alive and it can takes weeks to get their financial life back.
SSA’s master death file holds death records for some 83 million people, partly to assist financial institutions, insurance companies, and state and local governments in detecting fraud (they must have a subscription to access the database), and partly to allow survivor benefits to be paid to the spouse and/or children of a deceased number holder listed in the file.
Reporting a death
It is usually not necessary for a surviving spouse to report the death. Deaths are generally reported to SSA by the funeral home. However, if this is not done for some reason, a surviving spouse would need to call SSA at (800) 772-1213 and provide the name, Social Security number, date of birth, and date of death of the decedent.
Decedent’s benefit stops immediately
Once a death is reported, SSA will immediately stop benefits being paid to the decedent. The financial institution will place a hold on any benefits that are direct-deposited after the date of death and will return them to SSA.
To be entitled to a benefit for any given month, a decedent must be alive the entire month. But benefits are paid in arrears, so it’s possible for a decedent (his estate, really) to be entitled to a check that arrives after death. For example, the check deposited in April would be for March. If a decedent died on April 2, and if the check (for March) was deposited in the account on April 16, the estate would be entitled to that payment. Since the bank will likely put a hold on it, the estate would have to reclaim the benefit by filing Form SSA-1724. This form also takes care of any Medicare premiums withheld after the decedent’s date of death.
$255 lump sum death benefit
SSA pays a $255 one-time lump sum death benefit to the surviving spouse of the decedent. If there is no surviving spouse the $255 death benefit is paid to minor or disabled adult children. If there are no spouse or children, it may be paid to a former spouse who is eligible for survivor benefits (i.e., if they were married over ten years or she is caring for the decedent’s child). To claim this benefit the spouse or child would need to call SSA at (800) 772-1213. It cannot be claimed online.
Survivor benefits
Ongoing survivor benefits may be paid to a surviving spouse, any eligible ex-spouses, and any minor or disabled adult children. These benefits can be claimed by calling SSA at (800) 772-1213 and making an appointment with an agent at a local office. They cannot be claimed online.
If the decedent dies before his full retirement age and before he has claimed his own retirement (or disability) benefit, SSA establishes a “death PIA” approximately equal to the amount he would have received if he had continued to work and claim his retirement benefit at his FRA. This death PIA is held in the system and increased by annual COLAs until the surviving spouse is ready to claim it. If she remains unmarried she may claim it as early as age 60; however claiming that early will cause it to be reduced to 71.5% of the full amount.
If the decedent dies after his full retirement age but before he has claimed his benefit, the “original” survivor benefit will equal the amount he would have received if he had claimed as of the month of death, including any delayed credits earned up to the month of death. The “actual” survivor benefit will depend on when the widow claims it and may range from 71.5% to 100% of the amount depending on when, between the ages of 60 and FRA, that she claims it.
If the decedent was receiving benefits at the time of his death, the original survivor benefit will generally equal 100% of his benefit amount. (If he was receiving less than 82.5% of his PIA by virtue of having claimed at age 62, the original survivor benefit will be the special minimum of 82.5% of his PIA.) Again, her actual benefit will depend on when she claims it.
It will be important to coordinate the widow’s own retirement benefit with the survivor benefit, sequencing benefits to maximum advantage—that is, claiming one benefit and switching to the other. See this newsletter and use the Savvy Social Security software to analyze claiming strategies. A widow who remarries after age 60 may claim survivor benefits based on her former husband’s earnings record. If there is more than one deceased former husband, she may choose the highest benefit.
Surviving divorced spouses may also claim survivor benefits if they were married to the decedent over ten years and are currently unmarried (or remarried after age 60). The same switching strategies are available to surviving divorced spouses.
Source: Horsesmouth, LLC
Horsesmouth, LLC is not affiliated with Lane Hipple or any of its affiliates. -
ssa.gov/myaccount: What Clients Need To Know About Opening and Managing Their Social Security Account
Ever since SSA started offering Social Security accounts in 2012, the information and tools that people can access through their individual accounts have grown, making these accounts a very valuable resource for anyone who hopes to collect Social Security someday—in other words, everyone who works or is married to someone who works. And now that SSA is considering implementing certain anti-fraud strategies, it will be more important than ever for people to open and maintain their own Social Security account. This will enable them to verify their identity online and apply for benefits directly through the portal rather than waiting on hold for a telephone representative to take the application or traveling to a field office for an in-person appointment.
