Social Security, Medicare and Pensions

Transcription

1 Social Security, Medicare and Pensions 22 nd Edition Attorney Joseph L. Matthews

2 Introduction... 1 Chapter 1 Social Security: The Basics... 5 Learning Objectives... 5 Introduction... 5 History of Social Security... 5 The Beginning of Social Security... 6 Benefits Now Provide Diminished Security... 6 Saving Social Security... 6 What You Can Do... 7 Social Security Defined... 7 Retirement Benefits... 7 Disability Benefits... 7 Dependents Benefits... 8 Survivors Benefits... 8 Eligibility for Benefits... 8 Earning Work Credits... 8 Coverage for Specific Workers... 9 Earning Work Credits Determining Your Benefit Amount How Your Earnings Average Is Computed Benefit Formula Taxes on Your Benefits Your Social Security Earnings Record U.S. Citizens Rights to Receive Benefits While Living Abroad Receiving Benefits as a Noncitizen Noncitizens Living in the United States Non-U.S. Citizens Living Abroad Review Questions Review Answers Chapter 2 Social Security Retirement Benefits Learning Objectives Introduction Work Credits Required Checking Your Earnings Record Timing Your Retirement Benefits Claim If You Claim Benefits Before Full Retirement Age Your Break-Even Point Full Retirement Age If You Claim Benefits After Full Retirement Age Reversing a Suspension of Benefits The Amount of Your Retirement Check Increases for Cost of Living Reductions for Government or Foreign Pensions Working After Claiming Early Retirement Benefits Limits on Earned Income If Claiming Early Benefits Special Rule as You Approach Full Retirement Age Review Questions Review Answers Chapter 3 Social Security Disability Benefits Learning Objectives Introduction Who Is Eligible... 29

3 Work Credits Required Requirement of Recent Work Young Workers Blind Workers Disabled Widows and Widowers What Is a Disability? Conditions That May Qualify Listed Impairments Must Be Expected to Last One Year No Substantial Gainful Activity Special Rules for Blindness Examples of Disability Determinations Amount of Disability Benefit Payments Estimating Benefit Amounts Cost-of-Living Increases Collecting Additional Benefits Disability and Earned Income Other Social Security Benefits Other Disability Benefits Workers Compensation Medicare Medicaid and SSI Continuing Eligibility Review When Your Eligibility Will Be Reviewed The Review Process Returning to Work Trial Work Period Extended Eligibility for Benefits Quick Restart of Benefits Continuing Medicare Coverage Review Questions Review Answers Chapter 4 Social Security Dependents Benefits Learning Objectives Introduction Who Is Eligible Individuals Who Qualify Effect of Marriage and Divorce Calculating Dependents Benefits One Dependent Family Benefits Eligibility for More Than One Benefit Working While Receiving Benefits Government Pension Offset Review Questions Review Answers Chapter 5 Social Security Survivors Benefits Learning Objectives Introduction Work Credits Required for Eligibility Number of Work Credits Required Credits Earned Just Before Death Who Is Eligible Length of Marriage Rule Effect of Remarrying ii

4 Amount of Survivors Benefits Percentage of Benefits Awarded Estimating Benefit Amounts Eligibility for More Than One Benefit Working While Receiving Benefits Government Pension Offset Review Questions Review Answers Chapter 6 When to Claim Social Security Benefits, and Which One to Claim Learning Objectives Introduction Considerations for All Beneficiaries Your Lifetime Total: The Break-Even Point Factors to Consider Immediate Financial Need Continuing to Earn Before Full Retirement Age Life Expectancy Availability of Other Benefits Considerations for Specific Situations Unmarried, Divorced, or Widowed With No Benefits From Anyone Else s Work Record With Other Benefits From a Former Spouse s Work Record Married Couples Worker With Minor Child Review Questions Review Answers Chapter 7 Supplemental Security Income Learning Objectives Introduction Who Is Eligible Blind or Disabled Citizens or Longtime Residents Income Limits Asset Limits Benefit Amounts States With Federally Administered Supplements States With Their Own Supplements Reductions to Benefits Limit on Earned Income Limit on Unearned Income Limit on Outside Support Limit on Working Couples Review Questions Review Answers Chapter 8 Applying for Benefits Learning Objectives Introduction Retirement, Dependents, and Survivors Benefits When to Claim Benefits How and Where to File Your Claim Help on the Internet Documents You ll Need At the Social Security Office Withdrawing a Benefits Application iii

