Issuu on Google+

South& Central& Alabama& Development& Commission& Area& Agency& on& Aging& Aging& Disability& Resource& Center& (ADRC)& State& Health& Insurance& Program& (SHIP)&

Alabama&Benefit&Checklist& Assembled&by&Jan&Neal& This& publication& has& been& created& or& produced& by& South& Central& Alabama& Development& Commission,& Area& Agency& on& Aging,& Aging& 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&

3&


SSI and Community Medicaid Benefit

Eligibility Standard

Effective Date/Change Date

SSI Retirement and Disability

Single Monthly Income/Resources $741/$2000

Married Monthly Income/Resources $1102/$3000

Medicaid at Home

SSI eligibility

SSI eligibility

Medicare Buy-In for Medicare A, B & D

SSI eligibility

SSI eligibility

01-14/01-15

Institutional Medicaid/Community Medicaid Waiver Benefit/Penalty

Eligibility Standard

Nursing Home Medicaid

Single Person Income/Resources $2163 (with income over $2163 MQIT needed)/ $2000

Effective Date/Change Date Married Couple Income/Resource Set Aside $2163 (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 01-14/01-15 Married Spousal Resource Set Aside Standard 07-13/07-14

4&


$117,240 Monthly Spousal Allotment Transfer Penalty Home exclusion

$1939

07-13/07-14

1 month for every $5500 transferred Equity at or below $543,000

01-14/01-15 01-14/01-15

Medicare&Savings&Programs&(MSP) Benefit

Eligibility Standard

Effective Date/Change Date 03-13/03-14

MSP Program

Single Income/Resources (includes $20 disregarded)

QMB $978 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 $1169 Pays for: ~Medicare Part B

Married Income/Resources (Includes $20 disregarded) $1313

$1571

5&


premium QI-1 Pays for: ~Medicare premium

$1313 Part

$1765

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; $426 per month with fewer than 30 qrts.; $234 per month with 30 – 39 quarters $104.90 per month standard premium if drawing in 2012

$1216 per admission to hospital during a spell of illness

$304 per day for days 61 – 90; $608 per day for days 91 – 150 lifetime reserve

B

Effective Date/Change Date 01-14/01/15

Skilled nursing facility $152 per day for days 21 - 100

$147.00

20%

Premium for higher income beneficiaries below

6&


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 $104.90

01-14/01/15

N/A

$146.90

N/A

$209.80

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

$272.70 335.70

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

01-14/01/15

7&


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

$12.10 + your plan premium $31.10 + your plan premium $50.20 + your plan premium $69.30 + 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” ($32.42 in 2014; $31.17 in 2013) 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

8&


calculate income: add income (½ of 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)

01-14/01-15

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 992.50/<13,440 1330.83/<26,860 Each additional person in the home for whom applicant provides more than one-half of personâ&#x20AC;&#x2122;s support add 338.33 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 1332.88/<13,440 1789.63/<26,860

9&


LIS (Partial Subsidy)

Each additional person in the home for whom applicant provides more than one-half of personâ&#x20AC;&#x2122;s support add 456.75 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 1381.50/<13,440 1855.17/<26,860 Each additional person in the home for whom applicant provides more than one-half of personâ&#x20AC;&#x2122;s support add 473.67 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 $1430.13/<13,440 1920.71/<26,860 Each additional person in the home for whom applicant provides more than one-half of personâ&#x20AC;&#x2122;s support add 490.58 C. People eligible for Medicare at or below 150% of the poverty level with limited resources below (25%

10&


subsidy) Single Income/Resources 1478.75/<13,440

*Premium State Standard

Married Income/Resources Living Together 1986.25/<26,860

Each additional person in the home for whom applicant provides more than one-half of personâ&#x20AC;&#x2122;s support add 507.50 $29.67

Effective Date/Change Date 01-14/01-15

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

11&


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 01-13/01-14

30%

Early Retirement Earned Income Offset

12&


Category Based on NRA

Exempt Amount

SS Offset Penalty

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

$15,480

Withholding of $1.00 in benefits for every $2.00 earned over $15,480

$41,400

Withholding of $1.00 in benefits for every $3.00 earned over $41,400

Effective Date/Change Date 01-14/01-15

SSD Substantial Gainful Activity (SGA) Category Based on Disability

Allowable Mo. Earnings

Non-blind

$1070.00

Blind

$1,800.00

Effective Date/Change Date 01-14/01-15

13&


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

Gross Income Limit

Net Income Limit

Effective Date/Change Date 10-1-13/10-01-14

1

$1245

$958

2

$1681

$1293

3 4 5 6 7 8 Each Additional Member

$2116 $2552 $2987 $3423 $3858 $4294 $ 436

$1628 $1963 $2298 $2633 $2968 $3303 $ 335

Gift and Estate Tax $5,340,000 Federal Estate Tax Exemption and Lifetime exclusion for gifts Annual Gift Exclusion $14,000

2014/2015

2014/2015

14&



Alabama Benefit Checklist