On November 20, 2010, INOVA Mount Vernon Hospital will host an Operation Walk surgical event in Virginia.

As part of this event INOVA Mount Vernon Hospital will be providing free hip or knee surgery to anyone without health insurance living in Washington D.C., Maryland, and Virginia.

Call Genéa M. Luck at 703-664-7193 or Julie Warner at 703-664-7018 if you know anyone who does not have health insurance and they can benefit from a hip or knee replacement surgery.

Operation Walk provides everything for free (including all post-operative medical care, education, and rehabilitation).

To learn more about this operation walk event and others around the country, go to http://www.operationwalk.org

The U.S. Department of Health and Human Services has created a new website, which is designed to answer questions about the new Affordable Health Care Act. The website provides specific information on private and public programs for which you may be eligible.

The website is located at http://www.HealthCare.gov

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.

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.

Supplemental Security Income (SSI) is a federal program that helps people with disabilities and very low incomes pay for food, clothing and shelter. SSI is often confused with Social Security Disability Insurance (SSDI). One of the main differences between the two programs is that SSDI is available to people with disabilities no matter how much money they earn or have, while SSI places very strict limits on a recipient’s income and assets. However, in most states, an SSI beneficiary who receives even $1 from the program also qualifies for Medicaid health coverage, which can be far more valuable than SSI’s benefit itself.

How to Qualify for SSI:

This first requirement is often the hardest for SSI applicants to meet, in large part because the federal government’s definition of “disabled” is so narrow. In essence, adult SSI applicants who are seeking benefits based on a disability must show that they are almost completely unable to work at any job whatsoever. The applicant must have a physical or mental impairment that makes it impossible for him to engage in any “substantial gainful activity,” and this impairment must be expected to last for longer than one year or to result in death. If an applicant is able to engage in substantial gainful activity, then he will typically not be eligible for SSI. A child applicant must have a physical or mental impairment that results in marked and severe functional limitations and can be expected to last for longer than one year or result in death.

An SSI Beneficiary Must Have Very Limited Resources:

Once an SSI applicant has shown that she is disabled, she must also prove that she has less than $2,000 to her name. If the applicant can use or liquidate an asset to pay for food or shelter, the asset will probably count as a “resource” against this limit. A resource would include any funds held in the applicant’s bank accounts, retirement accounts, or in cash. If the applicant has set up a trust that does not meet specific requirements, the trust funds are also counted against the $2,000 limit. The applicant’s own home will not be considered an available resource, and her car is also exempt. The $2,000 resource limit does not disappear once a person qualifies for SSI. If an SSI beneficiary ends a month with more than $2,000 in her name, she will lose her benefits in the following month.

Income Is Key:

SSI recipients get only a modest monthly benefit, and this sum is reduced by any income they may have. In 2009, the maximum federal SSI benefit was $674 a month, although many states add a small supplement to this. In addition, SSI benefits are reduced by $1 for each dollar of unearned income a beneficiary receives (such as interest or dividends), and by $0.50 for each dollar of earned income (such as wages). SSI benefits are also reduced if an adult beneficiary lives in someone else’s home without paying rent, or if he receives free meals. Finally, the income of the people living with the beneficiary can count against the beneficiary. If the beneficiary’s combined income reduces his SSI benefit to zero, he loses SSI, along with any Medicaid benefits that may come with it.

Supplemental Needs Trusts Can Help:

Although SSI’s income and asset rules are highly restrictive, several types of trusts, called “Special Needs” or “Supplemental Needs” trusts, can protect an SSI beneficiary’s assets while allowing her to maintain SSI eligibility. Relatives and friends of the SSI recipient can also set up a trust for the recipient and fund it with their own money. If properly structured, these trusts also will allow an SSI recipient to continue receiving benefits. Unfortunately, a poorly drafted special needs trust can destroy any hopes an applicant has of ever qualifying for SSI.

Quality Advice Is Necessary:

SSI is a very complicated program with rules that most attorneys who do not focus on this practice area have trouble understanding. Therefore, it is essential to seek out a qualified special needs planner, such as the Attorneys at the Law Firm of Needham Mitnick & Pollack, who can guide you or your family through the complicated process of obtaining and maintaining SSI benefits.

October 14, 2009 – 3:00 p.m.

The Lupus Foundation of America is proud to present live moderated chats, featuring the nation’s leading experts in lupus. This is your opportunity to ask a question and learn more about lupus from thought leaders in a number of medical disciplines associated with lupus.

