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South Central Alabama Development Commission& Aging&and Disability& Resource& Center& (ADRC)&

Alabama&Benefit&Checklist& Assembled&by&Jan&Neal& Effective 03-01-16 This& publication& has& been& created& or& produced& by& South& Central& Alabama& Development& Commission,& Area& Agency& on& Aging,& Aging& and Disability& Resource& Center& (ADRC)& with& financial& assistance,& in& whole& or& in& part,& through& a& grant& from& the& Centers& for& Medicare& and& & Medicaid& Services,& the& Federal& Medicare& agency.&


Table&of&Contents&

SSI&and&Community&Medicaid………................................................ 4& Institutional&Medicaid&and&Community&Medicaid&Waiver……..….4& Medicare&Savings&Programs&(MSP):&QMB,&SLMB,&QIP1………. .......5& Medicare&Standard&A&&&B&Cost&Sharing………. ............................... 6& Medicare&Higher&Income&A&&&D&Cost&Sharing………....................... 7& Medicare&Late&Enrollment&Penalties……..........................................…...8& Low&Income&Subsidies….......................................................................……..8& Social&Security&Retirement&Age……....................................................….11& Social&Security&Early&Retirement&Benefit&Reductions……........….12& Social&Security&Early&Retirement&Earned&Income&Offset……...….12& Social&Security&Disability&Substantial&Gainful&Activity………. ..... 13& Alabama&Elderly&Simplified&Application&Project……… ................14& Gift&and&Estate&Tax………................................................................ 14&

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SSI and Community Medicaid Effective Date/Change Date

Benefit

Eligibility Standard

SSI Retirement and Disability

Single Monthly Income/Resources $753/$2000

Married Monthly Income/Resources $1120/$3000

Medicaid at Home

SSI eligibility

SSI eligibility

Medicare Buy-In for Medicare A, B & D

SSI eligibility

SSI eligibility

01-16/01-17

Institutional Medicaid/Community Medicaid Waiver Benefit/Penalty

Eligibility Standard

Nursing Home Medicaid

Single Person Income/Resources $2199 (with income over $2199 MQIT needed)/ $2000

Effective Date/Change Date Married Couple Income/Resource Set Aside $2199 (only income of spouse being institutionalized counts)/First $27,000 set aside for community spouse, resources over $50,000, ½ set aside for spouse up to cap of

Single Standard 01-16/01-17 Married Spousal Resource Set Aside Standard 07-15/07-16

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$119,220 Monthly Spousal Allotment Transfer Penalty Home exclusion

$1991

07-15/07-16

1 month for every $5800 transferred Equity at or below $552,000

01-16/01-17 01-16/01-17

Medicare&Savings&Programs&(MSP) Benefit

Effective Date/ Change Date

Eligibility Standard

03-16/02-17 MSP Program

Single Income/Resources (includes $20 disregarded)

QMB $1010 Pays for: ~uncovered Medicare expenses to replace purchase of Medicare supplemental policy; ~Medicare Part B premium ~Medicare Part D premium up to State Standard* SLMB $1208 Pays for: ~Medicare Part B

Married Income/Resources (Includes $20 disregarded) $1355

$1622

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premium QI-1 Pays for: ~Medicare premium

$1357 Part

$1823

B

Medicare Medicare Part

Premium

Deductible

Copayment

A

0 if eligible for SS (Retirement benefits; 24 months of disability) or RR or paid Medicare Tax with Civil Service; $411 per month with fewer than 30 qrts.; $226 per month with 30 – 39 quarters $104.90 per month standard premium if drawing in 2015 (otherwise $121.80) Premium for higher income beneficiaries below

$1288 per admission to hospital during a spell of illness

$322 per day for days 61 – 90; $644 per day for days 91 – 150 lifetime reserve

B

Effective Date/Change Date 01-16/01/17

Skilled nursing facility $161 per day for days 21 100 $166.00

20%

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Medicare Part B Premium for Higher Income Beneficiaries Based on Two Year’s Prior Yearly Reported Income Individual Tax Return Filed

Joint Tax Return Filed

$85,000 or less

$170,000 or less

Over $85,000 up to $107,000 Over $107,000 up to $160,000 Over $160,000 up to $214,000 Over $214,000

Over $170,000 up to $214,000 Over $214,000 up to $320,000 Over $320,000 up to $428,000 Over $428,000

Married with Separate Tax Return $85,000 or less

Part B Premium Amount

Effective Date/Change Date

Standard $121.80

01-16/01/17

N/A

$170.50

N/A

$243.60

Over $85,000 up to $129,000 Over $129,000

$316.70 389.80

Medicare Part D Premium for Higher Income Beneficiaries Based on Two Year’s Prior Yearly Reported Income Individual Tax Return Filed

Joint Tax Return Filed

$85,000 or less

$170,000 or less

Married with Separate Tax Return $85,000 or less

Part D Premium Amount

Effective Date/Change Date

Your plan premium

01-16/01/17

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Over $85,000 up to $107,000 Over $107,000 up to $160,000 Over $160,000 up to $214,000 Over $214,000

Over $170,000 up to $214,000 Over $214,000 up to $320,000 Over $320,000 up to $428,000 Over $428,000

