Some period of time after a claimant begins receiving Social Security Disability Benefits, the Social Security Administration (SSA) generally conducts a Continuing Disability Re-Evaluation (CDR). If you are less than 55 years of age at the time your benefits begin, a review is usually conducted every 3 years. If you are 55 years old or older, or if you have a condition that is unlikely to improve, your CDR will occur approximately every 7 years, until you reach retirement age.

A CDR may also occur if you are receiving Social Security Disability benefits and earning more than “substantial gainful activity” (SGA) per month. In 2016, the SGA amount for disabled non-blind beneficiaries is $1,130 per month. For blind beneficiaries, the amount is $1,820 per month. If you earn more than the SGA, your disability benefits will be in jeopardy. The exception to the SGA limitations is when the beneficiary is enrolled in a return-to-work plan through Social Security, which allows for a trial run of work for the beneficiary.

Continue Reading Passing a Social Security Continuing Disability Re-Evaluation

In case you were unaware, the fees for all attorneys who represent claimants seeking Social Security Disability Benefits are regulated by federal law. Furthermore, these fees are contingent on the attorney’s ability to successfully get an award of benefits for the claimant. In other words, if the attorney is not able to obtain an award of benefits for the claimant, the attorney does not get a fee.

The statute in question that regulates attorneys fees states that the attorney is entitled to get 25% of the claimant’s retroactive benefits or a flat fee (which currently stands at $6,000), whichever is less. An attorney is not entitled to receive any monies from a claimant’s monthly checks from Social Security.

Continue Reading Fees and Costs for Attorney Representation for Social Security Disability Benefits

Claiming Social Security Twice is Eliminated

Prior to 2016, some married individuals who were 62 or older had claimed Social Security retirement benefits twice. Previously, a person whose spouse was at full retirement age and was herself or himself at an early retirement age, age 62 to 65, could claim spousal payments and then switch to payments based on their own work, which would then be higher because they were claiming it at an older age.

As of this year, however, workers who turn 62 in 2016 or later will not be able to claim both types of payments, but instead one or the other. However, the younger spouse can still claim spousal benefits when he or she turns 66, and those individuals will continue to contribute to their own Social Security Retirement benefit until age 70, thereby receiving a higher benefit when they begin to receive their full retirement benefits 4 years later.

Stricter Rules for Suspended Payment of Benefits

In May 2016, the rules have changed for suspending your Social Security Retirement benefits until a later date when they would be higher, and this process will no longer be permitted. Previously, spouses and dependent children could claim payments based on your work record while your benefits were suspended and continued to grow.

This option is no longer available, however, as of May 2016. You will no longer be allowed to “file and suspend.” If the retired worker’s benefits are suspended, spousal and dependent benefits will not be paid.

Higher Medicare Part B Premiums for some Social Security Recipients

Most Social Security recipients will pay the same Medicare Part B premium in 2016, as they did in 2015. That amount is $104.90 per month. Increases in Medicare Part B premiums are tied to increases in Social Security benefits due to cost-of-living adjustments which did not occur this year. However, those individuals who are enrolling for the first time in Medicare Part B this year will pay a higher premium of $121.80 per month.

Beginning in late 2015, a new type of Roth Retirement Account, guaranteed by the government never to lose value, was offered to savers who earn less than $131,000 per year, individually, and less than $193,000 per year as a couple. The account, the purpose of which is to provide an easy way for people to start saving for their retirement, only has one investment option. This sole option is a Treasury savings bond with a variable interest rate which has averaged 3.19% over the past 10 years.

The interest on the bond is not taxed while in the account, and won’t be taxed at all if it is left in the account until the account holder reaches age 59 and a half. Individuals may contribute up to $5,500 year if under age 50, and $6,500 per year if age 50 and above.

Once the account balance reaches $15,000 or is 30 years old, the money will be transferred to a private sector Roth IRA. You can contribute to a myRA account with a direct deposit, either set up through your employer or from a checking or savings account, or you can direct that a portion of your tax refund be deposited into the account.

If you have any questions about Social Security and Retirement, it is recommended that you speak with experienced professional counsel to address your questions.

Since 2008, Medicare has refused to reimburse hospitals for the cost of treating patients who suffer avoidable medical complications. Although technically Medicare can actually expel a hospital with high rates of errors from the Medicare program, this is very rarely done.

However, in 2015, the federal government did cut payments to 721 hospitals which possessed documented high rates of infections and other patient injuries in the previous year. Among the 721 institutions were 2 frequently used by patients in Eastern Pennsylvania – the Hospital of the University of Pennsylvania, in Philadelphia, and Geisinger Medical Center in Dansville, Pennsylvania.

Hospital acquired conditions, or HACs, include infections, blood clots, bed sores, and other complications which are considered avoidable. The penalties levied on the 721 hospitals are estimated to be in excess of $300 million. In 2013, approximately 1 in 8 admissions to a hospital included an HAC. Populations at highest risk are the very young and the very old, as well as those who have chronic diseases which would place them at a higher likelihood of developing an HAC.

Continue Reading Government Cracks Down on Hospitals with High Rates of Complications

For those unsure or unaware, Medicare and Medicaid are both government health insurance programs. However, they are still different programs, and therefore require different eligibility requirements and different coverage. Essentially, Medicare is a government program designed to provide health insurance coverage for the elderly and disabled. On the other hand, Medicaid is a needs program, which means that it exists to cover the healthcare costs for the very low income individuals.

Medicare is a purely federal government program attached to Social Security. It is available to citizens and certain other legal residents at the age of 65, and also covers people who are disabled under the Social Security guidelines. It is a 4-part program which covers hospitalizations through Part A, outpatient and doctors visits through Part B (more about parts A and B), potentially private plans (Medicare Advantage Plans) through Part C, and prescription coverage, through Part D (more about parts C and D).