The LFA welcomes Ms. Sheri R. Abrams. Ms. Abrams is a Fairfax, Virginia, Attorney dedicated to helping people with Social Security Disability Benefits issues, as well as working with people to prepare Special Needs Trusts, Wills, Living Wills, a Health Care Power of Attorney, or a Financial Power of Attorney.

Ms. Abrams is a solo practitioner in Virginia, whose niche-within-a-niche is in the Special Needs area of estate planning, which requires additional care and experience, to properly understand and meet the needs of the community involved.

Ms. Abrams has received an AV Superior Rating, the highest ranking possible in the Martindale-Hubbell Law Directory.

For more information on this webchat please click here.

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.

Individuals with various health conditions are often reluctant to leave jobs because they are afraid pre-existing condition clauses will limit coverage of any such conditions under a new insurance plan. HIPAA (Health Insurance Portability and Accountability Act of 1996) limits the amount of time an insurer can refuse to cover pre-existing conditions to twelve months. HIPAA also ensures that in some cases there is no waiting period for new coverage. However, an insurer is still not required to cover every condition and disability. In some cases, they can still deny coverage altogether for certain conditions as long as the decision is based on sound actuarial data.State laws may offer more generous protections than HIPAA. You may want to contact your state insurance commissioner’s office to ask about the law where you live. A good place to start is the Web site of the National Association of Insurance Commissioners at www.naic.org.

A “pre-existing condition” is considered to be any condition for which medical advice, diagnosis, care or treatment was recommended or received within the previous six-month period. The maximum amount of time a plan can refuse coverage for any such condition is twelve months. If an individual starts a new job and is subject to a waiting period before being eligible to join the health plan, the waiting period and twelve-month period for the pre-existing conditions must coincide.

The twelve-month period for pre-existing conditions may also be reduced if the individual provides the new insurance plan with proof of their prior health coverage. When leaving a health plan, the plan must provide you with a Certificate of Coverage which details the dates you were covered under the plan. This continuous coverage can be credited toward the pre-existing condition period, provided there was not a “significant break” in coverage between jobs – this is defined as sixty-three days.

Therefore, if you had at least twelve months of “creditable coverage” (which can be from a group health plan, HMO, individual health insurance policy, Medicare, or Medicaid) and then left your job and you started a new job within sixty-three days thereafter, the pre-existing condition period would not apply. Your condition would be covered immediately (provided that the plan regularly covers that condition). COBRA coverage can also be credited towards continuous coverage.

HIPPA can also help provide access to individual insurance when group coverage is not an option. HIPAA guarantees access to an individual plan if: the individual had group coverage for at least eighteen months; did not have their group coverage terminated because of fraud or nonpayment of premiums; is ineligible for COBRA or has exhausted COBRA benefits; and is not eligible for coverage under another group health plan.

If an individual has group health insurance through his or her employer, the individual, his or her spouse and dependents can continue that coverage for eighteen months if a “qualifying event” (causing the employee to lose insurance coverage) takes place. This right to obtain continued coverage under COBRA only applies with regard to group health plans for private employers which have had 20 or more employees in the previous calendar year, and to state and local government employees. The most common qualifying events are the employee’s termination (including the employee voluntarily quitting), or a cut in the employee’s hours which results in the employee no longer satisfying applicable minimum work hour requirements for insurance coverage. However, COBRA coverage is not an option if the employee is terminated for “gross misconduct.” Also, qualifying events triggering the right of a spouse or dependent of an employee to obtain extended coverage include the death of the employee. 

The employer must notify the health plan within 30 days of a qualifying event (an employee’s termination, reduction in hours, or death). Within 14 days afterwards, the health plan must notify the employee (or beneficiary) of his or her right to continue coverage. The employee or beneficiary must respond within 60 days if they wish to continue on the group health insurance plan, and then has 45 days after electing coverage to pay the initial premium.

The individual who chooses continued coverage will have to pay both the employee and employer portions of the premium plus a 2% service charge. The individual’s continuing premium cost may not exceed 102% of the premium cost for the full employee rate. Group health coverage for COBRA participants is usually more expensive than health coverage for active employees, since usually the employer pays a part of the premium for active employees, while COBRA participants generally pay the entire premium themselves. It is ordinarily considerably less expensive, though, than individual health insurance coverage.

