

Ask the community...
Adding to what others have shared - I went through this exact same confusion when I first started Medicare two years ago! One thing that might help future newcomers is knowing that the 1095-B form is actually pretty basic - it just shows your name, coverage dates, and confirms you had qualifying health coverage. The most important info is really just when your Medicare coverage began, which you can find on your Medicare card or welcome packet if the form gets delayed. I keep a simple spreadsheet now with all my Medicare dates and key info as a backup. The first year is definitely the hardest as you figure out all these new processes!
That's such a smart idea about keeping a spreadsheet with all the Medicare dates and info! I wish I had thought of that from the beginning. You're absolutely right that the first year is the hardest - there are so many new systems and processes to learn. I'm definitely going to create a simple tracking document like you suggested so I'm better prepared next year. Thanks for the practical tip!
Just wanted to chime in as someone who went through this exact same experience! I turned 65 last year and had the same panic about finding the 1095-B form on the SSA website. Like everyone else mentioned, it definitely comes in the mail from CMS, not through your MySocialSecurity account. One thing I'd add is that if you're worried about missing the form in your mail, you can also sign up for Informed Delivery through USPS - it sends you previews of your incoming mail each morning so you won't accidentally throw away important tax documents. I started using it after almost tossing my 1095-B because the envelope looked like generic government mail. Also, don't stress too much if it's delayed - my tax preparer said the IRS is pretty understanding about Medicare forms arriving late since it's such a common issue. The most important thing is having your Medicare start date, which should be on your Medicare card or in your welcome materials. Glad you got yours sorted out!
That Informed Delivery tip is brilliant! I had no idea USPS offered that service. I'm definitely signing up for it right away - would have saved me so much stress this year wondering if I missed important mail. You're also right about not stressing too much if the form is late. My tax preparer actually told me the same thing about the IRS being understanding with Medicare-related delays. It's reassuring to hear from someone who went through this exact same experience last year. Thanks for sharing these practical tips!
Based on what you've shared, here's what I recommend as your next steps: 1. Help your daughter create a my Social Security account at ssa.gov to check her work credits. 2. Gather comprehensive medical evidence: - Clinical records from therapists/doctors - Psychological evaluations if available - Prescription medication history - Treatment notes documenting symptoms and limitations - Any hospitalizations or intensive outpatient treatment 3. Document how her conditions affect daily functioning: - Failed work attempts with specific details - Difficulties with daily activities - Social functioning limitations - Episodes of decompensation (periods when symptoms worsen) 4. Apply for both SSDI and SSI simultaneously online or by calling SSA. 5. Consider getting a disability attorney if initially denied (most work on contingency). The combination of multiple mental health conditions plus asthma could strengthen her case, especially if you can document how they interact to further limit her functioning.
This is incredibly helpful, thank you! I'm going to start gathering all this documentation right away. One more question - she's currently on my health insurance (thankfully). If she gets approved for disability, would she eventually qualify for Medicare or Medicaid? I'm wondering how her healthcare would work long-term.
With SSDI, she would get Medicare after 24 months of receiving benefits. With SSI, she would likely get Medicaid immediately in most states. Either way, she would eventually have health coverage, which is important for maintaining the treatment she needs. One thing I haven't seen mentioned yet: make sure her doctors are specifically documenting how her conditions limit her ability to work. Many doctors focus on symptoms and treatment but don't explicitly address work capacity in their notes. You might want to ask her providers to complete a Medical Source Statement or Residual Functional Capacity form that specifically addresses work-related limitations. Also, if she's denied initially (which is common), don't give up! Request reconsideration within 60 days, and if denied again, request a hearing before an Administrative Law Judge. Success rates increase significantly at the hearing level, especially with proper representation.
Thank you for this information about healthcare coverage - that's been a major concern. I'll definitely talk to her therapist about documenting work limitations specifically. Would it be helpful to get statements from previous employers about the accommodations they tried to make for her and why they weren't sufficient?
I'm in a very similar situation with irregular commission income! One thing that really helped me was creating a simple tracking spreadsheet from the start. I track every payment date, amount, and type (regular salary vs commission) as soon as I receive it. When I applied for benefits, I brought printouts showing my payment history for the past 6 months and estimates for the rest of the year. The SSA rep was really appreciative that I had everything organized and it made the interview go much smoother. Also, don't stress too much about the earnings test calculations - once you get your first annual report form from SSA, it walks you through everything step by step. The key is just keeping good records from day one so you're not scrambling later to remember when you got paid what amount. Your brother sounds like he's in good shape if he's only looking at 2 months over the limit for 2025!
This is exactly the kind of practical advice I was hoping to find! Creating a tracking spreadsheet from the beginning is such a smart idea. I'm going to help my brother set something up like that before he applies so we're organized from day one. It's reassuring to hear that the SSA rep appreciated having everything documented - we were worried they might think we were overthinking it. But it sounds like being prepared actually makes their job easier too. Thanks for sharing your experience with the annual report process. It's helpful to know what to expect down the road. With only 2 months projected over the limit, this is definitely more manageable than we initially thought!
