Monday, March 28, 2022

 How do I get antiviral pills for Covid-19?

NYT "Well" Section

Alex Merto

First, you must test positive with a P.C.R. or rapid test. This can be done at home, at a regular health care provider’s office, at a testing site or at one of the pharmacy chains, community health centers, long-term-care facilities or Veterans Affairs clinics participating in the “test to treat” program.

If you test positive at a participating location that dispenses antivirals and has an authorized medical provider, you can get a Covid-19 pill prescription (if eligible) and fill it on the spot. If you test positive at a different testing site or through an at-home testing kit, you can schedule an online or in-person visit with a provider at a “test to treat” location to get and fill a prescription as well.

And just like with other medications, your regular health care provider can call in a prescription to a pharmacy for you, said Kuldip Patel, the senior associate chief pharmacy officer at Duke University Hospital in North Carolina. A federal “test to treat” website, expected to go live soon, will include locations that test for the coronavirus and dispense antiviral treatments on the spot. For now, the drugs are free until the Federal Supply runs out.

 Who is eligible for antiviral pills?

NYT "Well" Section
Alex Merto

Not everyone who tests positive for Covid-19 will get a prescription for antiviral pills, said Dr. Annie Luetkemeyer, a professor of infectious diseases at the University of California, San Francisco. To be eligible, you must test positive and have symptoms that started within five days or fewer. You must also be at increased risk of developing severe Covid-19.

Those who are asymptomatic, or who have symptoms but are not higher risk, will not be eligible.

While this may seem like very specific criteria, many people in the United States have medical conditions that would qualify them for the high-risk category, Dr. Luetkemeyer said. That includes all adults 65 and older, as well as those of any age with certain health conditions like heart disease, cancer, diabetes or obesity, she said.

It’s important, though, that you get treatment within five days of the start of your symptoms. “That’s pretty soon because people often don’t test the first day they have symptoms,” Dr. Luetkemeyer said. “You might feel a little bit lousy and think maybe you just have a cold that’ll go away.” But if you wait more than five days, you will no longer be able to take the oral medicines, she said.

And while federal guidelines prioritize treatment for those who are unvaccinated or who are not fully vaccinated and boosted, your vaccination status will not affect your eligibility.

 How effective are Covid antivirals?

NYT "Well" Section

Alex Merto

Both Paxlovid and molnupiravir have been shown to reduce hospitalization and death from Covid-19 if taken early on in the course of an infection. “They are most effective when used within a few days of the onset of symptoms,” Dr. Gandhi said.

In a Pfizer trial published in December and conducted before the Omicron wave, Paxlovid reduced the risk of hospitalization and death in high-risk, unvaccinated people by 88 percent when given within five days of symptom onset.

Molnupiravir, however, has been shown to be less effective. One analysis from Merck, also published in December, showed that it reduced the risk of hospitalization and death in high-risk, unvaccinated adults with Covid-19 by only 30 percent if taken within five days of symptom onset.

Because of this lower efficacy, Dr. Gandhi said that “most clinicians, including myself, prefer Paxlovid if it’s available and if a person doesn’t take any other medications that make Paxlovid a problem for them.”

 What are antiviral drugs and how do they work?

NEW YORK TIMES " Well" Section

Alex Merto

Tamiflu, one of the most well-known antivirals, can minimize flu symptoms and shorten the course of illness when taken within a few days of getting sick. It can also be used prophylactically (in nursing home residents, for example) to prevent viral spread during outbreaks. Other antiviral therapies, like those for H.I.V. and hepatitis C, can be taken chronically, even in the absence of symptoms, to prevent the disease from progressing and to curtail symptom flares.

Most antivirals work by suppressing a virus’s ability to infect and multiply in your cells, said Dr. Rajesh Gandhi, an infectious diseases physician at Massachusetts General Hospital. This helps the body fight off an active infection by easing the symptoms and shortening the length of the illness.

But the exact way an antiviral does this depends on the treatment you use. Some antivirals prevent viruses from spreading to healthy cells by blocking the receptors on cell surfaces. Others inhibit the machinery that a virus needs to make copies of itself once it has already barged inside your cells. Because of this, it has been notoriously difficult for researchers to develop antiviral medicines that blunt viral replication without harming the human cells they hide inside, Dr. Gandhi said.

Monday, March 7, 2022

Social Security offices, closed in the pandemic, are expected to reopen in March.

 The agency, whose offices were closed nearly two years ago, and the unions representing its work force agreed to reopen more than 1,200 offices.

New York Times

By Mark Miller

  • Jan. 21, 2022

The national network of Social Security customer service offices, which were closed nearly two years ago at the start of the pandemic, is on track to reopen on March 30.

