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How does PIA affect Social Security benefits & is there a Medicare waiver with spouse's insurance?

I'm hitting 63 soon and feeling completely lost in the Social Security maze. Every time I think I understand something, I find five more complications! Can someone break down what PIA (Primary Insurance Amount) actually means in simple terms? How exactly does it determine what I'll get if I claim before my FRA (which is 67)? Also, my husband (61) plans to keep working until at least 68 and has excellent health insurance through his employer. When I turn 65, can I skip Medicare enrollment without penalties since I'm covered under his plan? Is there some kind of waiver form I need to fill out? The SSA website makes my head spin with all these acronyms and exceptions to exceptions. I've been trying to calculate potential benefit reductions and it's making me consider just waiting until FRA, but our house needs major repairs soon. Any clarity would be SO appreciated!

Your PIA is basically the amount you'd receive if you start benefits exactly at your full retirement age (67 for you). It's calculated based on your highest 35 years of earnings, adjusted for inflation. If you claim at 63, your benefit will be permanently reduced by about 23.33% from your PIA amount. As for Medicare, yes! You can delay enrollment without penalty if you have creditable coverage through your spouse's employer plan. You'll need to request a 'Medicare Part B Special Enrollment Period' when you eventually need to enroll. It's not technically a waiver, but documentation that proves you had qualifying coverage. Make sure your husband's employer has more than 20 employees though - that's a critical detail.

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Lauren Zeb

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Thank you so much! That helps a lot. So my PIA is like the 'baseline' amount before any reductions are applied? Do you know if the earnings used to calculate it are after the FICA tax or before? And for the Medicare delay, will his HR department know what documentation I need to get from them to prove I had coverage?

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Aurora Lacasse

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Just adding to what @helpful_guidance said about the PIA calculation - it uses your highest 35 years of earnings BEFORE any taxes are taken out. If you don't have 35 years of work, they'll use zeros for the missing years, which can lower your PIA. One important thing about claiming early: If you claim at 63, not only is your benefit reduced by ~23.33%, but that reduction is PERMANENT. Even after you reach FRA, you'll still receive that reduced amount (though you'll get cost of living adjustments on top of it). For Medicare: Get a letter from your husband's employer confirming you have creditable coverage. Keep it safe - you'll need it when you eventually enroll during your Special Enrollment Period (which lasts for 8 months after the employer coverage ends).

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Anthony Young

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This!!! I waited till my FRA and so glad i did. the reduckshun for early filing is BIG and its 4EVER. my neighbor took SS at 62 and regrets it every month when she sees her tiny check. if you can possibly wait, DO IT!!!

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Charlotte White

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OMG I'm in almost the same boat!! Turned 62 last month and feel like I need a PhD just to understand Social Security! I spoke to a SSA rep on the phone (after trying for DAYS) and they confused me even more about my PIA and early filing reductions. They kept mentioning something about "bend points" that I still don't understand. Did anyone here actually calculate their own PIA? Is there a simple calculator somewhere? The SSA site calculator wants me to enter my entire earnings history and I don't have all that information handy.

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Aurora Lacasse

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The bend points are just part of the formula SSA uses to make the system slightly progressive. Higher earners get a smaller percentage of their pre-retirement income replaced than lower earners. For a simple estimate, create a my Social Security account at ssa.gov - it'll show your estimated benefits at different ages using your actual earnings history (they already have it). Much easier than trying to calculate it yourself!

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Admin_Masters

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My wife and me went through this last year. The PIA thing is confusing but bottom line: retiring at 63 means you get about 75-80% of what you'd get at full retirement age. Thats a big hit! Just remember they dont use your last few years of earnings either, so working more doesn't always raise your benefit that much. For medicare we had insurance through my job so my wife didnt sign up right at 65. BIG MISTAKE! My company had only 18 employees so it wasn't "credible coverage" for SSA purposes. She got hit with a penalty that we pay extra every month now. Make absolutely sure your husbands plan qualifies!!!

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Lauren Zeb

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Oh no, that's exactly the kind of mistake I'm afraid of making! His company has about 200 employees, so it sounds like we should be okay on that front. But it's scary that one oversight can lead to permanent penalties.

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Matthew Sanchez

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Charlotte White

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Another consideration for your Medicare decision: Even with your husband's insurance, check if enrolling in Part A (hospital insurance) makes sense. It's premium-free if you qualify for Social Security and can serve as secondary insurance. Many people enroll in Part A at 65 even if they delay Part B due to employer coverage. Regarding your PIA question, here's a simplified way to think about it: 1) SSA looks at all your earnings up to age 60 (indexed for inflation) 2) Takes your highest 35 years (uses zeros if you don't have 35 years) 3) Calculates your Average Indexed Monthly Earnings (AIME) 4) Applies the bend point formula to your AIME to get your PIA This PIA amount is what you'd get at exactly FRA. For every month before FRA you claim, there's a reduction (approximately 0.55% per month for the first 36 months and 0.42% for months beyond that).

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Lauren Zeb

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Thank you for this breakdown! I didn't realize the calculation essentially stops at age 60 (for inflation adjustment purposes). My highest earning years were actually in my late 50s, so I guess those will count significantly. I'll definitely look into the Part A enrollment while delaying Part B.

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Ella Thompson

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dont overthink the pia thing its just govt speak for what your entitled too. my advice is DONT FILE EARLY if u can help it. every year u wait is like getting an 8% raise FOR LIFE. I filed at 62 cause I needed the money but now at 78 im really feeling the pinch with these tiny checks while my sister gets almost $800 more each month cause she waited till 70!!! for the medicare thing just get a letter from ur husbands HR dept saying u have coverage. keep it in a safe place.

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Anthony Young

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^^^^^ THIS! My husband filed at 62 and I waited until 70. My monthly benefit is almost DOUBLE his even though we had similar salaries! That 8-year difference is HUGE in the long run.

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Charlotte White

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So confused about one thing - if I file early like at 63, does my benefit amount EVER increase back to what I would have gotten at FRA? Or is that reduction really permanent for my entire life? The SSA website isn't clear about this (or maybe I just don't understand their explanation).

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The reduction for filing early is permanent - your benefit will never increase to what it would have been had you waited until FRA. However, you will receive annual Cost of Living Adjustments (COLAs) on your reduced benefit amount. The only exception is if you file early, then withdraw your application within 12 months and repay ALL benefits received - but that's rarely practical for most people.

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Aurora Lacasse

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About house repairs vs. waiting to file: Have you looked into a Home Equity Line of Credit (HELOC) to fund the repairs? Interest rates aren't great right now, but the long-term financial benefit of waiting until at least your FRA to claim Social Security could far outweigh the interest costs on a HELOC. Each year you delay claiming between your early retirement age (62) and age 70 results in approximately 8% higher benefits FOR LIFE. That's a guaranteed return you can't get anywhere else, especially with inflation protection through COLAs. If the house repairs are truly urgent and you have no other options, filing early might make sense, but I'd encourage exploring other financing options first to preserve your maximum Social Security benefit potential.

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Lauren Zeb

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That's actually a really smart suggestion I hadn't considered. Our home has appreciated quite a bit over the years, so a HELOC might work. I'll talk to our bank about options. If the interest rate isn't too painful, that could allow me to delay filing until at least my FRA. Thank you for this perspective!

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