Dear Marci,

I recently got a letter saying that I might be eligible for the Medicare Savings Program. How do I know if I qualify?

-Imani (New York, NY)

Dear Imani,

I’m happy to help with this question! The Medicare Savings Program (MSP) can help pay your Medicare costs if you have limited income and savings. States use different rules to count your income and assets to determine if you are eligible for an MSP.

Examples of income include wages and Social Security benefits you receive.
Examples of assets include checking accounts and stocks.
Certain income and assets may not count when determining your MSP eligibility. And some states do not have an asset limit.

You’ll want to check your individual state’s eligibility guidelines, but here are typical eligibility limits for some states:
Income limits:
Individual- $1,715
Couple- $2,320
Asset limits
Individual- $9,430
Couple- $14,130
If your income or assets seem to be above the MSP guidelines, you should still apply—different counting rules mean that you could still be eligible.

To learn about the eligibility rules for the MSPs in your state, contact your local State Health Insurance Assistance Program (SHIP).

Good luck!

-Marci

Dear Marci,

I want to put together a plan with my health care wishes in the event that I’m unable to make decisions at some point in the future. Can you help me get started?

-June (Bar Harbor, ME)

Dear June,

That’s very wise of you! First, it’s good to know that in most cases, you don’t need a specific form to put together your wishes. Second, these are your options in terms of the types of documents you may want to put together:

Health care proxy: This names someone you know as your proxy, or representative, and allows them to express your health care wishes for you if you’re unable to do so for yourself.
Living will: This lists out the type of medical care you would want in specified circumstances.
Advance directive: This can be a combination of both a living will and health care proxy documents.
Power of attorney: This names someone you trust as your agent to make property, financial, and other legal decisions for you, and is usually prepared by a lawyer.
Note: you can choose the same person to be your proxy in charge of making both medical and legal decisions, but you’ll have to put this on two separate documents.
Once you’ve decided which documents you’ll want to put together, you should make sure that they:
Comply with any state rules
Cover all the issues that are important to you
Next, make sure you discuss your future care documents with family members, health care providers, and anyone else you think should be in-the-know. You’ll want to give your providers a copy of your documents and bring a copy to the hospital each time you are admitted, if possible.

Here are some resources if you need help creating these documents or finding more information about your state’s rules:
Your state’s attorney general office or department of health
The National Hospice and Palliative Care Organization
The American Bar Association Commission on Legal Problems of the Elderly
Your state bar association
Your local hospital
Good luck!
-Marci

Dear Marci,

Some of my friends were chatting about health care directives and future health care wishes. Is this really important to do right now? I’m in good health.

-Rafael (Garden City, UT)

Dear Rafael,

It’s understandable to feel that you don’t need to think about this topic when you’re in good health! You should know, however, that putting your future health care wishes in writing can be very helpful to your family members, if you were to suddenly find yourself in a position where you can’t make health care decisions for yourself due to being incapacitated by injury or illness.

Every state has different rules about who makes decisions about your treatment if you are physically unable to do so. In many cases, the decision-making is left in the hands of your health care providers, unless you’ve assigned someone as your legal representative in advance.

If medical decisions are casually left up to your family, it can be difficult and time-consuming for them to agree on different treatment options. It can also be costly for them to get the legal right to make medical decisions for you, and they may also disagree on who should make these decisions for you. Having a plan with your wishes written out ahead of time can help to avoid confusion and disagreements, and it ensures your wishes are honored if you’re unable to speak for yourself!

Start by talking to your family about your wishes. When you’re ready, completing an advance directive is one of the most important things you can do for yourself and your family to ensure your healthcare wishes are met.

Good luck!

-Marci

Dear Luca,

Yes! There are indeed some changes coming in 2025, and you might’ve received an eligibility letter about it earlier this year. A new program called the Postal Service Health Benefits (PSHB) program will be offering health insurance to eligible Postal Service employees, retirees, and their eligible family members. PSHB will replace your current FEHB coverage beginning January 1, 2025. It’ll be the only health benefits program available through the Postal Service to employees, retirees, and their eligible family members. Here’s what you need to know:


Some eligible members will have to enroll in Medicare to keep their PSHB:

Active employees that are under the age of 64 (as of 12/31/24) and are participating in FEHB as of 12/31/24
Covered family members of retirees when the primary PSHB enrollee is enrolled in Medicare Part B

Note: Those who are enrolled in Medicare Part B as of 1/1/2025 must remain enrolled in order to continue participating in the PSHB program.


Some eligible members do not have to enroll in Medicare:
Retirees who retired on or before 12/31/24 and who are participating in FEHB as of 12/31/24.
Covered family members of retirees who are participating in FEHB as of 12/31/24 (unless the primary PSHB enrollee is enrolled in Medicare Part B, see above list)
Active employees age 64 or older (as of 12/31/24) who are participating in FEHB as of 12/31/24

Some retirees eligible for PSHB might still wish to enroll in Medicare as they transition from FEHB to PSHB.
Even though it isn’t required, enrolling in Medicare Part B may reduce a retiree’s overall health care costs.

You can learn more about the upcoming changes in the USPS’s fact sheets for current Postal employees and their document for retirees.

Good luck deciding!

-Marci

Dear Marci, 

I’m a federal employee with medical coverage and am going to retire soon. Do I need to get onto Medicare to have primary health insurance?

-Natalia (San Jose, CA)

Dear Natalia,

The quick answer is no. Employees covered under the Federal Employees Health Benefits (FEHB) program can keep their benefits after retirement if they’ve had FEHB for at least 5 years and the whole time they have been eligible for that coverage. Unlike other employer-based coverage, FEHB will continue to operate as a primary payer after your retirement if you don’t enroll in all or part of Medicare. However, declining Medicare Part B when you’re not covered as a result of current work means that you’ll likely owe a late enrollment penalty (LEP) if you enroll later.

The decision to enroll in Medicare when you retire from federal employment depends on your unique circumstances and preferences. Here are your options:

Keep FEHB and turn down Medicare.
FEHB is unlike most other retiree coverage in that it can remain as your primary insurance if you don’t enroll in Medicare.
If you decide to do this, you might still want to enroll in Medicare Part A, while declining Part B, since Part A is premium-free for many.
If you enroll in Medicare Part B later, you will likely have to pay a late enrollment penalty.
Keep FEHB and enroll in Medicare Part A and Part B.
You’ll have to pay both premiums.
Medicare will be primary, and the FEHB plan will cover your deductibles and cost sharing.
FEHB may cover some things that Medicare does not, and vice versa.
Your FEHB drug coverage is creditable for Part D, and you will not need to enroll in a separate Part D plan.
Note that FEHB drug coverage cannot be suspended separately from FEHB health coverage. If you want to keep your FEHB health coverage, you must keep drug coverage, even if you enroll in Part D.
Disenroll from FEHB and enroll in Medicare.
Keep in mind that you may lose the option of signing up for FEHB again in the future. Speak to the office of Personnel Management (OPM) to learn more about your FEHB-specific rights and options.
When you think about the pros and cons for each option, you might want to ask yourself the following questions:

Which insurance do my providers (and providers I wish to see in the future) accept?
What would be my costs for the health care services I use the most?
Which option offers flexibility for the future if I need it?
You can contact the U.S. Office of Personnel Management (OPM) if you’re a federal employee or retiree and want to learn more about your health benefits by calling 317-212-0454.

Good luck deciding!

-Marci