The Social Security Administration and unions representing the agency’s work force agreed this week to reopen more than 1,200 offices, contingent on changes in pandemic conditions and further negotiations. Bargaining is set to conclude by March 1, which would allow 30 days to plan for the office re-entry.

“This agreement will allow all the parties to wait and see what happens with the latest wave of the pandemic,” said Rich Couture, chief negotiator for the American Federation of Government Employees, one of three unions representing the agency work force involved in the talks. “Hopefully it subsides, but if it doesn’t, we can take further action to postpone the reopening if necessary.”

Social Security field offices handle benefit claims for retirement and Medicare. But they also assist with applications for Social Security Disability Insurance and Supplemental Security Income, the benefit program for low-income, disabled or older people. Since the pandemic began, nearly all public service has been available only online, and by phone and mail, and the agency work force of nearly 60,000 has operated virtually. Office visits are available only by appointment and only for a limited number of critical issues.

Processing of Social Security retirement benefits and Medicare claims has not been impaired during the office shutdown, agency records show. But there were sharp drops in 2020 in benefit awards for Supplemental Security Income and disability insurance.

Social Security had earlier announced a tentative plan for employees to return to the offices on Jan. 3. But that date was postponed because of disagreements between the agency and unions over specifics of the plan.

The new agreement calls for all employees and visitors to wear masks while at Social Security facilities, regardless of their vaccination status. Under the agency’s original plan, visitors who stated that they were vaccinated would have been permitted to forgo masks. The agreement also calls for negotiations between the agency and various segments of the work force over the specifics of each group’s reopening plan.

“Our main concern is to keep employees and the visiting public safe and healthy,” Mr. Couture said.

The details on office reopenings, including hours of operation, are still being negotiated, but are expected to be announced in March. The agency also plans to continue to allow telework to varying degrees for different jobs.

During the transition, the agency advises people to use its website wherever possible or to call its national toll-free number, 800-772-1213, as a starting point to receive assistance.

 

Monday, September 6, 2021

Answers to Your Questions on When to Start Collecting Social Security More details on why experts advise to wait to claim benefits and on benefits for divorced spouses.

https://www.nytimes.com/2021/09/01/your-money/social-security-when-to-collect.html?smid=url-share

RETIRINg

Susan B. Garland

Published Sept. 1, 2021Updated Sept. 3, 2021

Few retirement issues are as complex and controversial as Social Security and the strategies people can use to maximize their benefits.

So we were not surprised that an article The New York Times published in June on how women can make the most of Social Security generated many reader questions — some heated. It also provoked a pushback from some readers who disagreed with experts’ advice that individuals should wait as long as possible to claim benefits.

 

Likely to add to the debate is a recent announcement that Social Security is expected to be insolvent a year earlier than previously projected. Congress is likely to step in, many experts say, and moves that beneficiaries make now to maximize their benefits will help no matter what happens.

We are back to address several of your questions. First, keep the Social Security basics in mind:

  • You are entitled to a full benefit at full retirement age, which is 66 for someone born between 1943 and 1954. The full retirement age gradually rises to 67 for those born in 1960 or later.
  • You can claim as early as 62, but the benefit will be reduced permanently by a certain percentage for each month a beneficiary claims before full retirement age. The benefit rises 8 percent for each year a beneficiary delays claiming between full retirement age and 70.
  • A lower-earning spouse can collect a “spousal benefit” that is up to 50 percent of the higher earner’s full retirement benefit. A widow or widower can collect up to 100 percent of the deceased spouse’s benefit.

Now, let’s get to your most-asked questions.

Why not claim early and invest the benefits in the markets?

This strategy is highly risky, said Elaine Floyd, the director of retirement and life planning with Horsesmouth, a New York company that trains financial advisers on Social Security strategies and other issues.

A beneficiary who goes the investment route, Ms. Floyd said, would need to reap “consistently high returns” and must be disciplined enough to sock away the money every month. And if the beneficiary is married and the higher earner dies first, the spouse would receive a relatively low survivor benefit.

Ms. Floyd offered a hypothetical beneficiary whose monthly Social Security benefit at full retirement age is $3,000. Say the beneficiary claimed a reduced benefit at 62 and invested the money, earning an inflation-adjusted return of 3 percent a year. By age 95, the cumulative benefits and investments would be roughly $278,000 lower than if the beneficiary had waited until 70 to claim the larger benefit.

“It’s really an apples-to-oranges comparison,” she said. “An 8 percent retirement credit and lifetime income from Social Security are the law, but investment returns are not that predictable.”

Why not claim early, rather than draw down an I.R.A. and other savings?

It’s conventional wisdom to delay tapping an individual retirement account, instead enabling it to grow tax deferred. Roughly 40 percent of beneficiaries claim reduced Social Security benefits at 62 or 63.