5 Disability Benefits When to File Your Claim Documents You ll Need How Your Eligibility Is Determined Supplemental Security Income (SSI) Proof of Income and Assets Proof of Age If 65 or Older Proof of Blindness or Disability Proof of Citizenship or Qualifying Legal Residence Finding Out What Happens to Your Claim Notification of Eligibility Methods of Receiving Payment Review Questions Review Answers Chapter 9 Appealing a Social Security Decision Learning Objectives Introduction Reconsideration of Decision Requesting Reconsideration of Decision on Initial Benefits Claim Completing the Request for Reconsideration Form The Reconsideration Process Requesting Reconsideration of SSI Decision Administrative Hearing Requesting a Hearing Completing the Request for Hearing by Administrative Law Judge Form Preparing for the Hearing The Hearing Appeal to the National Appeals Council Completing the Form Appeal Procedure Lawsuit in Federal Court Lawyers and Other Assistance Deciding Whether You Need Assistance Where to Find Assistance Legal Limits on Lawyers Fees Review Questions Review Answers Chapter 10 Federal Civil Service Retirement Benefits Learning Objectives Introduction Two Retirement Systems: CSRS and FERS Retirement Benefits Who Is Eligible Calculating Benefits Survivors Benefits Thrift Savings Plan Disability Benefits to Federal Workers Who Is Eligible Definition of Disability Review of Disability Status Amount of Benefits Payments to Surviving Family Members Who Is Eligible Amount of Benefits Applying for CSRS or FERS Benefits iv

6 Review Questions Review Answers Chapter 11 Veterans Benefits Learning Objectives Introduction Types of Military Service Required Active Duty Active Duty for Training Compensation for Service-Connected Disability Who Is Eligible Amount of Benefits Changes to Your Rating Pension Benefits for Financially Needy Disabled Veterans Survivors Benefits Dependency and Indemnity Compensation Wartime Service Pension Aid and Attendance Medical Treatment Getting Information and Applying for Benefits Review Questions Review Answers Chapter 12 Medicare Learning Objectives Introduction The Medicare Maze Medicare and Medicaid: A Comparison Medicare: The Basics Health Coverage If You Stop Working Before Age Working After Age Employer-Based Health Coverage for Retirees Part A Hospital Insurance Who Is Eligible Types of Care Covered Medicare-Approved Facility or Agency Facility Review Panel Approval Foreign Hospital Stays Skilled Nursing Facilities Home Health Care Hospice Care How Much Medicare Part A Pays Benefit Period or Spell of Illness Hospital Bills Psychiatric Hospitals Skilled Nursing Facilities Home Health Care Hospice Care Part B Medical Insurance Eligibility and Premiums Types of Services Covered Services Not Covered by Medicare Part B How Much Medicare Part B Pays Deductible Amounts % of Approved Charges % of Approved Charges for Some Services Payments for Outpatient Therapies v

