Will SSDI Always Be There For ME?

2011 Open Enrollment Period for Medicare Part C and Part D

Every year, you have a chance to make changes to your Medicare Advantage (Medicare Part C) or Medicare prescription drug (Medicare Part D) coverage for the following year. Last year, the open enrollment period was from November 15, 2010 – December 31, 2010. For 2011, the open enrollment period is earlier, as indicated below.

Enrollment Period: October 15, 2011 – December 7, 2011.

What You Can Do in This Enrollment Period:

· Change from Original Medicare to a Medicare Advantage Plan.

· Change from a Medicare Advantage Plan back to Original Medicare.

· Switch from one Medicare Advantage Plan to another Medicare Advantage Plan.

· Switch from a Medicare Advantage Plan that doesn’t offer drug coverage to a Medicare Advantage Plan that offers drug coverage.

· Switch from a Medicare Advantage Plan that offers drug coverage to a Medicare Advantage Plan that doesn’t offer drug coverage.

· Join a Medicare Prescription Drug Plan.

· Switch from one Medicare Prescription Drug Plan to another Medicare Prescription Drug Plan.

· Drop your Medicare prescription drug coverage completely.

Source: Understanding Medicare Enrollment Periods – Tip Sheet. http://www.medicare.gov/Publications/Pubs/pdf/11219.pdf

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Health Care Reform - Changes in Law

This past week was the six month anniversary of the signing of the Affordable Care Act by President Obama. Several important pieces of the health care reform bill went into effect on September 23, 2010. This post highlights the most important changes in federal health care law. In addition, it provides more information on www.healthcare.gov, a national website that has valuable information for everyone wanting more information.

In effect as of September 23, 2010:

Rescission is Outlawed

Insurance companies aren’t allowed to drop people’s coverage when they get sick (this is known as “rescission”).

New Coverage Options for Children

Insurance companies aren’t allowed to deny coverage to children under 19 because of pre-existing conditions.

Children can stay on (or be added to) their parents’ insurance policies until they turn 26, if they can’t get insurance through a job. This applies to all insurance plans that provide dependent coverage. A new open enrollment period for children starts on September 23, 2010 and is required by law to continue for at least 30 days.

Ban on Lifetime Coverage Limits

For new individual insurance and all group plans, insurance companies aren’t allowed to put caps on the amount they will spend on lifetime coverage costs on “essential benefits”. Essential benefits include hospital stays, doctor visits, and prescription drugs.

Annual limits are restricted in all group plans and in new individual plans. Starting in 2014, annual limits will be banned completely.

More Preventive Services Covered by Private Health Coverage

All new group and individual plans will have to cover certain recommended preventive services, like cancer and diabetes screenings. Insurance companies will be required to offer these services free to the patient - without deductible, coinsurance, or copayment charges.

In effect in 2011:

Prescription Drug Discounts for People who Fall in Medicare’s Donut Hole

Starting January 1, 2011, people on Medicare who fall within the prescription drug coverage gap (the “donut hole”) will get a 50% discount on brand name prescription drugs and a 7% discount on generics.

These discounts are in addition to the annual rebates for people who fall in Medicare’s “donut hole”.

The website www.HealthCare.gov can provide you with invaluable information on changes under the health reform bill, the Affordable Care Act of 2010 (ACA).

For beneficiaries, there is an easy-to-use tool on this website called “Find Insurance Options”. Beneficiaries can use this tool by themselves to learn about the health care options that are available to them, given their circumstances (age, health condition, etc.). For example, it will provide information on specific Medicaid categories that they may be qualified for. It can ba found at: http://finder.healthcare.gov/ .

To read about changes to the High Risk Pool program in you state, go to http://www.healthcare.gov/law/provisions/preexisting/index.html and enter in your state. You will learn about how your state has chosen to implement its Pre-Existing Condition Insurance Plan program, which can either supplement or replace the existing state High Risk Pool. There is also a timeline on the website showing major changes that occur each year, with links to more information on each change.

