Virginia Disability Law Blog » Medicare/Medicaid Information

New Website, the Medicaid Reference Desk, provides help to the disabled

Sheri Abrams — Mon, 10 Oct 2011 02:10:21 +0000

The Medicaid Reference Desk is a tool to help people with intellectual and developmental disabilities find out what Medicaid can offer them.

The Medicaid Reference Desk is located at: http://www.thedesk.info/

Which States Offer the Best & Worst Medicaid Services to the Developmentally Disabled?

Sheri Abrams — Fri, 20 May 2011 19:32:06 +0000

According to United Cerebral Palsy’s 2011 report “The Case for Inclusion,” Vermont offers the best Medicaid services to the developmentally disabled, while Mississippi provides the worst services.

In my local area, Virginia ranks 38th, Maryland 31st, and the District of Columbia 47th.

Here is the complete list:

1. Vermont
2. Arizona
3. Michigan
4. New Hampshire
5. California
6. Washington
7. Delaware
8. Nevada
9. Massachusetts
10. Connecticut
11. New Mexico
12. Colorado
13. Hawaii
14. Minnesota
15. Pennsylvania
16. South Carolina
17. New York
18. Idaho
19. West Virginia
20. Wisconsin
21. Wyoming
22. Georgia
23. South Dakota
24. Montana
25. Kansas
26. Oregon
27. Florida
28. Missouri
29. Maine
30. Alaska
31. Maryland
32. Alabama
33. Kentucky
34. Rhode Island
35. Iowa
36. North Dakota
37. Louisiana
38. Virginia
39. Ohio
40. New Jersey
41. Tennessee
42. Indiana
43. North Carolina
44. Utah
45. Oklahoma
46. Nebraska
47. District of Columbia
48. Illinois
49. Texas
50. Arkansas
51. Mississippi

To see the entire report, please click here.

Worsening picture for Social Security & Medicare programs

Sheri Abrams — Tue, 17 May 2011 17:15:03 +0000

The Associated Press reports that the trustees for the Social Security and Medicare trust funds have shortened the life of these two trust funds.

The annual checkup by the trustees said that the Medicare hospital insurance fund will now be exhausted in 2024, five years earlier than last year’s estimate. While the Social Security trust fund will be exhausted in 2036, one year earlier than before.

The trustees for the trust funds said in their annual report that this has been caused by the worsening economy and they emphasized the need for Congress to make changes to avoid disruptive consequences in the future for millions of people who depend on Medicare & Social Security Benefits.

New Medicare Rule: Hospital Admission vs. “Observation”

Sheri Abrams — Mon, 27 Sep 2010 03:06:26 +0000

There is a new Medicare rule that is pushing hospitals to relegate patients to “observation” status vs. being fully admitted as an inpatient.

The limit is supposed to be 24-48 hours to make sure people are really sick enough to be there. Except that sometimes patients can be in as long as 5 days on “observation” status.

The big difference is instead of a patient meeting the three day hospitalization rule and then Medicare picking up the bill for the next round of skilled nursing care in a facility — those payments are now disallowed and the patient or their family ends up with the bill.

For more information please read this article entitled: “Hospitals Caught Between a Rock and A Hard Place over Observation”

How Come my Medicare Part B Premium is More than my Neighbors?

Sheri Abrams — Fri, 27 Aug 2010 19:24:56 +0000

Most Medicare beneficiaries will continue to pay the same $96.40 Part B premium amount in 2010. Beneficiaries who currently have the Social Security Administration (SSA) withhold their Part B premium and have incomes of $85,000 or less (or $170,000 or less for joint filers) will not have an increase in their Part B premium for 2010.

For all others, the standard Medicare Part B monthly premium will be $110.50 in 2010, which is a 15% increase over the 2009 premium. The Medicare Part B premium is increasing in 2010 due to possible increases in Part B costs. If your income is above $85,000 (single) or $170,000 (married couple), then your Medicare Part B premium may be higher than $110.50 per month.

In other words in 2010:

Beneficiaries who currently have the part B premium withheld from their Social Security benefit will pay $96.40.

New Part B beneficiaries will pay $110.50 (because they did not have the premium withheld from their Social Security benefit in the previous year).

Beneficiaries who do not currently have the Part B premium withheld from their Social Security benefit will pay $110.50.

Higher-income beneficiaries pay $110.50 plus an additional amount, based on the income-related monthly adjustment amount (IRMAA).

