June 2022

The Many Facets of Retirement Inequality

Retirement inequality is a thread running through several articles that have appeared here this year.

One blog that was particularly popular with our readers distinguishes retirees who have enough wealth to maintain the same spending levels throughout retirement from those who will, over time, have to cut back and reduce their standard of living.

The research behind the article – “Health and Wealth Drive Retirees’ Spending” – makes clear that wealth is just one component of a satisfying lifestyle. Even retirees who can afford to maintain their living standard may not be healthy enough to enjoy their money to the fullest. The retirees who have both – health and wealth – are best equipped to maintain their pre-retirement lifestyle.

Homeownership also marks a dividing line between the haves and have-nots. A home is one of retirees’ largest sources of wealth. Although most are hesitant to withdraw home equity, the ones who have equity and tap it to pay medical bills see large, positive health benefits, according to “Using Home Equity Improves Retirees’ Health.”

Pensions are another dividing line. “Retirees with Pensions Slower to Spend 401(k)s” shows the value of having guaranteed income from defined benefit pensions, which are all but extinct outside the public sector. …Learn More

Limiting Medical Debt: a 50-State Ranking

Lawmakers in Maryland, California and Maine have made the most effort to prevent residents from drowning in medical debt. Texas, South Carolina and Tennessee do the least.

This is the assessment of an organization known as Innovation for Justice, a team of researchers at the University of Arizona and the University of Utah. They ranked the 50 states on whether they have taken myriad steps to minimize medical debt. These legislative measures range from restrictions on the healthcare industry’s billing and collection practices to how debt claims are handled in the courts.

Medical debt is the single largest category of consumer debt, and the Kaiser Family Foundation estimates that 100 million Americans are behind on paying their medical or dental expenses – and a quarter of them owe more then $5,000.

This project would be important at any time and is even more so during a pandemic when many people have incurred medical debt for COVID. Some of that debt is even for bills the federal government would’ve paid on behalf of the uninsured cashiers, drivers, retail workers, restaurant servers and cooks who were on the front lines in the worst days of the pandemic.

Putting the state rankings into a national perspective, the consumer protections to prevent the accumulation of debt are not exactly impressive. Only three of the 50 states qualify as having good protections. The researchers ranked another 27 states as weak and 20 as poor.

Compare Medical Debt Policies by US StatesMaryland, which sits at the top of the medical debt scorecard, satisfies most of the researchers’ criteria for debt reduction. State lawmakers have limited residents’ debt by mandating that patients be screened for health insurance or government health benefits. The state also regulates hospital billing practices, instructing them to offer a payment plan before sending a patient’s bill to collections and requiring that bills itemize every charge, every payment, and whether charity care has been provided to the patient.

Last but not least, Maryland expanded its Medicaid program, as encouraged by the Affordable Care Act, to extend subsidized or free health insurance to more of its low-income workers. Medical debt has been reduced in the states that expanded their coverage. The lowest-ranked states – Texas, South Carolina and Tennessee – are among the states that have not expanded Medicaid.

Visit the medical debt scorecard to see what your state is – or isn’t – doing. …Learn More

Problem? Medicare Rights Center Can Fix it

He is a one-time heart surgery patient and vulnerable to COVID. She has to take her medication religiously twice a day to prevent a blood pressure spike.

Image of Mr. and Mrs. Quader.

Mr. and Mrs. Quader.
Source: Medicare Rights Center.

During the pandemic, Mr. and Mrs. Quader of Brooklyn, New York, got a notice that the health care subsidy they had been receiving through the Medicare Savings Program for low-income retirees had been terminated.

Luckily, counselors on the Medicare Rights Center’s telephone hotline solved the couple’s problem – just like they have helped tens of thousands of retirees nationwide every year that the center’s New York City helpline has been operating.

“They knew where to go. They knew what to do,” Mrs. Quader said in one of several video testimonials posted to the Medicare Rights Center’s website. “They stood by us every time.”

She made the call to the center because she had just happened to hear about it. It turned out the Quadar’s paperwork had been lost in the system, and the couple’s counselor got the benefits restored.

Rose. Source: Medicare Rights Center.

Rose.
Source: Medicare Rights Center.

The Medicare Rights Center’s services, which are free of charge, cover myriad problems retirees encounter under Medicare, such as how to appeal insurance company denials of coverage for treatments or medications. The counselors also solve unique problems like that of a 66-year-old woman named Rose. The Plant City, Florida, resident needed a replacement wheelchair but had received one she was unable to use, rendering her immobile. The center got her a chair that worked for her.

“When I sat down in that chair for the first time, it was nice and cushy,” she said in a Medicare Rights Center video. “I could finally go [outdoors] and see the light.”

Many people who call the center need help with simpler issues like enrolling in Medicare Parts A and B or sorting out their options for additional coverage. Bill’s enrollment problem was much more complicated. …Learn More

Early Life Traumas Lead to Early Retirement

little girl choosing and taking book from shelf to readMental illness, obesity, smoking, chronic disease – researchers have been able to connect the dots between an array of stresses early in life and how people will fare as they age.

New research zeroes in on the adversities experienced by children and young adults that ultimately contribute to a premature retirement due to a disability.

The basic finding is not terribly surprising – that life’s financial and social circumstances can lead to disabling conditions that will either nudge, or force, older workers to leave the labor force early.

More remarkable is the exhaustive list of past experiences that can increase that risk.

For example, childhood financial adversity in this study took many forms – an unemployed father, family relocations for financial reasons, or even having few books in the house. People whose families struggled financially when they were children were the most likely to retire prematurely.

