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Centers for Medicare and Medicaid Services (CMS) Releases 2010 Medicare Fact Sheet and Part B Premium Increase

Steven Butler — Mon, 19 Oct 2009 04:21:39 +0000

On October 16, 2009, the Center for Medicare and Medicaid Services (CMS) released the 2010 Medicare Fact Sheet. According to CMS, the Medicare Part B monthly premium will increase to $110.50 for 2010. This is an increase of $14.10 per month (or $169.20 per year). Since there was no Cost-Of-Living Adjustment (COLA) for Social Security beneficiaries for 2010, the majority of individuals currently on Medicare will not see an increase in their monthly premium. (Federal Law includes a “hold harmless” provision that indicates that premiums will not be increased for Medicare beneficiaries receiving Social Security Benefits, if the increase from COLA does not exceed the increase in the Medicare monthly premium.)

As a result of the hold harmless provision of the Social Security Act, CMS indicated in the 2010 fact sheet that 73% of beneficiaries are protected from an increase in 2010. The Part B premium provides beneficiaries with co-insurance for doctor visits. Individuals that first enroll in Medicare Part B after November 2009 will have to pay the increased monthly premium of $110.50. The majority of beneficiaries that will be required to pay a higher premium are those that currently do not have the Part B premiums withheld from monthly Social Security payments (including individuals with low incomes whose premiums are paid through state subsidies).

Beneficiaries that file an individual tax return and have a “modified adjusted gross income” greater than $85,000 in 2010, or individuals that file a joint return and have “modified adjusted gross income” of greater than $170,000, will also be responsible for higher Medicare Part B premiums for 2010. Medicare has published a Frequently Asked Question on its’ website to help individuals with “Higher Income Levels” determine their Medicare Part B premium for 2010.

Additionally, the Medicare Part B deductible for doctor visits will be increased from the current $135 per year to $155 per year for 2010. The Medicare Part A deductible (that is paid when an individual has an inpatient hospital, skilled nursing facility, hospice or other qualified home health care service of 1-60 days) will increase to $1100 for 2010. This is an increase of $32 from the 2009 deductible. (According to my reading of 42 U.S.C.S. S 1395l, there is no “hold harmless” provision for Medicare Part A and Part B deductibles). All beneficiaries enrolled in Medicare Part D prescription drug coverage will also experience increased monthly premiums in 2010.

As indicated above, the majority of individuals that are currently receiving Medicare benefits will not see an increase in monthly Medicare Part B premiums for 2010, but will experience a net increase in Medicare costs as deductibles and Part D premiums will increase. Individuals that are currently disabled, but will not qualify for Medicare coverage until after November 2009, will not only face the increased deductibles and Part D premiums, but will also be required to pay the increased Medicare Part B premium of at least $110.50 per month when their Medicare coverage begins. Medicare has updated its’ Frequently Asked Questions to help individuals determine if their Medicare Part B premium will increase.

Although the “hold harmless” provision has protected current Medicare beneficiaries from seeing a monthly Part B premium increase in 2010, the next time Social Security payments are increased for COLA, it is likely that Medicare beneficiaries will see a much more sizable jump in their monthly premium payment. Not only will the beneficiaries have to pay the increase that occurs in that current year, they will also be responsible for any increases that had previously occurred that had not impacted them because of the “hold harmless” provision. (For example, if there is an increase of Social Security Payments because of COLA in 2011 and Medicare premiums increase to $120 per month in 2011, the individual would have their monthly Medicare Part B premium increased from $96.40 per month to $120 per month).

President Barack Obama called for Congress to quickly pass an Economic Recovery Provision for 2010 that would extend a onetime payment of $250 to all individuals receiving Social Security Retirement, Disability and Supplemental Security Income Payments. If you are currently receiving Social Security benefits and eligible for Medicare Coverage, it is important that you contact your United States Senators and United States Representative(s) to encourage them to support President Obama’s Economic Recovery Payment for 2010 so that you can qualify for a onetime payment of $250 in 2010. Delaware Residents should contact Senator Thomas Carper, Senator Edward Kaufman, and Representative Michael Castle. Passage of this legislation would help offset the increased costs that will be incurred from the Medicare deductible increases and the increase in Medicare Part D premiums outlined above.

If you are currently a client of Linarducci & Butler and have additional questions about the Medicare premium increase, please contact our office.