Under new anti-fraud measures, anyone applying for benefits or changing their direct-deposit information will need to do it through their Social Security account. If they are unable to do so, they would need to provide the necessary documentation in person at a field office. Now that most field offices are not taking walk-ins, this would require waiting on hold for a representative to make an appointment, and then traveling to the nearest field office to show the required documentation. I have to say that anyone who mistrusts the Internet for the purpose of verifying identity will just have to get over it. This is the way it’s done now, and it really should cut down on fraud compared to relying on human telephone representatives to verify identity.
This latest initiative reaffirms the fact that everyone needs to open a Social Security account at ssa.gov/myaccount.
Benefits of having a Social Security account
In addition to greater ease in verifying identity and applying for benefits, there are additional benefits to having an online Social Security account. By having an account clients can:
Download their latest statement. This, of course, is the first step in doing Savvy scenario planning for your client. They can either download a copy of their statement and send the PDF to you, or they can refer to their benefit estimate and give you the amount they are projected to receive if they file at their full retirement age. This is their PIA, which you will enter into the Savvy Software. The software will adjust for claiming age and COLAs based on the client’s projected filing date.
Use the Retirement Estimator. The benefit estimates shown on the statement presume continued earnings to claiming age. If a client plans to retire before claiming Social Security, the Retirement Estimator will allow them to see what their benefit would be if they were to stop working earlier. The Retirement Estimator taps into their existing earnings record, so all they have to do is enter projected earnings going forward (e.g., $0). Since this tool is accessible only through an individual’s Social Security account, you would not be able to run it for them, but you can help walk them through it. Be sure to have your clients enter a retirement date that corresponds to their FRA, otherwise the tool will assume they want to apply for benefits at 62 and the benefit estimate will incorporate the reduction for early claiming. The Savvy Software needs the FRA estimate and will make any adjustments for early claiming.
Check their earnings record. The statement shows annual earnings but it now batches earlier earnings by decade. By scrolling down to the bottom of the page on the Social Security online account, clients can access their complete year-by-year earnings. If there are any errors or discrepancies, they can contact SSA about correcting their earnings record. New earnings are reported each year, usually between March and October. It’s a good idea for clients to check in each year to make sure their newly reported earnings are correct. SSA gets this information directly from the W-2s that go to the IRS, so errors are rare. But if a client is self-employed, SSA uses net Schedule C income as reported on the client’s tax return. This is where errors sometimes occur, especially if a client gets an extension on their filing date.
Get a benefit verification letter. Clients who are already receiving Social Security can access their full benefit information via their account including the gross amount and any withholdings for Medicare or taxes. If they need to provide income verification for a loan application or other purpose, they can download their latest benefit verification letter showing all the information.
Get 1099s. For clients receiving benefits, each year’s SSA-1099 is posted on their Social Security account going back to 2019.
How to establish a Social Security account
SSA has adopted strict and effective cybersecurity measures for online Social Security accounts, so your clients need not worry about entering their personal information. Once they do it and the account is set up, interacting with SSA will be very easy as many functions such as address and direct-deposit changes can be done online. Once identity is verified, the account will tap into the information SSA has on file for them allowing people to see their personal earnings and benefit information and also update SSA’s records with any changes on their end.
Prior to 2021, setting up a Social Security account was simply a matter of establishing a username and password and answering a number of questions in an attempt to verify identity. SSA had teamed up with the credit reporting agencies to ask questions only clients would know the answer to, such as the street they lived on five years ago and to which bank they send their mortgage payments. This was not ideal, as clients often did not remember previous residences or otherwise were unable to answer the questions. Once the account was set up, clients would access it by entering their username and password—also not ideal because passwords can be stolen. Fraudsters could go in and change direct-deposit information and have their victims’ Social Security checks sent to them.
So SSA has switched to more effective identity verification methods paired with two-factor authentication for logging in. The two credentialing methods are Login.gov and ID.me. Anyone who has previously opened a Social Security account with a username and password can still access their account for the time being, but this login method will soon be retired, so everyone is encouraged to switch over to one of the other methods before that happens.