N/A N/A Over $85,000 up to $129,000 Over $129,000

$12.70 + your plan premium $32.80 + your plan premium $52.80 + your plan premium $72.900 + your plan premium

Medicare Late Enrollment Penalties Part B Late Enrollment Penalty Part D Late Enrollment Penalty

10% per each full 12 – month period eligible without coverage X cost of Medicare Part B premium at time of sign up = amount added to monthly cost of Part B premium 1% of the “national base beneficiary premium” ($34.10 in 2016) X the number of full, uncovered months eligible without coverage or creditable coverage = amount added to monthly cost of Part D

Permanent Permanent

Enrollment Periods Standard Part D Premiums Low Income Subsidy (Extra Help purchasing Medicare Part D) Benefit

Categorical Eligibility

Effective Date/Change Date

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calculate income: add income (gross earned income or net from self-employment minus 65 divided by 2) + all other income calculate resources: do not count home, adjoining land, household personal property, vehicles or life insurance C.LIS (Full Subsidy)

01-16/01-17

A. People eligible for Medicare and Medicaid who live in nursing facilities or receive home and community based waiver NOTE: Automatically receive benefit and pay no monthly premium*, no annual deductible and no copayments for drugs. B. People eligible for Medicare and Medicaid who apply and income is at or below 100% of the poverty level with limited resources (100% subsidy) Single Married Income/Resources Income/Resources Living Together 1010.00/<7280 1356.67/<10,930 Each additional person in the home for whom applicant provides more than one-half of personâ&#x20AC;&#x2122;s support add 346.67 C. People eligible for Medicare and Medicaid who apply and income is at or below 135% of the poverty level with limited resources (100% subsidy) Single Married Income/Resources Income/Resources Living Together 1356.50/<7280 1824.50/<10,930

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LIS (Partial Subsidy)

Each additional person in the home for whom applicant provides more than one-half of personâ&#x20AC;&#x2122;s support add 468.00 A. People eligible for Medicare at or below $140% of the poverty level with limited resources below (75% subsidy) Single Married Income/Resources Income/Resources Living Together 1406.00/<12,120 1891.33/<24,250 Each additional person in the home for whom applicant provides more than one-half of personâ&#x20AC;&#x2122;s support add 485.33 B. People eligible for Medicare at or below 145% of the poverty level with limited resources (50% subsidy) Single Married Income/Resources Income/Resources Living Together $1455.50/<12,140 1958.17/<24,250 Each additional person in the home for whom applicant provides more than one-half of personâ&#x20AC;&#x2122;s support add 502.67 C. People eligible for Medicare at or below 150% of the poverty level with limited resources below (25%

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subsidy) Single Income/Resources 1505.00/<12,140

*Premium State Standard

Married Income/Resources Living Together 2025.00/<24,250

Each additional person in the home for whom applicant provides more than one-half of personâ&#x20AC;&#x2122;s support add 520.00 $31.32

Effective Date/Change Date 01-16/01-17

Social Security Normal Retirement Age (NRA) Born

NRA

Effective Date/Change Date Permanent

1937 and prior

65

1938

65 and 2 months

1939

65 and 4 months

1940

65 and 6 months

1941

65 and 8 months

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1942

65 and 10 months

1943 â&#x20AC;&#x201C; 1954

66

1955

66 and 2 months

1956

66 and 4 months

1957

66 and 6 months

1958

66 and 8 months

1959

66 and 10 months

1960 and later

67

SS Early Retirement Benefit Reduction Category based on NRA NRA 66 (born 1943 or later) NRA after 66 (born after 1954)

Reduction of benefits when retire at 62 25%

Reduction of benefits when retire at 63

Reduction of benefits when retire at 64

20%

13.3%

Reduction of benefits when retire at 65 6.7%

Effective Date/Change Date 01-16/01-17

30%

Early Retirement Earned Income Offset

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Category Based on NRA

Exempt Amount

SS Offset Penalty

Exempt Earnings for early retirees/workers whose NRA IS NOT in 2016 Exempt Earnings for early retirees/workers whose NRA IS in 2014 and earnings predated reaching NRA

$15,720

Withholding of $1.00 in benefits for every $2.00 earned over $15,720

$41,880

Withholding of $1.00 in benefits for every $3.00 earned over $41,880

Effective Date/Change Date 01-16/01-17

SSD Substantial Gainful Activity (SGA) Category Based on Disability

Allowable Mo. Earnings

Non-blind

$1130.00

Blind

$1,820.00

Effective Date/Change Date 01-16/01-17

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Alabama Elderly Simplified Application Project (AESAP) Food Assistance for 60+ Household Size

Gross Income Limit

Net Income Limit

Effective Date/Change Date 10-1-15/09-30-16

1

$1276

$981

2

$1726

$1328

3 4 5 6 7 8 Each Additional Member

$2177 $2628 $3078 $3529 $3980 $4430 $ 451

$1675 $2021 $2368 $2715 $3061 $3408

Gift and Estate Tax $5,450,000 Federal Estate Tax Exemption and Lifetime exclusion for gifts Annual Gift Exclusion $14,000

2016/2017

2016/2017

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Alabama Benefit Checklist  

(Effective 03/16) A benefit checklist for quick reference and ease of update as categorical eligibility for benefits change.

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