Q&A: Medicare Advantage questions

Dear Liz: You posted a letter against Medicare Advantage plans. The letter suggested that you had to go to their doctors, which is false. You can go out of network with a higher deductible. I will also tell you that most of those same doctors accept your in-network deductible. I do this all the time when I’m at my summer home.

Answer:
As mentioned earlier, Medicare Advantage plans are offered by private insurers as an alternative to traditional Medicare. The plans can differ in what they cover and how.

For example, if your Medicare Advantage plan is a preferred provider organization, you may indeed have some coverage if you use a medical provider outside the plan’s network. If the Medicare Advantage plan is a health maintenance organization, the plan may not cover out-of-network care except in an emergency. HMOs also may require you to get a referral to see a specialist.

Contrast that with traditional Medicare, which allows you to see any medical provider that accepts Medicare (which is most of them). One of the downsides to traditional Medicare is the co-insurance, including deductibles and copayments. However, you can purchase a supplemental, or Medigap, policy from a private insurer to cover those. There are a number of Medigap plans, but what they cover is standardized.

Medicare Advantage plans often pay for things that Medicare does not, such as hearing, eye care and dental. Many people who sign up for Medicare Advantage are, like you, pleased with their coverage. Others are not, though. Read on:

Dear Liz: Regarding the pros and cons of traditional Medicare versus Medicare Advantage options, I want to share a personal horror story about my parents. Both are now deceased, and I went through hell dealing with their Medicare Advantage plans.

These plans often send classy color brochures in the mail to seniors approaching 65, inviting them to a free lunch to hear all about the excellent care that they supposedly will receive when signing up with these health plans — all with no extra monthly premiums! Both my parents fell for the promises offered by these “free” plans.

As you wrote in your response, there are serious and inconvenient limitations to the quality of care and the hospitals and doctors covered in these networks. It was frustrating.

My mother’s primary care doctor always seemed exhausted and never explained anything correctly. He seemed to be annoyed when we asked him to repeat information. My dad’s plan told him it was not contracted with the hospital closest to him and referred him to a hospital much farther away. His primary care physician was rude, disrespectful and uncaring.

As my father’s health advocate, I was always arguing with his insurer. My dad became depressed at the poor quality of care and the lack of support from this company. I think he just gave up. He passed away in 2018 of prostate cancer, which had spread into his lower back. Had he received proper testing when it was supposed to be done, the cancer may have been caught early and treated. It was too far gone to treat by the time it was diagnosed.

If you stay with traditional Medicare, there are supplemental health plans that cost a few hundred dollars a month. I have heard from friends and relatives that the care is better through paid supplemental plans.

Bottom line: You get what you pay for. Probably best to stick with plain old Medicare; you might just live longer.

Answer: Like all private health insurance, Medicare Advantage plans can vary dramatically in quality. You can’t assume that one person’s experience with Medicare Advantage will be the same as another’s.

You can assume, however, that any insurance with lower upfront costs will have higher costs or more restrictions, or both, if you need a lot of care. If you want more freedom to choose your medical providers and you can afford the premiums, traditional Medicare with a supplemental policy may be a better fit.

Q&A: Financial aid and 529 plans

Dear Liz: As a grandparent who has established 529 accounts for each of my grandchildren, I was particularly interested in your advice to the writer who asked you how to use money that’s left in the 529 account to pay off a loan debt. Although it seems that “the horse had already left the barn,” why didn’t the niece use all the funds in the 529 account before accruing student loan debt? Am I missing something?

Answer: It’s possible the withdrawals could have reduced the niece’s financial aid, so she opted to take out loans instead.

In the past, the federal financial aid formula heavily penalized withdrawals from 529 college savings accounts held by people other than the beneficiary’s parents. The accounts themselves weren’t counted by the formula, but any withdrawals were treated as untaxed income to the student. The standard advice was to wait until the last financial aid form had been filed to begin taking withdrawals.

That’s going to change, although not as soon as originally expected.

The Consolidated Appropriations Act of 2021 required the Free Application for Federal Student Aid, or FAFSA, form to be simplified, removing several questions including one about whether the student got money from people other than parents.

The new FAFSA form was supposed to be released next year, but the Department of Education announced in June that the proposed changes would be delayed but implemented in time for the 2024-25 award year. Until the form has been updated, you’d be smart to hold off on tapping the 529s if your grandchildren will need financial aid.

Q&A: Mailing checks really is a bad idea

Dear Liz: I differ with your opinion that electronic payments are far more secure than sending checks through the mail. My own personal experience sending checks for about 40 years with only one mishap (which wasn’t attributable to the USPS) provides great confidence in mail as a payment system. In contrast, not a month goes by without news of some large organization entrusted with all kinds of personal and financial information being breached in a cyberattack. If the bad guys get my credit card information, I’m out no greater than $50. I’m not also going to risk them having my bank account and routing numbers for the dubious convenience of saving a stamp. Yes, mailboxes get broken into, but until there are real penalties for inadequate computer security, corporations will continue to underfund their network security and be reactive instead of proactive. I’ll take my chances with the local thieves and not the worldwide population of black hat hackers.