This coverage may continue for eighteen months, as long as the premiums are paid. If the individual should join a new employer’s group health plan, the COBRA coverage is not automatically terminated. The individual has the option of either continuing the COBRA coverage for the full eighteen months or terminating it. Continuing COBRA coverage when joining a new plan may be helpful if plan participants are subject to exclusions or waiting period requirements under the policy. However, the individual may need to carry the premiums of both policies during this time.

If an individual was determined to be disabled under the Social Security Act within the first sixty days of COBRA coverage, the individual may choose to buy an additional eleven months of COBRA coverage, extending the COBRA coverage to twenty-nine months. If the individual chooses this option, any beneficiaries also receiving the COBRA coverage will be eligible for this extended period.

When the COBRA coverage ends, an offer will be made for an option to convert to an individual health plan if this option is generally available to active employees under the plan. Assuming the employee wishes to convert, he or she will want to determine if the conversion plan is affordable (it is likely to be more expensive than group coverage) and extensive enough, or if an individual needs to seek coverage elsewhere.

COBRA coverage may also be terminated early if after electing COBRA the individual joins another health plan (including Medicare) that covers all existing conditions. If the new plan does not cover a certain condition that COBRA is currently covering, or if you are still subject to a twelve-month pre-existing condition clause, you can maintain the double coverage.

Disabilities take many forms, and not all of them affect a person with special needs’ ability to make decisions. In fact, although many, if not most, people with either mental illness or some form of cognitive disability may require significant care, they can still carry out most day-to-day activities. In most cases, people with disabilities have the capacity to create their own estate planning documents, and in some cases it is crucial that they do so.

One scenario that often arises has to do with “HIPAA” regulations. HIPAA, which stands for Health Insurance Portability and Accountability Act of 1996, is the primary federal regulation governing a patient’s private medical information. HIPAA gives a patient the right to manage his/her medical information and regulates who can access that information. Because medical providers must follow HIPAA regulations, it is difficult for caregivers who legitimately need to access another person’s medical records, often in an emergency, to do so without a health care power of attorney that authorizes the information’s release. Under HIPAA, doctors in these situations can disclose medical information to patients’ families, but they are not required to do so without a release from the patient.

Parents of children with special needs often bump into these restrictions for the first time when their child reaches 18 and obtains his/her own right to privacy under HIPAA. If the child is not under guardianship, either because he/she does not require it or because no one has obtained it, it may be hard for a parent to obtain information from a doctor or hospital without some form of HIPAA release from their child. In these cases, it is important for the child to execute a valid health care power of attorney and living will, if they are able to do so. The health care power of attorney and living will not only allows access to medical records, but will also provide that the child’s wishes are carried out if he/she ever requires serious medical care.

Another case for estate planning involves adults with an episodic illness. These adults may be perfectly functional and rational 99 percent of the time, yet they are completely disabled when their illness does strike. Having a functional health care power of attorney and Financial Power of Attorney allows an agent to help a person with an illness manage his/her affairs when necessary, without having to obtain an emergency guardianship when that person falls ill.

Finally, there are people with cognitive disabilities who require assistance only with certain tasks but who are perfectly capable of making estate planning decisions, including the choice of who receives their property.

Attorney Sheri Abrams can help you or your family member create these important documents, and can also recommend additional ways to carry out other important estate planning goals.

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.

The American Recovery and Reinvestment Act of 2009 (known as the Stimulus Bill) provides a premium reduction to certain qualified individuals.  Individuals eligible for COBRA coverage who were involuntarily terminated by their employer on or after September 1, 2008 through December 31, 2009 who are eligible for COBRA and elect COBRA may be eligible to pay a reduced premium amount that is only 35 percent of the premium costs for the COBRA coverage.
The premium reduction for an individual ends upon eligibility for other group coverage (or Medicare), after 9 months from the beginning of the reduction, or when the maximum period of COBRA coverage ends, whichever occurs first.  The premium reduction provisions relate only to premiums for coverage periods beginning after the law was enacted –February 17, 2009.

If a person was terminated between September 1, 2008 and December 31, 2009 and was covered by an employer’s plan on their day of employment, the plan administrator should provide a notice of eligibility to elect COBRA and to receive a premium reduction.  Individuals involuntarily terminated during this period have the right to elect COBRA coverage even if they did not elect coverage when it was first offered; they may also do so if they did elect COBRA, but are no longer enrolled (for example, because they were unable to continue paying the premium). This election period begins February 17, 2009 and ends 60 days after the plan provides the required notice.

For more information the employer should be contacted directly to ask about getting the premium reduction, and how to reconcile any amounts that might have been overpaid after February 17, 2009.

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.

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