Any questions may be directed to: rsi5@srt.com

Medicare Savings Programs

The Medicare Savings Programs provide special limited Medicaid coverage to assist with certain costs for Medicare beneficiaries with low income and few assets. In North Dakota, these programs include the following.

The Qualified Medicare Beneficiaries (QMB) program pays for Medicare premiums, deductibles, and coinsurance payments. The income level (maximum income) for QMB eligibility is equal to 100 percent of the poverty level applicable to a family of the size involved. For 2009/2010, the monthly income level is $903 for a one-person unit and $1,215 for a two-person unit.

The Specified Low-Income Medicare Beneficiaries (SLMB) program pays only the Medicare Part B premiums for the beneficiaries. Individuals who have SLMB coverage may also have coverage under another Medicaid program, such as the Workers with Disabilities Medicaid buy-in program, if they meet the eligibility criteria for the other Medicaid program. The income level for SLMB is equal to 120 percent of the applicable poverty level. For 2009/2010, the monthly income level is $1,083 for a one-person unit and $1,457 for a two-person unit.

The Qualifying Individuals (QI) program pays only the Medicare Part B premiums for the beneficiaries. However, unlike SLMB coverage, QI coverage is not available to beneficiaries who are in receipt of any other Medicaid benefits for the same period. The income level for QI is equal to 135 percent of the applicable poverty level. For 2009/2010, the monthly income level is $1,219 for a one-person unit and $1,640 for a two-person unit.

Effective January 2010, the asset limits for the Medicare Savings Programs are: $6,600 for a one-person unit ($4,000 in 2009); or $9,910 for a two-person unit ($6,000 in 2009).

Individuals who are covered by one of the Medicare Savings Programs are automatically entitled to extra help (the low-income subsidy) in paying for Medicare prescription drug coverage (Medicare Part D).

Sources: Medicaid Program Policy Manual 510-05-60 (Medicare Savings Programs) and 510-05-85-40 (Income Levels); Medicare and You 2010, page 79.

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A FREE WISE WEBINAR HIGHLIGHTING SUPPORTS AND SERVICES FOR TICKET HOLDERS WITH MENTAL HEALTH DISABILITIES

JUNE 23, 2010 FROM 3:00 – 4:30 PM (EASTERN)

If you are a person with a mental health disability interested in learning about the Ticket to Work Program or other Social Security Work Incentives, you can attend a FREE Web-based education event on work incentives! This first-ever Mental Health Work Incentive Seminar Event (WISE) Webinar will feature presentations by people who know the ins and outs of all available work incentives, including the Ticket Program. A success story of a Social Security beneficiary who used work incentives successfully will be shared. We will also be joined by a mental health peer counselor who currently works encouraging other people with mental health disabilities in their recovery through work.

Want specific information on how work and work earnings will impact your personal Social Security disability benefits? Please visit www.ssa.gov/work or www.choosework.net to get more information and to find a list of resources available in each state, including the Work Incentives Planning Assistance (WIPA) projects, professionals who can provide more information on your individual situation.

Register for this free WISE Webinar or find WISE events in your area at www.cessi.net/wise.

Approximately 2 days before the event, all those who have registered will receive an e-mail message with instructions on how to log in to the Webinar.

If you have questions, please email wise@cessi.net or call 1-877-743-8237 (v/tty).

Any questions may be directed to: rsi5@srt.com

2010 Mecicare Part B Premium Costs

Medicare Part B Premium Fact Sheet

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Health Care Reform - Changes Important to People With Disabilities

The recently passed Patient Protection and Affordable Care Act (Public Law 111-148) and Health Care and Education Reconciliation Act (Public Law 111-152) will result in significant reform of our nation's health care system, including extending coverage to many more millions of Americans. There's a lot to learn about the new laws, and many people have questions about how the changes will take effect. It's important to remember that some changes in the new laws will not happen immediately, but will happen over a period of years, through 2019.