Are You In Medicare Prescription Drug’s “Donut hole”? $250 Checks Are On The Way

Sheri Abrams — Fri, 11 Jun 2010 01:21:00 +0000

The government is mailing $250 checks this week to seniors and the disabled who fall into the gap in Medicare’s prescription drug coverage. The first checks will be sent June 10, three weeks earlier than scheduled, to about 80,000 people. The rebates are the first step in closing the Medicare “donut hole.” The Department of Health and Human Services estimates that about 4 million seniors will get the rebates in 2010. These payments are part of the new health care reform law.

Seniors and the disabled on Medicare get stuck in the donut hole if their prescription drugs cost too much to be paid for through basic Medicare coverage, but aren’t expensive enough to qualify for catastrophic coverage.

Now You Can Apply for Medicare Online

Sheri Abrams — Wed, 07 Apr 2010 14:35:26 +0000

Social Security has unveiled its newest online service – an application for Medicare benefits.

This new online application, which takes less than 10 minutes to complete, is for people reaching the Medicare eligibility age of 65 who want to delay filing for Social Security retirement benefits.

Currently about a half million Americans enroll in Medicare each year without applying for monthly benefits.

“Social Security’s online services are the best in all of government and exceed the top private sector companies in customer satisfaction,” said Michael J. Astrue, commissioner of Social Security.

“The new Medicare application is a welcome addition to our suite of online services and will make it easier than ever to sign up for Medicare.”

To apply online for Medicare, go to www.socialsecurity.gov and choose Retirement/Medicare under the header, “Click Below To Apply For.”

You will be asked a brief series of questions. If you have a question or need additional information, there are convenient “more info” links. When you’re done, just click the “Sign Now” button to submit the application. There are no paper forms to sign, and usually no additional documents are required.

If more information is needed, Social Security will contact you by phone or letter.

For a variety of reasons, more and more Americans are choosing to delay receiving Social Security retirement benefits past the Medicare eligibility age of 65.

Although the age to collect full retirement benefits used to be age 65, it is now age 66 for individuals just becoming eligible for retirement benefits and will eventually become age 67. Benefits can be increased by up to 32 percent if someone delays receiving them until age 70.

Extra Help with Medicare Prescription Drug Plan Costs

Sheri Abrams — Sun, 31 Jan 2010 03:34:01 +0000

Michael J. Astrue, Commissioner of Social Security, and Chubby Checker, Grammy Award winner and rock and roll legend, have launched a new campaign to inform millions of Americans about a new “twist” in the law that makes it easier to qualify for extra help with Medicare prescription drug costs. The extra help program currently provides assistance to more than nine million older adults and people with disabilities — saving them an average of almost $4,000 a year on their Medicare prescription drug plan costs. To apply for extra help, there is an easy-to-use online application available at www.socialsecurity.gov.

To qualify for extra help, people must meet certain resource and income limits. The new Medicare law eases those requirements in two ways. First, it eliminates the cash value of life insurance from counting as a resource. Second, it eliminates the assistance people receive from others to pay for household expenses, such as food, rent, mortgage or utilities, from counting as income. There also is another important “twist” in the law. The application for extra help can now start the application process for Medicare Savings Programs — state programs that provide help with other Medicare costs. These programs help pay Medicare Part B (medical insurance) premiums. For some people, the Medicare Savings Programs also pay Medicare Part A (hospital insurance) premiums, if any, and Part A and B deductibles and co-payments.

To learn more about the extra help program and to view the new TV spot featuring Chubby Checker, go to www.socialsecurity.gov/extrahelp.

Virginia’s Plan for the Elimination of Waiting Lists under Medicaid

Sheri Abrams — Sun, 15 Nov 2009 02:56:00 +0000

During its 2009 session, the Virginia General Assembly expressed its intent to eliminate the waiting lists for the Medicaid Intellectual Disabilities (formerly “Mental Retardation”) Waiver and the Individual and Family Developmental Disabilities Supports Waiver.

In doing so, it required the Department of Medical Assistance Services (DMAS) to collaborate with the Department of Planning and Budget to increase the number of funded waiver slots at a minimum of 67 slots for the Individual and Family Developmental Disabilities Supports waiver and 400 slots for the Intellectual Disabilities waiver per year, until the waiting lists are eliminated and directed the Governor to develop a plan to eliminate the waiting lists for these waivers by the 2018-2020 Biennium.