7 Legal Limit on Amounts Charged Assignment of Medicare-Approved Amount Different Payment Structure for Hospital Outpatient Charges Part D Prescription Drug Coverage Eligibility Premiums, Deductibles, Copayments, and Coverage Gaps Restrictions on Coverage Deciding on a Part D Plan Medicare Coverage for People with End-Stage Renal Disease (ESRD) Eligibility for ESRD Medicare Coverage Qualifying Medical Condition Earned Work Credits Medical Care Covered by ESRD Medicare Coordination of Medicare with Group Health Insurance Coverage When ESRD Medicare Coverage Begins When ESRD Medicare Coverage Ends Applying for ESRD Medicare Coverage Review Questions Review Answers Chapter 13 Medicare Procedures: Enrollment, Claims, and Appeals Learning Objectives Introduction Enrolling in Part A Hospital Insurance Those Who Receive Social Security Benefits Those Who Do Not Receive Social Security Benefits Appealing Denial of Coverage Enrolling in Part B Medical Insurance Those Who Receive Social Security Benefits Those Who Do Not Receive Social Security Benefits Delayed Enrollment Medicare s Payment of Your Medical Bills Inpatient and Home Care Bills Outpatient and Doctor Bills Paying Your Share of the Bill How to Read a Medicare Summary Notice Date of the Notice Medicare Intermediary Type of Claim Services Provided Division of the Bills Sample Forms Appealing the Denial of a Claim Decisions About Inpatient Care (Medicare Part A) Payment of Doctor and Other Medical Bills (Part B) Medicare Part D: Enrollment, Exceptions, and Appeals Enrollment Exceptions Appeals Switching Part D Plans When You May Switch Plans Plans You May Switch To How to Switch From One Plan to Another State Health Insurance Assistance Programs (SHIPs) Review Questions Review Answers vi

8 Chapter 14 Medigap Insurance Learning Objectives Introduction Gaps in Medicare Gaps in Part A Hospital Insurance Gaps in Part B Medical Insurance Standard Medigap Benefit Plans Basic Benefits Included in All Medigap Plans Descriptions of the Standard Medigap Plans Terms and Conditions of Medigap Policies Premium Increases Eligibility and Enrollment Preexisting Illness Exclusion Finding the Best Medicare Supplement Using an Insurance Agent Senior Associations Only One Medigap Policy Required Replacement Policies Review Questions Review Answers Chapter 15 Medicare Part C: Medicare Advantage Plans Learning Objectives Introduction Medicare Advantage Managed Care Plans Health Maintenance Organization (HMO) HMO With Point-of-Service (POS) Option Preferred Provider Organization (PPO) Provider Sponsored Organization (PSO) Medicare Advantage Fee-for-Service Plans How Most Medicare Advantage Fee-for-Service Plans Work Fee-for-Service Plans With Tiered Payment Disadvantages of Medicare Advantage Fee-for-Service Plans Choosing a Medicare Advantage Plan Choice of Doctors and Other Providers Access to Specialists and Preventive Care Prescription Drug Coverage Extent of Service Area Other Plan Features Comparing Medigap and Medicare Advantage Plans Your Rights When Joining, Leaving, or Losing a Medicare Advantage Plan Joining in the First Six Months After Enrolling in Medicare Joining During a Plan s Open Enrollment Period Leaving the Plan Joining When Dropped From Another Medicare Advantage Plan Joining When Moving to a New Geographic Area Review Questions Review Answers Chapter 16 Medicaid and State Supplements to Medicare Learning Objectives Introduction Medicaid Defined Who Is Eligible Categorically Needy Medically Needy Determining Couples Income and Assets vii

9 Financial Help From Friends or Family Medical Costs Covered by Medicaid Services Covered in Every State Optional Services Requirements for Coverage Care Must Be Prescribed by Doctor Provider Must Be Participating in Medicaid Treatment Must Be Medically Necessary Cost of Medicaid Coverage No Payments to Medical Providers Fees to State Medicaid Agency for Services Other State Assistance Qualified Medicare Beneficiary (QMB) Specified Low-Income Medicare Beneficiary (SLMB) and Qualifying Individual (QI) Applying for Medicaid, QMB, SLMB, or QI Where to File Required Documents and Other Information Application Procedure Retroactive Benefits Review of Eligibility What to Do If You Are Denied Coverage Review Questions Review Answers Glossary Index viii