Answer: You’re quite right that databases where information is stored can be vulnerable to hackers if companies don’t take the proper precautions. But avoiding electronic payments doesn’t keep your information out of those databases. Information about you is collected and stored whether you like it or not. You didn’t contribute your Social Security number, date of birth and credit account details to Equifax, for example, but chances are good you were one of the 147 million Americans whose information was exposed when that credit bureau was breached.

In contrast to some databases, electronic payment transactions have strong encryption that makes it extremely difficult for hackers to intercept and read the information. Criminals would much rather target information that’s at rest in databases than try to capture and decode it in transit.

Your checks are almost certainly being converted to electronic transactions, in any case. Few checks are physically passed between banks these days. Often a biller will take the routing and account numbers that are printed on your check and use them to request an electronic funds transfer through a clearinghouse such as the Automated Clearing House (ACH).

Because those numbers are printed on every check you send out, by the way, anyone who sees that piece of paper, from a mail thief to someone inputting the payment into a company’s computer system, could misuse that information. That’s a far bigger risk than the possibility an electronic payment could be hacked in transit.

Q&A: Establish home’s value at spouse’s death

Dear Liz: I think you left one thing off your list of things to do when your spouse dies. If you’re a homeowner, establish the value of the house as of the date of death. The best way would be to have a local Realtor run some comparables for your neighborhood. But even a printout from Zillow would suffice. As you know, a surviving spouse receives a step-up in basis as of the date of death so it’s important to know what the house was worth at that time for when the house is sold down the road. I see many clients at our CPA firm who have to try to figure out many years later what their house was worth when their spouse died.

Answer: Thank you for the excellent suggestion.

In fact, many things were left off last week’s list of things to do when a spouse dies, which is why I directed people to their attorney or accountant for a detailed checklist. I also recommended people consult a fee-only financial planner, since there probably will be decisions that require expert help.

Q&A: Tax consequences of giving versus bequeathing

Dear Liz: Someone who expects to be an executor recently wrote to you about a plan to distribute individual pieces of art to family members. Your response addressed the executor’s responsibility to determine the art’s worth before doing so. You also suggested having the parent designate what was to go to whom. What would the consequences be of the parent giving the pieces of art to the intended recipient prior to death? My mother did both; i.e., gave some to me and some to my sister prior to her death, and designated others to be distributed following her death. She had personal rather than financial reasons for doing it this way.

Answer: Let’s say your mom bought a painting from a struggling artist for $500. Later, the artist became famous and the painting’s value rose to $500,000. If she gave you the painting and you sold it, you would have to use the amount she paid — her basis — to determine the taxable profit ($499,500).

If she bequeathed the painting to you instead, the artwork would get a new tax basis which is usually its value on the day she died. You could sell the painting for $500,000 and not owe a dime in taxes.

Few people have artworks that experience that kind of appreciation — or any appreciation, for that matter. The issue of basis most often comes up when people are transferring real estate, stocks or other assets in transactions that are reported to the IRS. If your mom did have valuable works, though, transferring them through bequests could be advisable.

Q&A: To sell or not to sell that collection

Dear Liz: You’ve twice advised collectors to sell their collections while they’re still alive, rather than leave the task to an executor who won’t have the collector’s intimate knowledge of the market for these items. Collectibles bring joy to the collector and are probably most valued the closer the end approaches. It would bring sadness rather than joy to unload them right at that point in life. Right now, I’m trying to declutter my house and even the stuff that has been moldering in boxes for decades hurts a little to let go of. I’m named as the executor in a buddy’s trust and will need to move his tools. Even if his old arthritic hands can’t operate the lathe anymore, he looks at the machine and I can see the memory of turning a bowl in the expression he wears. I say, accept the responsibility of an executor fully.

Answer: If you haven’t served as an executor, you may not fully understand how daunting and time consuming the task can be even without having to deal with a large collection.

No one is suggesting that people divest themselves entirely of a prized collection. But letting go of stuff can be immensely freeing, as well as a real gift to the people we leave behind.

If you need motivation to continue your decluttering, consider reading Margareta Magnusson’s book, “The Gentle Art of Swedish Death Cleaning: How to Make Your Loved Ones’ Lives Easier and Your Own Life More Pleasant.”

Q&A: Retitling a deed after marriage

Dear Liz: Our house was titled “joint tenant with right of survivorship” after my husband inherited the property in 1998. As a same-sex couple, we were not married at the time. However, we legally married in 2013. Will one of us get the step-up in tax basis when the other passes, or do we have to retitle the house some way? We also want to avoid probate. We live in California.