The full report can be accessed here.

What is Medicaid?

Sheri Abrams — Mon, 10 Aug 2009 02:35:28 +0000

Because of its size and cost, Medicaid has been called the “workhorse” of the U.S. health system. Now it’s front and center in the debate on overhauling the U.S health system and expanding coverage to the uninsured.

With 60 million enrollees, Medicaid dwarfs other insurance programs, including its cousin, Medicare, which covers 44 million elderly and disabled people.Medicaid is a joint federal-state program, with the federal government picking up about 57 percent of the overall Medicaid tab. But the federal contribution varies by state, ranging from 50 percent to 73 percent, with poorer states getting a bigger matching rate.

Medicaid isn’t a one-size-fits-all program; after meeting certain federal requirements, each state has the flexibility to shape coverage and benefits. As a result, the Medicaid program in Pennsylvania bears little resemblance to the one in Louisiana. For example, non-working parents in Pennsylvania qualify for Medicaid if their incomes are below twice the federal poverty level ($44,100 for a family of four). But in Louisiana, non-working parents qualify only if their incomes are below 11percent of the poverty level ($2,426 for a family of four). States frequently experiment with new concepts in benefit design, eligibility and delivery systems.

In general, Medicaid covers about 45 percent of poor Americans, defined as those with incomes below the federal poverty level (about $22,000 for a family of four). To be eligible for coverage, individuals must fall below certain income thresholds, which vary by state, and belong to certain categories, such as having dependent children, or being pregnant or disabled. In 20 states, a parent in a family of four who gets paid the federal minimum wage makes too much to qualify. Only 18 states cover adults without dependent children.

Medicaid benefits include mental health services, transportation-to-health services, and comprehensive screenings and treatment for children. In addition, Medicaid enrollees have much lower out-of-pocket costs than people with private coverage. There are typically no monthly premiums and no, or very low, co-payments

However, in many states, specialists and dentists don’t see Medicaid patients. Providers typically blame low reimbursement rates as the main reason for not accepting Medicaid patients. In Kentucky, Medicaid pays doctors $210for a colonoscopy; Medicare pays $333. Private insurers usually pay more. In Pennsylvania, Medicaid pays doctors $300 for an appendectomy, while Medicare pays $575.

About 76 percent of all enrollees are children and their parents. And 65 percent of people on Medicaid come from working families. About three quarters of Medicaid spending is for the elderly and disabled, even though the two groups make up only about one quarter of the program’s enrollees. Medicare provides little coverage for long-term care, so many elderly, after depleting their savings, rely on Medicaid to pay their costly nursing home bills.

Administrative costs of Medicaid are less than 7 percent, or half the rate that’s typically seen in the private sector. Medicaid holds down costs in part by paying providers lower fees and doing little marketing.

Help for Those on Medicare with Prescription Costs

Sheri Abrams — Sat, 04 Jul 2009 02:55:55 +0000

Adults covered by Medicare who have limited income and resources may be eligible for extra help – available through Social Security – to pay part of their monthly premiums, annual deductibles, and prescription co-payments. The extra help is worth an average of $3,900 per year.

To figure out whether a Medicare recipient is eligible, Social Security needs to know the individual’s income and the value of her/his savings, investments, and real estate (other than the home lived in). To qualify for the extra help, the individual must be receiving Medicare and also have income limited to $16,245 for an individual or $21,855 for spouses living together. Even if the annual income is higher, one still may be able to get some help with monthly premiums, annual deductibles and prescription co-payments. Some examples where income may be higher include if either spouse:

** Supports other family members who live with them;
** Have earnings from work; or
** Live in Alaska or Hawaii; and
** Resources limited to $12,510 for an individual or $25,010 for a married couple living together (i.e. resources include such things as bank accounts, stocks and bonds. Social Security does not count a house
or car as resources).

Social Security has an online application. You can find it at www.socialsecurity.gov/prescriptionhelp. To apply by phone or have an application mailed to you, call Social Security at 1-800-772-1213 (TTY 1-800-325-0778) and ask for the Application for Help with Medicare Prescription Drug Plan Costs (SSA-1020). Or go to your local Social Security office.