This article was written by Steven Butler. Steven is a partner at Linarducci & Butler, PA and his practice is limited to Social Security Disability/SSI claims. Steven offers free initial consultations for Social Security Disability/SSI claims to residents of Delaware, Maryland, New Jersey and Pennsylvania. To schedule a consultation with Steven, please use the Linarducci & Butler Contact Form or call 302-613-0707 to schedule an appointment.

Relevant Links:

Social Security Administration Officially Announces No COLA for 2010 and Publishes 2010 Fact Sheet On October 15, 2009, the Social Security Administration officially announced...
Don’t lose Medicaid Because of the Receipt of Social Security Disability Insurance Benefits Individuals that are approved for Social Security Disability Insurance benefits...
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Social Security Administration Officially Announces No COLA for 2010 and Publishes 2010 Fact Sheet

Steven Butler — Fri, 16 Oct 2009 05:23:28 +0000

On October 15, 2009, the Social Security Administration officially announced that there will be no Cost-of-Living Adjustment (COLA) for Social Security Disability and Supplemental Security Income recipients for 2010. This is the first time since the Cost-of-Living Adjustment was codified by Congress in 1975 that there will not be an increase in benefits for recipients. The maximum Supplemental Security Income Benefit will remain at $674 per month in 2010.

Although there will be no COLA for 2009, increases were announced for Substantial Gainful Activity and Quarters of Coverage. Substantial Gainful Activity (SGA) for 2010 will be defined as earned income of $1,000 per month or more. Individuals that earn less than $1,000 per month can still potentially qualify for Disability Benefits despite working. Individuals that are already receiving Social Security Disability Insurance are able to work on a part-time basis as long as earned income does not exceed SGA.

In 2010, individuals must earn at least $1,120 to earn one Quarter of Coverage for Social Security purposes. To earn the maximum of 4 Quarters of Coverage for the year, an individual would need to make at least $4,480 of earned income in 2010. (Individuals must establish that they have at least 20 Quarters of Coverage in the last 10 years before becoming disabled to potentially qualify for Social Security Disability Insurance).

The Center for Medicare and Medicaid Services announced on October 16, 2009 that Medicare Part B monthly premiums will also increase in 2010.

For individuals that are enrolled in Medicare in November 2009 and December 2009, Federal Law has a “hold harmless provision” that prevents an increase to Medicare Premiums if COLA is not large enough to cover increase of Part B Premium. This means that for most individuals currently receiving Social Security Disability Insurance benefits there will be no increase in Medicare premiums as long as Medicare eligibility and enrollment began no later than November 2009. Additional information about the “hold harmless provision” of the Social Security Act can be found at the Center for Medicare Advocacy Website. (For a detailed description of the 2010 Medicare Premium and Deductible increases, please see “CMS Announces 2010 Medicare Fact Sheet and Part B Premium Increase.”)

What you can do.

If you are currently receiving Social Security benefits, it is important that you contact your United States Senators and United States Representative to encourage them to support President Obama’s Economic Recovery Payment for 2010 so that you can qualify for a onetime payment of $250 in 2010. Delaware Residents should contact Senator Thomas Carper, Senator Edward Kaufman, and Representative Michael Castle and encourage each Congressman to support the Economic Recovery Payment for 2010.

If you are currently a client of Linarducci & Butler, PA, please contact our office with additional questions.

Relevant Links:

Centers for Medicare and Medicaid Services (CMS) Releases 2010 Medicare Fact Sheet and Part B Premium Increase On October 16, 2009, the Center for Medicare and Medicaid...
Social Security Disability Applicants’ Access to Professional Representation Act of 2010 Signed Into Law Today the National Organization of Social Security Claimants’ Representatives (NOSSCR)...
Applying for Social Security Disability Insurance while Receiving Long Term Disability Benefits When you are receiving Long Term Disability (“LTD”) benefits, you...

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Don’t lose Medicaid Because of the Receipt of Social Security Disability Insurance Benefits

Steven Butler — Fri, 18 Sep 2009 18:31:23 +0000

Because of financial struggles that occur when an individual is disabled and unable to perform work, it is common for an individual to qualify for Medicaid coverage (poverty based medical insurance program) in Delaware prior to applying for or being found disabled under the Social Security Disability Insurance (SSDI) program of the Social Security Administration. Prior to March 1, 2001, many individuals who were on Medicaid before they were approved for SSDI, lost their eligibility for Medicaid as a result of being approved for SSDI. Once an approval was issued, the Delaware Division of Social Services would send an individual a notice indicating that their Medicaid was terminated because of their income from SSDI.

