Let's consider what the I.O.U.s held by Social Security represent. The I.O.U.s are bookkeeping entries, a lot like entries in checking accounts, but are not represented by real cash sitting in a strong box anywhere. The U.S Treasury collects Social Security payroll taxes from employers. In turn, the U.S. Treasury issues I.O.U.s to the Social Security trust fund. In the meantime, those payroll taxes are immediately used for other federal budget operations. When more payroll taxes were collected than needed to pay benefits, that reduced the amount of borrowing from the public that was needed for the general revenues, and lowered taxes. Now, however, the situation has reversed, and the Treasury must increase borrowing from the public to redeem the I.O.U.s held by the trust fund in order to pay benefits. Increased borrowing, and the cost of interest on the debt, further drives up our federal spending. According to many economists, that can weaken our economy, and our nation's ability to respond to a crisis. .At that point Congress would either must cut benefits in a major way or raise taxes to pay for continued benefits, something that Congress has refused to do for years. .The Congressional Budget Office recently estimated in their September budget outlook that Medicare outlays for 2020 would rise about 12 percent — roughly double the rate forecast by the Medicare Trustees in their April 2020 report. This suggests that the Medicare Part B premium increase for 2021 could be about .40 per month higher in 2021, rising from 4.60 to 2.00. But even this estimate does not include the impact of cost shifting due to protecting people with low Social Security benefits from reductions due to the high Medicare Part B increase. .Sources: "Prescribers With Questionable Patterns In Medicare Part D," Department of Health and Human Services Office of Inspector General, June 201"Medicare Fraud Outrunning Enforcement Efforts," The Center For Public Integrity, July 3, 2013. .Cutting the annual cost-of-living adjustment (COLA) by switching to a more slowly rising measure of inflation – the "chained" Consumer Price Index (CPI) – is currently one of the most popular deficit reduction proposals on the table. Backed by lawmakers on both sides of the aisle – including President Obama – proponents are calling it a small "technical correction." But "chaining" the COLA would compound over the course of a retirement and, after ten years, it would amount to an per month benefit cut for the average retired married couple – an amount that most seniors simply cannot afford to lose. .Unlike most of the top 10 causes of death, such as heart disease and cancer, which are covered in large part by Medicare, Alzheimer's care comes with extraordinary costs that are not covered. Medicare covers medically necessary inpatient hospital care, doctor's fees, outpatient services such as blood tests, and Part D covers many prescription drugs. However, a dementia diagnosis most often requires custodial care, like help bathing, eating, dressing, and supervision. Medicare does not cover custodial care. .Here's where to go for help with these services: .In shopping for housing you will find that many senior living communities have medical criteria for acceptance. Since your sister has no children, she may need a facility that provides a continuum of care. As her health declines, she would move from independent living to assisted living, and finally nursing or memory care as her health declines. If her income is limited, all the more reason to start looking for affordable facilities ahead of time. It's not uncommon to encounter waiting lists at the most desirable facilities. .Low and middle-income earners pay taxes on all of their earnings. In recent years, however, the share of total wages earned in the U.S. and subject to Social Security payroll tax has declined because the earnings of the most highly paid workers have grown rapidly. Most of the proposals to increase the taxable maximum would also raise benefits of the affected workers by counting earnings above the old cap in the benefit formula. The non-partisan Congressional Budget Office (CBO) has estimated that eliminating the taxable maximum would extend the Social Security solvency as much as 50 years.[1]