Senate Considers Making Changes To The Medicaid Waiver Program

Sheri Abrams — Mon, 22 Jun 2009 02:30:33 +0000

The Senate Finance Committee is working on ideas to change the way people become eligible for and utilize the Medicaid Home and Community Based Services Waiver Program.The Medicaid Home and Community Based Services Waiver is a federal program administered by the states, which provides funding for people with disabilities to live in the community and obtain support services. There are currently long waiting lists for this waiver program in many states.

The Senate Finance Committee is creating policy options as part of President Barack Obama’s efforts to reform the American health care system.

The options pertaining to the waiver program include:

• Requiring states to lift their caps on the number of waiver recipients to include more people. Or, prohibiting states from using waiting lists to prevent eligible individuals from accessing services.

• Eliminating a current requirement that in order to obtain funding from the waiver individuals must need an institutional level of care.

• Giving states more latitude to determine income requirements for waiver eligibility.

• Allowing individuals to enroll in multiple Medicaid waivers at one time.

How to Choose a Medigap Policy

Sheri Abrams — Sat, 02 May 2009 22:07:53 +0000

Once you become eligible for Medicare, you will be inundated with offers from insurance companies for Medigap (supplemental insurance) policies. Sorting through these offers can be confusing. Not only are there 12 standardized plans, but there can be huge differences in premiums between companies.

Medicare plans A and B cover only a portion of medical costs. Medigap policies are designed to fill in the “gaps” in coverage. The first step is to figure out what coverage you will need. The government created 12 standardized plans (Plans A through L). Plans in Massachusetts, Minnesota, and Wisconsin have some extra options, so if you live in those states, check with the state department of insurance to find out the differences.
If you regularly see doctors who charge above what Medicare pays, Plans F, G, I, or J which cover excess charges, may be the right plan for you.
If you regularly travel outside the United States, Plans C, D, E, F, G, H, I, and J include coverage for this.
If you have a chronic condition with high medical bills, Plan K or L may work best. Both pay only a portion of covered expenses, but have a yearly out-of-pocket cap on medical expenses. Once you reach the cap, the policy pays 100 percent of all further medical services.

Once you’ve decided what type of coverage you need, the next step is to decide which company to buy from. Each plan covers the same medical services, but premiums can vary significantly from company to company. The companies use three different methods to set premiums: attained age, issue age, or community.

Attained-age policies set the premium based on your age, so the premium automatically increases as you get older. Before buying an attained age policy, check with the insurance company to get the premium costs for the next age increments, so you’ll know the level of increases to expect each year.
Issue-age policies set the premium at the age you first buy the policy. The premium will never be higher than the amount the company is charging new buyers at the same age. For example, suppose you buy the policy at age 65. In five years, the premium will be the amount the company is charging new 65-year-old buyers. While your premiums may increase, the increases may not be large because the company will keep premiums lower to attract new buyers.
Community policies charge the same price to everyone in your area regardless of your age. The premiums go up only when the insurance company raises premiums on all policies of the same type. These increases are regulated by state insurance departments.

While the premiums on an attained-age policy may be lower at first, it is generally better to buy an issue-age or community policy, which may be more expensive at first but doesn’t increase as much over time.

Following are some other things to keep in mind when choosing a policy:

Look for a company that has arranged to file Medigap claims automatically. Companies that offer automatic filing of claims with Medicare can save time and effort.
It is a good idea to purchase from a financially sound company. Make certain that the insurer is rated in the top two categories by one of the services that rates insurance companies, such as A.M. Best or Weiss.
Contact your state insurance department to find out if the insurance company has any complaints filed against it.

Bills Introduced to End Medicare Waiting Period

Sheri Abrams — Wed, 08 Apr 2009 01:40:56 +0000

Bills have been introduced in the House of Representatives and the Senate to phase out, over the next ten years, the Medicare 24-month waiting period. S. 700, introduced by Sen. Jeff Bingaman (D-NM), and H.R.1708introduced by Rep. Gene Green (D-TX), also would, upon enactment, eliminate the waiting periodfor those individuals with “life-threatening conditions.”

Sheri Abrams, Attorney at Law, know all too well the hardships faced by clients if they are caught in the 24-month waiting period once cash benefits are awarded. Those individuals found eligible most quickly usually have the most serious medical conditions, yet they will need to wait for Medicare coverage at the time when they need it the most. There have been indications that the waiting period will be an issue in the expected debate over health care reform. Nevertheless, Sen. Bingaman and Rep. Green, longtime advocates for elimination of the waiting period, decided to reintroduce their legislation.