The attached summary was created by the World Institute on Disability. It is intended to be a "plain language" overview for the general public, with a timeline showing major implementation dates, so that people can get a better understanding of the changes that will affect them in the short-term, to help people prioritize what to focus on first, and learn the details in stages.

2010-04-02 - Health Care Reform Article

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Important Changes to the Medicare Part D Low-Income Subsidy

Individuals who enroll in the Medicare prescription drug program (Medicare Part D) may get assistance in paying the premiums for this coverage by applying for the Part D low-income subsidy. SSA also refers to this program as “Extra Help”.

Beginning January 1, 2010, changes in the law make it easier for some people to qualify for Extra Help with their Medicare prescription drug plan costs. Under the Medicare Improvements for Patients and Providers Act:

· SSA will no longer count as a resource any life insurance policy; and

SSA will no longer count as income the help beneficiaries receive regularly from someone else to pay their household expenses—food, mortgage, rent, heating fuel or gas, electricity, water, and property taxes.

In addition, beginning January 1, 2010, when beneficiaries apply for Extra Help, they also can start the application process for the Medicare Savings Programs. These are the state programs that provide help with Medicare Part B premiums and other Medicare costs – what we often refer to as QMB or SLMB. Social Security will now notify the State when beneficiaries apply for Extra Help and the State will contact beneficiaries to help them apply for a Medicare Savings Program.

For a complete explanation of the changes to Medicare Part D low-income subsidy, go to
http://www.socialsecurity.gov/pubs/10040.html

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New Commission to Address Debt, Social Security

Washington Post

Faced with growing alarm over the nation's soaring debt, the White House and congressional Democrats tentatively agreed Tuesday to create an independent budget commission and to put its recommendations for fiscal solvency to a vote in Congress by the end of this year.

Under the agreement, President Obama would issue an executive order to create an 18-member panel that would be granted broad authority to propose changes in the tax code and in the massive federal entitlement programs -- including Medicare, Medicaid and Social Security......FULL STORY

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2010 Medicare Premiums and Deductibles

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Changes to Medicare Part D Extra Help May Expand Eligibility

The Social Security Administration is asking partners to help spread the word about changes in the law beginning January 1, 2010, that could make more people eligible for “extra help” in paying for premiums and out-of-pocket expenses under Medicare Part D prescription drug coverage. The two most significant changes are that life insurance policies will no longer count as a resource, and income assistance received from someone else for household expenses (food, mortgage, rent, heating fuel or gas, electricity, water, and property taxes) will no longer count. A webinar on the changes will be held September 15, 2009, at 2 pm Eastern. RSVP for the webinar at http://www.ssa.gov/survey/mipparsvpsurvey.htm

For more information about Social Security work incentives, refer to the 2009 Red Book found at http://www.socialsecurity.gov/redbook/. The Red Book is a general reference tool and self-help guide designed to provide a working knowledge of these provisions. If you have any questions, please call the Social Security Administration toll-free at 1-800-772-1213 or contact your local SSA office. The Social Security Administration has a very comprehensive and user-friendly web site with extensive information, publications, and forms available. In addition to the main website, specific sections are dedicated to disability issues.

You may find earlier versions of work incentive emails on the www.nebraskatickettowork.org website.

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People With Disabilities Lose Advocate - Ted Kennedy

During his tenure in the Senate (46 years), Sen. Ted Kennedy was crucial in establishing and supporting key legislation that benefit people with disabilities. Here are a few:

• In 1978, Kennedy co-sponsored Civil Rights Commission Act Amendments, which expanded the jurisdiction of the Civil Rights Commission to protect people from discrimination on the basis of disability.

• Kennedy introduced the Americans With Disabilities Act in 1990. The bill was designed to prohibit employers from discriminating in job hiring and in the workplace against people who had a disability.

• His vote helped break a Republican filibuster against a bill that blocked cuts in Medicare payments to doctors.

• Supported a bill that required pharmaceutical companies to negotiate prescription drug prices covered under Medicare Part D.

• Voted for expanding the enrollment period for Medicare.

