Q&A

  • I am confused about Medicare. I thought it was all free when I got my Social Security, and now I find out that I have to pay for it.

Medicare has four parts. Part A is free. It is included with your Social Security retirement benefit when you are 65, and with your disability benefits stating with the third year of benefits. If you take your retirement benefit at a reduced level, before you are 65, you do not get Medicare right away.

Medicare starts at age 65. Part A is for hospital benefits, ambulance rides, and some other benefits. You should sign up for Medicare at age 65 even if you do not take your Social Security retirement benefit until you are at your full retirement age or even older, especially if you want the larger monthly amount.

Part B is for your doctor's bills. You have to pay for Part B. There is a premium for Part B and the amount of the premium depends on your adjusted gross earnings for the second year before the current year. People who made more in earnings pay a higher premium. When you apply for Medicare, you are asked if you want Part B. Most people should say yes. If you get your primary care at the VA, you may not need this.

Medicare Part B has a deductible and a co-pay. Most people have a Medicare Supplemental insurance to pay for all or some of the deductible and co-pays. If you are poor enough, you can also get Medicaid, which pays the Medicare premium and all the other fees to health care providers.

Part C is what you should choose, along with Part B, if you want an HMO. The Part B premium pays for this. If you take Part C, the federal government pays the HMO a set amount of money every month for your care, whether you get any care or not. The amount of money paid depends on where you live and some other factors, but not on the amount of care you get. If you sign up for Part C, you usually have to go to the HMO doctors for care, although they may approve you seeing an outside doctor in special situations.

Part D is a prescription drug benefit. There are many insurance plans to consider for Part D, and you should consider the medicines you take before you pick the plan you want. There may be people at your nearby senior center who will explain the different plans and help you find the one that is best for you. Medicaid also pays for some medicines. You have to pay for Part D. Some Medicare supplemental insurance includes medicines.

The premium for Part B and the premium for Part D will be deducted from your Social Security benefit. If you do not receive a monthly Social Security benefit, you will have to pay these fees yourself.

  • I was born and raised in Puerto Rico. I then left and worked in New York and New Jersey for 10 years and then I returned to Puerto Rico where I live now. My younger brother also left Puerto Rico many years after me, and he worked in New York and New Jersey, and he still lives in New York. Both of us worked in the same company in New York and New Jersey. The jobs we had usually paid a little more than minimum wage. When I reached retirement age, I applied for retirement benefits at my local Social Security Administration office in Puerto Rico. I was told my retirement benefit amount was $700 per month. Two years later, my brother in New York retired at age 66. His retirement benefit was $728, but he also got several hundred dollars more under SSI (Supplemental Security Income). So I went back to the Social Security office in San Juan to apply for SSI. But I was told there was no SSI in Puerto Rico. Is that correct?

Yes, correct. SSI is available to residents of the 50 states. SSI is not available in Puerto Rico or the US Virgin Islands.

  • I stopped working more than 15 years ago due to a partial leg amputation. I got a prosthesis, but I was never able to return to work activity, because there were always problems with the prosthesis and I needed many additional surgeries during the past 15 years to improve the prosthesis performance. The last surgery improved the prosthesis somewhat, but I now suffer with diabetes which makes me feel very fatigued all day. I am now 55 years old and my wife lost her job. Can I apply for SSI and get benefits right away?

Yes, assuming you meet certain financial criteria of less than $3,000 (per couple) in cash assets, and other criteria, you are entitled to SSI benefits. Social Security regulation 20 C.F.R. 416. 962(b) states that if you have a severe medically determined impairment, no past relevant work (work performed within the last 15 years), have a limited education and reached the age of 55, an award of benefits to you will follow.