The bills would phase out the 24-month waiting period over the next 10 years. In 2010, it would be reduced to 18 months and then reduced by 2 months each year until January 2019, when it would be totally eliminated.
Under current law, the Medicare waiting period does not apply to only two conditions: (1) end-stage renal disease and (2) amyotrophic lateral sclerosis, (ALS or “Lou Gehrig’s disease”). The bills would extend the exception to all “life-threatening conditions.” These are not delineated in the bills, but are defined as conditions that are “fatal without medical treatment.” The Secretary of Health and Humans Services would be responsible for compiling a list of such conditions, with regular updates. To compile the list, the Secretary would be required to consult with various federal health agencies and to annually review the SSA “compassionate allowances” list.

A Warning for Medicaid Beneficiaries Traveling Out of State

Sheri Abrams — Mon, 16 Mar 2009 04:15:42 +0000

Access to affordable health care through the Medicaid program is one of the great benefits afforded to most recipients of Supplemental Security Income (SSI). In many states, full Medicaid coverage is often equal to, or even better than, many private health insurance plans, allowing SSI beneficiaries and other Medicaid recipients to effectively manage their illness or disability.

However, many Medicaid recipients don’t realize that their health insurance coverage may not provide a full set of benefits should they require care while out of state. For example in some states Medicaid only covers out-of -state emergency room visits to stabilize emergency conditions. Should a beneficiary need to be admitted to a hospital in another state or if he must receive essential, regular psychiatric care or medications from an out-of-state provider, some states will not pay for the services through Medicaid. In these situations, a caregiver or other family member is often required to sign an agreement to pay for the services before the person with special needs can receive care.

Since Medicaid is administered as a joint program between the state and federal governments, each individual state has its own rules regarding out-of-state Medicaid coverage. If a loved one with special needs is planning to take an out-of-state trip, or if you live near your state border and travel between states for work or recreation, it makes sense to find out your states out-of-state Medicaid rules. By investing the time now you could save thousands of dollars in medical bills down the road.

Medicare Premium to Remain Unchanged in 2009

Sheri Abrams — Thu, 25 Sep 2008 02:31:55 +0000

For the first time in eight years, Medicare’s monthly premium will remain unchanged for most of the program’s44 million beneficiaries. The Centers for Medicare and Medicaid Services (CMS) announced that the Part B premium will remain at its 2008 level of $96.40 for 2009 for individuals earning $85,000 or less or couples earning $170,000 or less. The premium will go up for higher earners (see list below). The Part B deductible will remain at its 2008 level as well.

The monthly premium paid by beneficiaries enrolled in Medicare Part B covers a portion of the cost of physicians’ services, outpatient hospital services, certain home health services, durable medical equipment, and other items.

This is only the sixth time since Medicare was created in 1965 that the Part B premium stayed the same for two consecutive years. The premium will hold steady in part because Medicare’s reserves have increased, however, monthly rates are likely to go up in 2010 as health costs continue to rise.

While the Part B premium and deductible will not rise, other Medicare deductibles and co-payments will. Here are all the new Medicare figures for 2009:

Basic Part B premium: $96.40/month (unchanged)
Part B deductible: $135 (unchanged)
Part A deductible: $1,068 (was $1,024)
Co-payment for hospital stay days 61-90: $267/day (was $256)
Co-payment for hospital stay days 91 and beyond: $534/day (was $512)
Skilled nursing facility co-payment, days 21-100: $133.50/day (was $128)As directed by the 2003 Medicare law, higher-income beneficiaries will pay higher Part B premiums. About 5 percent of current Part B enrollees are expected to be subject to the higher premium amounts. Following are those amounts for 2009:

Individuals with annual incomes between $85,000 and $107,000 and married couples with annual incomes between $170,000 and $214,000 in 2009 will pay a monthly premium of $134.90.

Individuals with annual incomes between $107,000 and $160,000 and married couples with annual incomes between $214,000 and $320,000 in 2009 will pay a monthly premium of $192.70.

Individuals with annual incomes between $160,000 and $213,000 and married couples with annual incomes between $320,000 and $426,000 in 2009 will pay a monthly premium of $250.50.

Individuals with annual incomes of $213,000 or more and married couples with annual incomes of $426,000 or more in 2009 will pay a monthly premium of $308.30.

Rates differ for beneficiaries who are married but file a separate tax return from their spouse:

Those with incomes between $85,000 and $128,000 will pay a monthly premium of $250.50.