Answer: As you know, California is one of the community property states that allows both halves of a property to get a step-up in tax basis when one spouse dies. This double step-up can be a huge tax saver, since none of the appreciation that happened before the death is taxed. Other community property states include Arizona, Idaho, Louisiana, Nevada, New Mexico, Texas, Washington and Wisconsin. In Alaska, spouses can sign an agreement to make specific assets community property.

In contrast, in common law states, only half of the property gets the step-up to a new tax basis when one spouse dies. The other half retains its original tax basis.

Although assets acquired during a marriage are generally considered community property regardless of how they’re titled, in your case the property was acquired before marriage. The current title of joint tenants with right of survivorship would avoid probate, but it will not achieve full step-up in basis when the first spouse dies, said Mark Luscombe, principal analyst for tax research firm Wolters Kluwer.

Q&A: Your prized collection isn’t going to sell itself

Dear Liz: I am in the process of winding down my duties as executor of the estate of a 91-year-old gentleman who, like the reader who wrote to you, had a prized collection. I had repeatedly urged him to dispose of his prized things. I reasoned that because he was retired and had the time, and because he knew the story behind his prized items, he was in a far better position to find a buyer than I would ever be. (Knowing the provenance of the item is important because people purchase the story, not just the item itself.) He did dispose of some of the more valuable things and actually got some good cash, which he was able to enjoy. But he didn’t follow my advice completely, which meant that when he died, I had to deal with his remaining prized collectibles.

My suggestion to any older person who has collectibles is: Don’t wait to dispose of items that have market value. If you’re retired and have the time, sell the items yourself! If you don’t need the cash, deposit the money into the bank account that will pass to your heirs in due course. Don’t burden your executor — who is probably still working full time and who has bigger things to deal with, like your house, car and investment accounts — with disposing of your collectibles.

Answer: Obviously, parting with collectibles can be tough. The alternative, though, could be that precious items wind up in a yard sale or a dumpster. Collectors who sell get the satisfaction of knowing that the items are going to people who really want them.

Q&A: Death doesn’t take a holiday

Dear Liz: In a recent response, you wrote, “Your living trust should name a successor trustee who can take over managing your affairs if you should become incapacitated or die.” This sort of writing is not uncommon but it implies some people won’t die. It would have been better to write “… take over managing your affairs when you die or if you should become incapacitated.” This is important, since it is noteworthy how many people are unwilling to face the facts when it comes to being prepared and finances: None of us are going to get out of this alive.

Answer: Good point!

Q&A: Why it makes sense to play the Social Security waiting game

Dear Liz: I’m concerned that you don’t make it clear that in order for a Social Security benefit to grow, a person needs to keep working and earning the same income that they’ve been making. I’ve retired recently and am lucky enough to have a pension to live on. I talked to someone at the Social Security office recently. She recommended that I go ahead and start drawing my benefits now because there will be minimal growth for the next seven years if I’m not working. She says lots of people think that they should wait, no matter what. However, she says it doesn’t make sense if you’re not working. Even my personal financial advisor was recommending that I wait, but the person at the Social Security office convinced me otherwise. When you go on Social Security’s website to check your benefits, all the estimates are based on continued employment at your current salary. There’s no way to check and see what your estimates are if you are working less or not at all. I think it’s important to give the whole story.

Answer: Yes, it is, and you didn’t get the whole story — or even correct information — from the Social Security employee who convinced you to ignore your financial advisor.

Benefits grow by 5% to 7% each year you delay starting between age 62 and your full retirement age, which is between 66 and 67, depending on the year you were born. After your full retirement age, your benefit grows by 8% each year you delay until age 70, when it maxes out. That guaranteed growth happens regardless of whether you continue working or not.

You are correct that Social Security’s estimates of the dollar amount you’ll receive assume you will continue working until you apply, so it’s possible that your benefit will be somewhat lower when the agency actually calculates your first check. But that doesn’t mean you won’t benefit from the delay — you just won’t benefit quite as much as they’re estimating.

If you want to get a better idea of what your benefit will look like without additional earnings, you can use an online tool like Social Security Solutions or MaximizeMySocialSecurity.

Your financial advisor probably has access to similar tools, as well as a wealth of research about the best claiming strategies that make it clear most people are better off delaying. Plus, your advisor knows the details of your personal financial situation.

The woman at the Social Security office did not. Even if she had her facts straight, she should not have been giving you advice about maximizing your benefits.

You may still have time to rectify this mistake. You can withdraw your application within 12 months and pay back the money you received to reset the clock on your benefits. If it’s been longer than 12 months, you can suspend your benefit once you reach your full retirement age and at least get the 8% delayed retirement credits for a few years.