As someone who recently went through this process with quarterly bonuses, I can confirm what others have said - SSA definitely goes by payment date, not when the income was earned. One additional tip: when your brother applies, he should ask the SSA representative to put a note in his file about his quarterly commission structure. This way, when he does his annual earnings report, there's already a record that his income pattern was discussed upfront. It can help avoid questions or delays during the review process. Also, since he's starting benefits mid-year in July, he'll want to be extra careful about those September and December commission months. Even though it's only 2 months over the limit, make sure he reports those expected amounts during his application interview so there are no surprises. Good luck to your brother!
That's such a valuable tip about asking SSA to put a note in his file about the quarterly commission structure! I hadn't thought about that but it makes total sense - having it documented upfront could save a lot of headaches later. We'll definitely make sure to mention that when he applies and ask them to add it to his record. You're absolutely right about being careful with those September and December months. Since those will be his first few months receiving benefits, we want to make sure everything is reported accurately from the start. Better to over-communicate about the commission structure than have them think we're trying to hide something. Thanks for sharing your experience with quarterly bonuses - it's really helpful to hear from people who have actually been through this process!
To directly answer your original question - yes, the maximum benefit for someone filing at FRA is increasing for 2025, and yes, this is separate from the COLA adjustment. The COLA applies to people already receiving benefits, while the maximum benefit calculation applies to new filers. However, this doesn't mean you'll get more than a 2.5% increase overall. Your benefit is calculated based on your own earnings history, not on what the maximum potential benefit is. The only way this affects you personally is through small adjustments to the PIA calculation formula that happens each year. For most people, these formula adjustments result in very small differences - we're talking about maybe $5-15 per month different than if you had filed with the exact same earnings history the previous year. Your claiming age and earnings history are FAR more important factors in determining your benefit amount.
Just to add another perspective here - I work in benefits consulting and help people navigate SS claims regularly. The confusion around maximum benefits vs COLA is super common, but here's the key thing to remember: unless you've been a very high earner for most of your career, these year-to-year changes in the maximum benefit calculation won't meaningfully impact your actual benefit amount. What WILL impact your benefit significantly is making sure you have an accurate earnings record with SSA before you file. I always tell my clients to create a my.ssa.gov account and review their earnings history at least 6 months before filing. I've seen cases where missing or incorrect earnings records cost people hundreds of dollars per month in benefits. Also, don't stress too much about timing your application to the exact month - focus more on whether you want to claim at FRA, delay for delayed retirement credits, or claim early with reduced benefits. That decision will have a much bigger impact on your monthly payment than any formula adjustments.
Brian Downey
You're doing the right thing by planning ahead! I work with SSA cases and see this situation frequently. Your wife absolutely should apply for SSDI now - not just for potential immediate benefits, but to establish her disability onset date in the system. This is crucial because if something happens to you, she'll need that official disability determination to qualify for disabled widow benefits before age 60. One thing I'd add to what others have mentioned: make sure she applies within the statute of limitations. Generally, you have 5 years from your disability onset date to file for SSDI. If her health issues started 12 years ago, she might need to be strategic about documenting when her condition became severe enough to prevent work. Also, even if she's initially denied (which happens to about 65% of first-time applicants), don't give up. The appeals process exists for a reason, and having that denial on record still helps establish when she first sought disability recognition, which could be important for future survivor claims.
0 coins
Lauren Wood
•That's really valuable insight about the 5-year statute of limitations - I hadn't thought about that timing issue at all. Since her severe symptoms started about 12 years ago, should we be documenting when she actually had to stop working or when her condition worsened to the point of being disabling? I want to make sure we approach this correctly from the start.
0 coins
Evelyn Xu
This is such an important topic that more couples need to understand! I went through something similar with my parents. My dad was receiving SSDI and my mom had chronic conditions but never applied because his benefits covered their needs. When he passed away unexpectedly, we learned the hard way about these rules. What really helped us was understanding that there are actually two separate things happening here: your wife establishing her own disability status with SSA, and the future potential for survivor benefits. Even if her SSDI application results in $0 monthly payments (due to family maximum rules or other factors), having that official disability determination is what opens the door for early survivor benefits. One thing I'd strongly recommend is keeping detailed records of her medical appointments, treatments, and how her conditions affect daily activities. The SSA will want to see a clear picture of her functional limitations, not just diagnoses. Also, if she hasn't seen doctors recently for her conditions, it might be worth scheduling some appointments to get current medical evidence before applying. You're being really smart to think about this now rather than waiting. The peace of mind alone is worth going through the application process.
0 coins
Landon Flounder
•This is really helpful advice, thank you! I hadn't considered that she might get $0 in monthly payments but still have the disability determination on file - that makes total sense. We definitely need to get her back to seeing doctors regularly for her conditions. She's been managing with her current medications but hasn't had recent evaluations that would show how her conditions have progressed. I'll start scheduling those appointments before we begin the application process.
0 coins