Medicaid is a joint federal and state program that covers healthcare costs for low income individuals. Additionally, it covers long-term custodial care for poor and elderly individuals. There is a Medicaid program for each state in the U.S., and the federal government funds up to 50% of the costs of each state’s Medicaid program.

Continue Reading The Key Differences between Medicare and Medicaid

In my last blog, I discussed how to determine eligibility for Medicare Parts A and B. This blog today will focus on Parts C and D.

Medicare Part C, known as a Medicare Advantage Plan, replaces Medicare Parts A and B through a health insurance plan offered by a private insurer. In order to be eligible for a Medicare Advantage Plan, you must already be enrolled in Medicare Parts A and B and must reside in the service area of the insurer with whom you are seeking coverage.

Additionally, if you have a Medicare Advantage Plan you will not need a Medicare Supplemental Plan, as Advantage plans usually cover more than what Medicare Parts A and B cover.

The enrollment period for a Medicare Advantage Plan is the same as the initial enrollment period for Medicare Parts A and B. Alternatively, you can sign up during the Annual Election Period from October 15 to December 7, for coverage effective January 1st of the following year. You can also enroll during a Special Election Period, if you qualify.

Medicare Part C is optional, and there is no penalty for choosing this alternative to the traditional Medicare Parts A and B. In addition, you will continue to make your Medicare Part B premiums even if you enroll in an Advantage Plan. Monthly rates and plan coverage will vary by the insurance company and your specific plan.

Medicare Part D, known as the Medicare Prescription Drug Plan, is prescription coverage and is available through private insurers, like a Medicare Advantage Plan, and it is completely optional. To be eligible to enroll in a Medicare Prescription Drug Plan you must have Medicare Parts A and B, and live in the service area for the plan in which you wish to enroll.

If you have any questions about Medicare and retirement benefits, it is recommended that you speak with experienced legal counsel to discuss your situation.

Medicare is often discussed on the news, but very little time is spent explaining how precisely patients can qualify. Medicare Part A covers inpatient hospital stays or care in a skilled nursing facility. Medicare Part B covers outpatient medical care, such as doctor visits. In order to qualify for Medicare Part A and Part B, you must be a U.S. citizen or a permanent legal resident for at least 5 years.

In addition to this, you must also meet at least one of the following criteria:

  1. You are age 65 or older and are eligible for Social Security – You become eligible for Social Security at age 62. There is a possibility that you may be eligible for Social Security benefits at an earlier age because you have a disability pursuant to the Social Security guidelines. If you are already receiving Social Security benefits, you will automatically get Parts A and B when you become 65. If you are not already receiving Social Security benefits, however, you must sign up for Medicare. You can do sign up three months prior to your 65th birthday, but no later than three months after your birthday. If you sign up at a later date, you will pay a higher premium for your Part B benefit.
  2. You become permanently disabled and receive disability benefits for at least two years –You automatically get Parts A and B 24 months after Social Security has declared you disabled.
  3. You have end-stage Renal Disease – This means you have permanent kidney failure and require dialysis or a kidney transplant. You must apply for Medicare if you meet this criterion. Enrollment is not automatic.
  4. You have ALS (Amyotrophic Lateral Sclerosis a.k.a. Lou Gehrig’s Disease) – You will automatically get Parts A and B the month your Social Security Disability benefits begin.

If you have any questions about retirement benefits or social security, it is recommended that you speak with experienced legal counsel to discuss your situation.

The Spousal Retirement Benefit offered by Social Security is a little known and poorly advertised gender-neutral benefit, which is available to any person who is 62 years old and whose spouse has filed for his or her retirement benefits. The benefit to the spouse is based on the retiring/retired worker’s earnings. The spousal benefit can be as much as half of the retiring worker’s primary insurance amount, depending on the spouse’s age at retirement. If the spouse begins receiving benefits before his or her full retirement age, the spouse will receive a reduced benefit.

If the spouse intending on collecting this spousal benefit has not reached his or her full retirement age yet, this claim will be deemed to be for all benefits available to the claimant. It will also be seen as a request for the spouse’s own retirement, as well as the spousal benefit. If the spouse’s benefit is greater than the retiring or retired worker’s benefit, the spouse cannot receive a spousal benefit.

Continue Reading The Spousal Retirement Benefit: Social Security’s Best-Kept Secret

Medicare is now in its third year of testing their “Independent at Home” project, which was created by the Affordable Care Act. This program provides Medicare’s frailest senior citizen patients, who all suffer from multiple chronic conditions, with house calls by healthcare professionals.

These are Medicare’s most expensive type of patient, because they are often too debilitated or fragile to make the trip into a physician’s office, lab or x-ray facility on a regular basis. The program includes not just visits by physicians and nurses, but also social workers, mobile x-rays and lab work.

On June 18, 2015, Medicare announced that it saved more than $25 million in the first year of the study, because these seniors were able to avoid pricier hospital or emergency room care.

In 2013, Medicare paid for more than 2.6 million customized primary care house call visits, for approximately 8,400 patients, across its 17 programs nationwide. This program was designed to benefit both the patients, who would be able to stay comfortable at home, as well as the physicians. Provided that the physician meets the “Independent at Home” program’s goals, they would qualify for a potential share in government savings. This way, physicians who might lose out on a full day’s worth of in-office patients, and by extension their reimbursements, have a way to supplement their losses on days spent traveling to visit at-home patients.

There is currently pending legislation in Congress to extend the Independent at Home Project for another two years.