The main method for logging in is now Login.gov. Some clients may already have ID.me accounts for other government uses; if so, they can keep them and use them for their Social Security account. Anyone outside the U.S. would use ID.me. But most people will be starting from scratch with Login.gov, which is a U.S. government sign-in service that provides a simple, secure, and private way for the public to access government websites. Supported web browsers are Google Chrome, Microsoft Edge, and Apple Safari. Before starting, clients should make sure they have the latest version of their browser; if they have any technical difficulties signing up, clearing their cache and cookies may resolve the problem. Here are instructions for clearing cache and cookies for Chrome, Edge, and Safari.
Related: SSA Sign-In Process to Change Soon
To start, clients can refer to Login.gov instructions. They’ll need to enter their email address, wait for a verification link, and then create a username and create a strong password. In addition, they’ll need to set up a second layer of security such as face or touch unlock, an authentication application such as Google Authenticator or 1Password, or a physical security key. However, the easiest two-factor authentication method (which I use but which SSA says is not the most secure) is to simply have a code sent to your telephone via text message.
Once the Login.gov account is set up, SSA does require a photo ID to verify identity. Clients can simply take a picture of their driver’s license or passport and upload it to the site.
Most clients should have no trouble creating their Social Security account. It takes a little bit of time initially, but will save time in the long run and is very secure. Make this part of your checklist for all clients regardless of age.
Source: Horsesmouth, LLC
Horsesmouth, LLC is not affiliated with Lane Hipple or any of its affiliates. -
Social Security Announces Expedited Retroactive Payments and Higher Monthly Benefits for Millions
Actions Support the Social Security Fairness Act
Written by Mark Hinkle, Social Security Press Officer
Today, the Social Security Administration announced it is immediately beginning to pay retroactive benefits and will increase monthly benefit payments to people whose benefits have been affected by the Windfall Elimination Provision (WEP) and Government Pension Offset (GPO). These provisions reduced or eliminated the Social Security benefits for over 3.2 million people who receive a pension based on work that was not covered by Social Security (a “non-covered pension”) because they did not pay Social Security taxes. The Social Security Fairness Act ends WEP and GPO.
“Social Security’s aggressive schedule to start issuing retroactive payments in February and increase monthly benefit payments beginning in April supports President Trump’s priority to implement the Social Security Fairness Act as quickly as possible,” said Lee Dudek, Acting Commissioner of Social Security. “The agency’s original estimate of taking a year or more now will only apply to complex cases that cannot be processed by automation. The American people deserve to get their due benefits as quickly as possible.”
People who will benefit from the new law include some teachers, firefighters, and police officers in many states; federal employees covered by the Civil Service Retirement System; and people whose work had been covered by a foreign social security system.
Many beneficiaries will be due a retroactive payment because the WEP and GPO offset no longer apply as of January 2024. Most people will receive their one-time retroactive payment by the end of March, which will be deposited into their bank account on record with Social Security.
Many of these people will also receive higher monthly benefits, which will first be reflected in the benefit payment they receive in April. Depending on factors such as the type of Social Security benefit received and the amount of the person’s pension, the change in payment amount will vary from person to person.
Will I receive retroactive payments?
Anyone whose monthly benefit is adjusted, or who will get a retroactive payment, will receive a mailed notice from Social Security explaining the benefit change or retroactive payment. Most people will receive their retroactive payment two to three weeks before they receive their notice in the mail, because the President understands how important it is to pay people what they are due right away. Social Security is expediting retroactive payments using automation and will continue to handle many complex cases that must be done manually, on an individual case-by-case basis. Those complex cases will take additional time to update the beneficiary record and pay the correct benefits.
Social Security urges beneficiaries to wait until April to ask about the status of their retroactive payment, since these retroactive payments will process incrementally into March. Since the new monthly payment amount will begin with the April payment, beneficiaries should wait until after receiving their April payment, before contacting Social Security with questions about their monthly benefit amount.
Visit the agency’s Social Security Fairness Act webpage to learn more and stay up to date on its progress. Visitors can subscribe to be alerted when the webpage is updated.
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2025 Reference Guides
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