The study was based on surveys asking older working people born during the Baby Boom, the Depression, and World War II about stressful or traumatic events experienced in childhood and middle age. The researchers followed them through several years of surveys to determine who retired before turning 62. The early retirees were asked whether a medical condition or chronic disability was either an important reason for leaving the labor force or prevented them from continuing to work altogether.

Added to the childhood traumas are a range of social adversities faced by young and middle-aged adults – the death of a spouse, natural disasters, combat duty, divorce, violence, or having a child addicted to drugs – that also increased the likelihood of early retirements. …Learn More

Economists Show Inequities’ Roots in Slavery

Conversations about the vast White-Black disparity in U.S. wealth may acknowledge its roots in slavery. But four economists have now made the case quantitatively by charting changes in the wealth gap since the Civil War.

The political and societal influences on wealth accumulation between 1860 and today are multifaceted but the basic trajectory is this:

The wealth gap shrank by roughly half during the Civil War era from 1860 to 1870 and dropped in half again between 1870 and 1920, the researchers said in their recent paper. The decades of improvements in Blacks’ per capita wealth, compared with Whites’, occurred despite a quick end to Reconstruction after the Civil War and the rise of Jim Crow laws around 1890 that curtailed recently freedmen’s rights in the South. (I’ll explain more about this counterintuitive finding below.)

Progress continued but was more modest after the 1920s and started stalling out around the 1950s. The situation deteriorated after the go-go-1980s on Wall Street as Black Americans’ wealth levels fell behind largely because they own much less stock and haven’t equally enjoyed the bull market gains of recent decades.

The wealth gap is so entrenched today, the study concluded, that reaching equality is “an extremely distant or even unattainable scenario.” …Learn More

Does Private Disability Affect Federal Rolls?

Does Private Disability Affect Federal Rolls?

Economists have long thought that if employees have disability insurance on the job, they might never migrate over to the government’s disability rolls. A new study finds just the opposite.

In Canada, the existence of short-term disability in the private sector increased the number of people going into the national government’s program by 18,300 in 2015 and increased program spending by 5 percent, according to a researcher at the University of Toronto.

The logic behind this is that enrollment rises in the government program, which provides long-term benefits, because a negative incentive is at play. If employees with a disability or workplace injury have short-term coverage at work, they will have a regular source of income to tide them over while they apply for government benefits and wait for a response.

The Canadian study has implications for the United States, because the two countries’ programs are similar. The connection between U.S. government and employer disability is also of interest because some policymakers here would like to see mandates for employer disability become more widespread. Ten U.S. states and the District of Columbia currently require employers to provide the coverage for serious medical conditions.

This research adds a new voice to a lively debate on both sides of the U.S.-Canada border. Others have argued that when companies offer short-term disability, they prevent some people from going onto the government rolls by giving them time off to recover from an illness or injury before it becomes chronic. Employers also have an incentive to control their insurance costs by preventing injuries or accommodating employees with disabilities so they can keep working. …Learn More

Get Help with Medicare Coverage Denials

The United States has a notoriously complex healthcare system, and Medicare is no different.

In the early months of the pandemic, the Medicare Rights Center received a large number of calls to its telephone help line from people over 65 who had suddenly been laid off and lost their employer coverage. Even when there isn’t a crisis, the center’s staff and volunteers answer all manner of questions about Medicare enrollment rules, insurance options, and what to do when an insurance company denies them coverage.

Sarah Murdoch is the center’s director of client services and oversees the helpline. She spoke with Squared Away about the common issues retirees face and how they can address them.

Question: Your helpline fielded 42,000 questions about Medicare in 2020 and 2021. How does that compare to past years?

It’s in that ballpark year to year – around 20,000 questions. But we saw, within that 42,000, a shift in the actual trends.

Throughout the pandemic, particularly in 2020 when there were lockdowns and people were getting laid off left and right, we got a lot of calls from people who unexpectedly had no income. We heard from people who had insurance through their job and that was not an option anymore. Or they were already on Medicare and were trying to figure out how to pay their costs, or they were laid off and had to figure out how to get into Medicare. That has eased up but was a big thing we saw in the beginning of the pandemic.

We also had questions related to benefits for low-income people. We told people who suddenly had zero income about the income requirements for the Medicare Savings Program, Medicaid, and the state pharmaceutical assistance programs – anything that can lessen the hardship.

In 2020 and 2021, nearly a third of the complaints on your helpline were about service denials by insurers that provide Medicare Advantage or Part D drug plans. Start with Advantage plan denials – are they a big issue for retirees?

The Medicare Advantage plans often have doctor and hospital networks, whereas original Medicare doesn’t have networks. People may be denied coverage by an Advantage plan if they have an out-of-network provider. It could also be a denial of a medical service or a prescription medication. We do see it more but it’s hard to tease that out from the fact that more people are just enrolled in Medicare Advantage.

Do Medigap supplements to Medicare have similar issues with denial of coverage?

Medigap is different – the plans are never making their own claim determinations. If something is approved by original Medicare, then Medigap is going to pay for it as long as the retiree has a Medigap plan that has that type of coverage. In the Medicare Advantage policies, however, insurers are making the claims determination. All of the insurance companies have their own claims adjusters making those decisions – as opposed to contractors who process claims for the Medigap plans on behalf of the Centers for Medicare and Medicaid Services. The Medigap insurer isn’t making any decisions as to whether something is covered or not – it has already happened at the government level. …Learn More