Presented by: Teresa R. Banda Benefits Counselor Lead Specialist Health Information, Counseling and Advocacy Program Bexar Area Agency on Aging Alamo

Transcription

1 Presented by: Teresa R. Banda Benefits Counselor Lead Specialist Health Information, Counseling and Advocacy Program Bexar Area Agency on Aging Alamo Area Council of Governments San Antonio, Texas

2 Types of Social Security Benefits Social Security Retirement Social Security Disability Supplemental Security Income Benefits for Family Medicare Medicaid How to Get More Information

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4 Social Security benefits for workers Retirement Social Security Disability Social Security benefits for adults disabled since childhood Social Security benefits for disabled widows and widowers Supplemental Security Income

5 Age 62 Early Retirement Must have 40 quarters (credits) of coverage 40 quarters = 10 years of employment You can acquire 4 quarters/credits per year Full Retirement Age (FRA) Full Retirement age This is the age where an individual becomes entitled to a full unreduced benefit

6 Work In 2012 each $ 1,130 in earnings gives you 1 credit $2,260 earns 2 work credits $ 3,390 earns 3 work credits $ 4,520 earns 4 work credits (maximum number of credits in 1 year = 4)

7 Your Spouse: If he /she is 62 or older At any age while caring for a child under age 16 or disabled A divorced spouse, provided the marriage lasted 10 years, and not currently married and is at least age 62 Your Children: If they are unmarried If they are in elementary or secondary school full time up to the age of 18 or 19 and 2 months

8 To qualify, the disabled person must have a recent work history, or credits Special rules apply to younger persons who need less work to qualify and for persons who apply based on blindness

9 Must have a physical or mental impairment (or combination of conditions) Inability to perform substantial work activity Disability must be expected to last 12 consecutive months or result in death Age, education and past work history are considered

10 Benefits can be paid to Disabled Widows or Widowers as early as age 50, but not yet 60 Disabling Condition must be established before or within a prescribed period

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12 Health insurance for three groups of people 65 and older Under 65 with certain disabilities Any age with End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS ), commonly known as Lou Gehrig's Disease

13 Any person who has received 24 months of Social Security Disability benefits is entitled to Medicare. A person who qualifies for Social Security and SSI can be eligible for both Medicare and Medicaid. A Medicaid recipient who is eligible for Medicare can receive the benefits of the Qualified Medicare Beneficiary Medicaid (QMB) Program.

14 What are the Four Parts of Medicare? Part A Hospital Insurance Part B Medical Insurance Part C Medicare Advantage Plans, like HMOs and PPOs Part D Medicare Prescription Drug Coverage Includes Part A & B and usually Part D coverage

15 Extra Help Medicaid Medicare Savings Programs

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17 Medicare eligibility is based on having paid into the Medicare trust fund. Persons who have 40 Social Security credits do not pay a premium for Medicare Part A. Persons who have 30 to 39 Social Security credits pay a reduced premium for Medicare Part A. Medicaid is need based.

18 A person who qualifies for Medicare and is low income may qualify for the state s Medicare Savings Program Qualified Medicare Beneficiary Medicaid (QMB) Program Specified Low Income Beneficiary (SLMB) Qualified Individual (QI-1)

19 If an individual with Medicare qualifies for QMB they will have no cost-sharing for Medicare Part A, Part B, and will have no premiums or co-pays If an individual with Medicare qualifies for SLMB or QI-1 the state of Texas will pay their Medicare Premiums (average $99.90)

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21 Distinguished From Social Security Disability Insurance (SSDI): SSI is needs based, while SSDI is bought by workers as they are employed From Social Security (SS): SSI is paid from the US Treasury, while SSDI is paid for through Social Security payroll taxes

22 Determination is made by the Social Security Administration (SSA). For both Social Security Disability and SSI based on disability, SSA contracts with the Disability Determination Service (DDS) to make the initial eligibility determination. In Texas, the Disability Determination Service (DDS) is in the Department of Assistive and Rehabilitative Services. This Department is commonly called DARS.

23 Federal benefit rate for 2012 of $698 a month (single) or $1,048 a month (married couple where both are eligible) reduced dollar-for-dollar by any countable income. Regular Medicaid accompanies SSI in Texas.

24 In Texas, all persons who receive Supplemental Security Income (SSI) also receive Medicaid In Texas, Medicaid eligibility is automatic when SSI eligibility is determined by SSA SSI is administered by the federal Social Security Administration

25 $2,000 for an individual and $3,000 for a married couple in countable assets to be eligible for SSI (and Medicaid) Major Exclusions: Residence Household goods/personal affects One vehicle

26 A resource is cash or any other personal property or real estate property owned by the applicant, spouse or parents (if applicable). It may be owned by the applicant, or the applicant has rights, authority or power to convert to cash.

27 Long-term facility-based Medicaid generally nursing facility care that is not community based. Waivers Special programs allowed by the Centers for Medicare and Medicaid Services (CMS) that is generally community based.

28 (TTY ) MEDICARE ( ) (TTY )

29 Introduction to Medicare Resource Guide Centers for Medicare & Medicaid Services (CMS) MEDICARE ( ) (TTY ) Social Security TTY / Railroad Retirement Board Resources State Health Insurance Assistance Programs (SHIPs)* *For telephone numbers call CMS MEDICARE ( ) for TTY users ivers/ Affordable Care Act l Medicare Products Medicare & You Handbook CMS Product No Your Medicare Benefits CMS Product No Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare CMS Product No To access these products View and order single copies at Order multiple copies (partners only) at productordering.cms.hhs.gov. You must register your organization.

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