• Kennedy called for extending Medicare coverage to all Americans, medical coverage for the uninsured and modernizing health care systems by using new technologies to cut costs.
  

• Sponsored the Family Opportunity Act of 2006, allowing states to expand Medicaid coverage to children with special needs.

• Sponsored the Health Insurance Portability and Accountability Act (HIPAA) in 1996.

• In 1997, he rallied for the State Children's Health Insurance Program (SCHIP) under which uninsured children from low-income families could get insurance.

Any questions may be directed to: rsi5@srt.com

Health Care Reform Will Not Weaken Medicare

Last week at a Florida health care forum, Alliance President Barbara Easterling outlined how health care reform will strengthen Medicare. It will:

• Close the “donut hole” in Medicare Part D, the one that guarantees insurance companies keep getting their monthly premiums even when they aren’t giving you any benefits.

• Allow Medicare to negotiate for volume discounts with the drug companies.
  

• End wasteful taxpayer subsidies to the private insurance companies who run Medicare Advantage plans.

• Keep you healthier by eliminating the co-pay for Medicare preventive services such as checkups and cancer screenings.

• Offer an opportunity for early retirees to buy into Medicare

Any questions may be directed to: rsi5@srt.com

Are you 65 or eligible for Medicare?

The North Dakota Insurance Department invites you to attend a free seminar on Medicare Part d, supplements and Medicare Advantage plans.

6:30-9 p.m. Tuesday, Aug. 11th
Minot Commission on Againg
21 1st Ave. SE, Minot

Registration is required by Aug. 6th

1.888.575.6611 or janfrank@nd.gov

Any questions may be directed to: rsi5@srt.com

Legislation We Can All Agree On!

When a person becomes entitled to SSDI, he/she currently has a 2 year waiting period before they would be eligible for Medicare benefits. This waiting period often causes desperate financial situations involving medical expenses and in North Dakota, Recipient Liability.

On a number of occasions I've been asked: "Why is there a 2 year waiting period?". I don't like to be stumped by a question. I lose sleep over questions that take a lot of research to answer. So you could imagine my surprise when, this morning, I found out that there is hope in ending this peculiar rule.

Sens. Jeff Bingaman (D-NM), Sherrod Brown (D-OH), and Susan Collins (R-ME) and Reps. Gene Green (D-TX) and Lee Terry (R-NE) introduced the Ending the Medicare Disability Waiting Period Act of 2009 (S. 700/H.R. 1708). This bill would phase out Medicare's two-year waiting period for individuals with disabilities under age 65 who receive Social Security Disability Insurance (SSDI) benefits.

Please support this bill in any way possible.

Any questions may be directed to: rsi5@srt.com

Help With Medicare Prescription Drug Costs

Ever wish that there was some help out there for your medicare premiums and/or prescription drug coverage? There is!

Medicare beneficiaries are eligible for the extra help if they have limited income and resources. The extra help can increase their cost savings by paying for part of the monthly premiums, annual deductibles and prescription co-payments under the new prescription drug program. The extra help is estimated to be worth an average of $3,900 per year.

How to get it:

* Online application for help with Medicare prescription drug costs.

* "Do I qualify?" Online tool.

* Application pdf

Any questions may be directed to: rsi5@srt.com

Medicare Premiums for 2009

Part A: (Hospital Insurance) Premium

Most people do not pay a monthly Part A premium because they or a spouse has 40 or more quarters of Medicare-covered employment.
The Part A premium is $244.00 per month for people having 30-39 quarters of Medicare-covered employment.
The Part A premium is $443.00 per month for people who are not otherwise eligible for premium-free hospital insurance and have less than 30 quarters of Medicare-covered employment.