Effective March 1, 2001, Delaware extended Medicaid eligibility to certain individuals that were approved for SSDI. The program was named “Medical Assistance During Transition to Medicare” or “MAT” and was codified as part of the Delaware Administrative Code. (See Title 16 Sec. 17800 of Delaware Administrative Regulations).

Beginning March 1, 2001, individuals in Delaware who were already receiving Medicaid and were approved for at least one month of Supplemental Security Income payments (SSI is the Social Security Administration’s poverty based disability program) no longer lost their eligibility for Medicaid because of the receipt of SSDI. The only requirements were that 1) the individual lost Medicaid because of receipt of SSDI, and 2) they were not yet eligible for Medicare. This was an important change, because previously these same individuals would lose eligibility for Medicaid if their SSDI payments were above the State income limits. Since Medicare does not begin until 24 months after eligibility for the first SSDI payment, before MAT, it was common for individuals to lose Medicaid and have to go months or even as long as 2 years without government provided medical coverage, despite being found disabled by the Social Security Administration.

Unfortunately, MAT did not extend Medicaid coverage in every situation. Only individuals that were approved for SSDI and had at least one month of SSI eligibility qualified for this program. The result was that anyone in Delaware that was receiving Medicaid and approved for SSDI, but was not approved for SSI (or never applied for SSI), still lost their Medicaid eligibility and had no government provided medical insurance coverage until Medicare began.

Effective September 1, 2008, Delaware extended MAT to any individual that was 1) not yet eligible for Medicare and 2) lost eligibility for Medicaid on or after January 1, 2008 due to the receipt of SSDI. As a result, even if an individual never met the requirements for SSI, they became eligible to retain Medicaid as long as they were receiving Medicaid before their SSDI claim was approved. This change in the Administrative Regulations closed a loophole that was causing many individuals in Delaware to lose all government provided medical coverage once they were approved for SSDI until they were finally eligible for Medicare.

In effect, this now means that no Delaware resident who is receiving Medicaid should lose government provided medical insurance just because of being found disabled by the Social Security Administration. Unfortunately, the regulations are not being applied consistently by the Delaware Division of Social Services. Many of my clients have had Medicaid benefits terminated after being approved for SSDI benefits, even though they should still qualify under MAT. I have found that several employees of the Delaware Division of Social Services are still not aware of these changes, and need reminders on how to properly apply the MAT Regulations.

I recommend that individuals that receive a notice that their Medicaid coverage has been terminated because of receipt of SSDI (who are not yet eligible for Medicare), print out copies of the applicable regulations and provide them to their Social Worker. Additionally, the individual should provide the Social Worker with the Notice of Approval from the Social Security Administration to prove that the source of their new income is SSDI benefits.

In order to implement this Medicaid gap coverage, individuals that fall within these limited categories are made eligible for $5.00 in an optional Delaware SSI State Supplement program regardless of the amount of their earned or unearned income. A Medicaid redetermination may be necessary after qualifying for SSDI, but the Administrative Regulations provide that eligibility for Medicaid continue until Medicare eligibility begins.

Remember, both of these extensions of Medicaid only apply if you were already receiving Medicaid before you were approved for SSDI. If you did not qualify for Medicaid before being found disabled under the SSDI program, you will still need to wait 24 months from the date of your first SSDI payment until you are eligible for Medicare Coverage. If you have not yet been approved for SSDI, and do not have medical insurance, you can use the Delaware Division of Social Services online Application for Social Services and Internet Screening Tool to determine if you qualify for State Assistance while waiting for your disability determination.

If you were represented by an attorney for your Social Security disability claim, and your Medicaid is terminated before you are eligible for Medicare, I would recommend that you ask your attorney to write a letter to your Social Worker describing the applicable regulations and explaining why you should retain your eligibility. If you live outside of Delaware, it is important that you determine if your State has a similar MAT program.

Relevant Links

Applicable Medical Assistance during Transition to Medicare Regulations

Delaware Administrative Code Title 16, Section 17800 Medical Assistance during Transition to Medicare
Delaware Administrative Code Title 16, Section 17801 Status Eligibility
Delaware Administrative Code Title 16, Section 17802 Financial Eligibility
Delaware Administrative Code Title 16, Section 17803 Eligibility Determination
Delaware Administrative Code Title 16, Section 13434 Recipients of Optional State Supplement Payments

Delaware Medicaid

Medicare

United State Medicare

Sample Letter

Sample Letter Requesting Redetermination of Medicaid Termination

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