But many researchers say reversing the order — living on retirement savings in the early years and holding off on collecting benefits — is likely to increase monthly income over a lifetime.

One reason, experts say, is the roughly 77 percent boost in benefits a beneficiary receives by claiming at 70 rather than at 62.

Another is the difference in how I.R.A. withdrawals and Social Security benefits are taxed. Individuals pay the ordinary federal income tax rate on all I.R.A. withdrawals. But just 85 percent, 50 percent or none of their Social Security benefits are taxed.

The amount subject to tax depends on your “provisional income,” which includes half of benefits and 100 percent of nonbenefit income. The more I.R.A. income, the more likely you are to pay at a higher marginal rate and be taxed at the 85 percent threshold.

With this formula in mind, a new retiree should start I.R.A. withdrawals early, when the marginal rate is likely lower, said Laurence Kotlikoff, an economics professor at Boston University.

By the time the beneficiary is 70 and starts claiming enhanced Social Security benefits, her I.R.A. withdrawals will be smaller because she drew down her assets for eight years, Dr. Kotlikoff said.

“Many if not most people should take I.R.A. withdrawals earlier than planned to stay out of a high tax bracket later and have less of their Social Security benefits hit by taxes,” said Dr. Kotlikoff, who created an online financial planning tool for individuals and financial planners.

Consider a person who is due a $2,200 monthly Social Security benefit at full retirement age. Her $500,000 I.R.A. and $200,000 in other savings are expected to grow at an inflation-adjusted 2 percent a year.

Say she claims her benefit at 62 and waits until 72 to take her I.R.A. required minimum distributions. If she lives to 100, she would generate roughly $900,000 in discretionary income after paying for housing and other expenses, according to Dr. Kotlikoff’s calculations. The income would come from benefits, I.R.A. earnings and retirement savings.

She would do better by drawing down her I.R.A. at 62 and starting benefits at 70. Because of a lower tax bite and higher benefits, “She would pocket, at no risk, an extra $163,000,” Dr. Kotlikoff said.

Will my Social Security benefits be reduced if I work?

A worker who claims benefits before full retirement age may run into the “earnings limit,” in which Social Security temporarily withholds $1 in benefits for every $2 in earnings above a certain amount — in 2021, the limit is $18,960.

And though a person may need benefits to supplement low earnings, the downside of permanently reduced benefits also exists if you claim early, whether or not you exceed the earnings limit, Ms. Floyd said.

A working widow who collects a survivor benefit could also face the earnings limit. A widow can claim a survivor benefit as young as 60, though her benefit will be reduced by claiming before full retirement age. If she is working and exceeds the earnings limit, part of those reduced benefits will be withheld.

The earnings limit also applies to the spousal benefit claimed by a nonworking spouse if the other spouse is working and both are younger than full retirement age. Social Security withholds benefits on total household earnings that exceed the limit.

Withheld benefits are not lost forever, however. At the beneficiary’s full retirement age, Social Security will adjust the monthly benefit upward to account for the withheld benefits. The beneficiary will continue to receive the higher payment even after she recoups the withheld benefits, which could take 12 years.

This is how it works: Say a person is eligible for a benefit of $24,000 a year at full retirement age but claims at 62 and gets a reduced benefit of $16,800. If the beneficiary earns $25,000, the government will withhold $3,020 for the year, which is half of the earnings above the limit. At full retirement age, the beneficiary will continue to receive the reduced benefit of $16,800 but eventually will get the withheld money back in the form of a higher benefit.

James Blair, the lead consultant with Premier Social Security Consulting in Cincinnati, said he advises working clients to balance the Social Security income they will receive by claiming early with the permanent reduction in benefits.

“If Social Security is withholding two or three checks, they will get paid for the majority of the year,” said Mr. Blair, a former Social Security administrator. “If they’re only getting two or three checks, it usually is better to wait to claim.”

Can a person who is due a public pension also collect Social Security benefits?

Two rules could reduce benefits for people who are also entitled to a public pension on earnings not covered by Social Security.

One rule is the “windfall elimination provision” (known as the W.E.P.), which applies to people who worked at jobs covered by Social Security but also worked as noncovered government employees and are due a pension.

When it is time to claim benefits, many people are unprepared for these cuts, Mr. Blair said. Possible W.E.P.-related reductions are not reflected in the worker’s Social Security statement, which shows the history of annual earnings and estimates of future benefits only for jobs covered by Social Security.

“You can have someone who looks at the Social Security statement and it shows a benefit of $1,000 at full retirement age,” Mr. Blair said. But the individual — a teacher who is due a public pension, for example — may be surprised later if the benefit is much lower, he said.