Part B: (Medical Insurance) Premium
$96.40 per month*

Medicare Deductible and Coinsurance Amounts for 2009:

Part A: (pays for inpatient hospital, skilled nursing facility, and some home health care) For each benefit period Medicare pays all covered costs except the Medicare Part A deductible (2009 = $1,068) during the first 60 days and coinsurance amounts for hospital stays that last beyond 60 days and no more than 150 days.
For each benefit period you pay:

A total of $1,068 for a hospital stay of 1-60 days.
$267 per day for days 61-90 of a hospital stay.
$534 per day for days 91-150 of a hospital stay (Lifetime Reserve Days).
All costs for each day beyond 150 days
Skilled Nursing Facility Coinsurance

$133.50 per day for days 21 through 100 each benefit period.

Part B: (covers Medicare eligible physician services, outpatient hospital services, certain home health services, durable medical equipment)

$135.00 per year. (Note: You pay 20% of the Medicare-approved amount for services after you meet the $135.00 deductible.)



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People Who Want Medicare Prescription Drug Coverage Should Apply Now

It’s open season for the Medicare prescription drug program. Everyone who is covered under Medicare is eligible for the prescription drug coverage. From November 15 to December 31, newcomers can join a prescription drug plan and people already participating should look at their current plans.

It’s also a good time for beneficiaries to investigate whether they may be eligible for extra help paying Medicare prescription drug program costs. Social Security offers extra help to participants who have limited income and resources.

The extra help will pay for all or most of the monthly premiums and annual deductibles. It also will help with the prescription co-payments. This extra help is worth an average of $3,600 per year. Some people with limited income and resources qualify for these big savings and don’t even know it.

Learn more about extra help and apply online by going to www.socialsecurity.gov/prescriptionhelp/index.htm.

Any questions may be directed to: rsi5@srt.com

Medicare Part D Open Enrollment November 15, 2008, to December 31, 2008

Your Medicare Prescription Drug Plan will probably change what it costs and what it covers for calendar year 2009. Now is the time for beneficiaries to review any changes being made by their current plan and to compare it to others to make sure the current plan still meets their needs. People entitled to Medicare who do not yet have prescription drug coverage can also enroll in a drug plan during open enrollment.

For residents of North Dakota, 48 Medicare Prescription Drug Plans (PDPs) are available for 2009. You can find information to help you compare these plans on Medicare’s website at www.medicare.gov.

If you have limited income and resources, you may qualify for extra help to pay for the monthly premiums, annual deductibles, and co-payments related to the PDP. If you have Medicare and Medicaid, you automatically qualify for the extra help. Otherwise, you can request help by completing the application found online at https://s044a90.ssa.gov/apps6z/i1020/main.html, or you can call Social Security at 1-800-772-1213 to apply over the phone.


Any questions may be directed to: rsi5@srt.com

WWD and Private Health Insurance—Scenario

John is a gainfully-employed individual with a disability, and he has healthcare coverage under Worker with Disabilities (WWD), North Dakota’s Medicaid buy-in program. He pays a premium of $80 per month for the WWD coverage. John’s employer recently told John that John has worked for the business long enough, and is working enough hours, to qualify for coverage under the employer’s health insurance plan. John’s share of the premium for this coverage would be just $40.00 per month.

Should John have both WWD coverage and the private health insurance? The answer depends on a number of factors, including what items and services the private insurance plan covers, whether John will lose the private insurance if his work hours decrease, and whether John has to pay the premiums for both WWD and the private plan.

The private insurer would be required to be the primary, or first, payer of the medical expenses covered under the plan. After that, WWD, as a Medicaid-type program, would fill in the gaps as the secondary payer.

Medicaid might pay John’s share of the premium for the private health insurance if it is "cost effective" for Medicaid to do so. If this is cost effective, Medicaid could even require John to apply for and take the private insurance so that the private insurer would pay first. However, if Medicaid required John to enroll in the private plan, Medicaid would pay the premium for the private insurance in order to save money for the WWD program. Medicaid would not require John to enroll in the private plan if Medicaid would not pay the premium for it.

John should bring this matter to the attention of his eligibility worker at the county Medicaid office for a "cost effectiveness" determination.

Source: Medicaid Program Policy Manual sections 510-05-20-05 and 510-05-20-15.



Any questions may be directed to: rsi5@srt.com