In addition to W.E.P. reductions, a government pensioner who applies for a Social Security spousal or survivor benefit can face reductions. The “government pension offset” (G.P.O.) reduces those benefits by two-thirds of the government pension.

For example, widows and widowers are typically entitled to a survivor benefit that is 100 percent of their late spouse’s benefit. But if a widow is receiving a monthly government pension of $2,000 and her late husband’s Social Security benefit was $1,500, her survivor benefit would be reduced by $1,333 and she would collect just $166, according to the Social Security Administration.

Mr. Blair said individuals who are eligible for a public pension and Social Security can estimate their future benefits by running the numbers on the W.E.P. and G.P.O. calculators.

Pensioners are exempt from the W.E.P. offset if they paid into Social Security for 30 years or more in jobs with “substantial earnings” ($26,550 in 2021).

Older people who fall short of the 30 years could eliminate or reduce the W.E.P. impact by working more years at the substantial earnings level, even if they already started collecting benefits, Mr. Blair said.

Can a divorced woman who was married for more than 10 years claim a spousal benefit on her ex-husband’s work record and then switch to her own retirement benefit?

Not any longer. The government eliminated a strategy that allowed a spouse or a divorced spouse to use a “restricted application” to file for a spousal benefit while letting her own retirement benefit grow. Now only people born before 1954 can do this.

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Instead, when a spouse or divorced spouse files for benefits, the government will give her all the benefits she is eligible for — whether it is her retirement benefit or a spousal benefit, said William Reichenstein, a principal of Social Security Solutions, a company that helps individuals maximize their lifetime income.

A divorced spouse can file for a spousal benefit even if the ex-spouse has not yet claimed a benefit as long as both are at least 62 and are divorced for more than two years. A married spouse must wait until her spouse has filed.

But if the ex-spouse dies, the picture changes. The surviving ex-spouse can claim a survivor benefit as early as 60 and allow her retirement benefit to grow until as late as 70. Or she can claim her reduced retirement benefit early and then switch to a higher survivor benefit at full retirement age.

“If you were married for 10 years, keep tabs on the ex,” Ms. Floyd said. “Once he dies, that survivor benefit could be higher than your own.”

A version of this article appears in print on Sept. 5, 2021, Section BU, Page 8 of the New York edition with the headline: Claiming Social Security: Why You Should Wait. Order Reprints | Today’s Paper | Subscribe

 

 


Monday, August 2, 2021

WHAT IS AN "ANNUAL NOTICE OF CHANGE"? OR "ANOC"?

 


What is an Annual Notice of Change?

Dear Marci, 

Last year I received an Annual Notice of Change, or ANOC. Should I expect another one this year? What should I do with an ANOC? 

-John (Nashville, TN) 
 

Dear John, 

The Annual Notice of Change, or ANOC, is the notice you receive from your Medicare Advantage or Part D plan in late September. So yes, you should expect to receive another one this year!  

The ANOC gives a summary of any changes in your plan’s costs and coverage that will take effect January 1 of the next year. The ANOC is typically mailed with the plan’s Evidence of Coverage (EOC), which is a more comprehensive list of the plan’s costs and benefits for the upcoming year. You should review these notices to see if your plan will continue to meet your health care needs in the following year. If you are dissatisfied with any upcoming changes, you can make changes to your coverage during Fall Open Enrollment.  

Here are three types of changes to look for:  

Find out what you can expect to pay for services in 2022. Costs such as deductibles and copayments can change each year. For example, your plan may not have had a deductible in 2021, but it could have one in 2022. A deductible is the amount of money you owe out-of-pocket before your plan begins to cover your care. Another example is that your plan may increase the copayments you owe for visits to your primary care provider or specialists.  

Check to see if your doctors, hospitals, and other health care providers and pharmacies will still be in network for 2022. Plan networks can change each year, which means your doctor may not be in your plan’s network for 2022. You have the lowest out-of-pocket costs if you go to providers and pharmacies that are in your plan’s network. If you see an out-of-network provider, your plan may not cover any of the cost of your care, leaving you to pay the cost out-of-pocket. You should also contact your providers directly to confirm that they will still be accepting your plan in the coming year.  

Look through the plan’s formulary. The formulary is the list of drugs the plan covers. Formulary changes can happen from year to year, meaning your drug may not be covered in 2022 even though it was covered in 2021. Make sure your drugs will still be covered next year. If they are not, then you may want to select a different drug plan that covers all of your drugs. If the formulary is incomplete, or you do not see your drug(s) on the list, contact the plan directly to learn more. 

If you have not received an ANOC by the end of September, you should contact your Medicare Advantage Plan or Part D plan to request it. This notice can be very helpful in determining whether you should make any changes to your coverage during Fall Open Enrollment. Reading your ANOC should also prevent any surprises about your coverage in the new year! 

-Marci