The Nutshell Wisconsin Benefit Specialists Benefit Check-Up Guide

Transcription

1 The Nutshell Wisconsin Benefit Specialists Benefit Check-Up Guide FEDERAL POVERTY LEVEL (FPL) [2015] size 100% FPL 120% FPL 135% FPL 150% FPL 250% FPL 1 $ / mo. $1, / mo. $1, / mo. $1, / mo. $2, / mo. 2 $1,327.50/ mo. $1, / mo. $1, / mo. $1, / mo. $3, / mo. SUPPLEMENTAL SECURITY INCOME (SSI) [based on SSA COLA for 2015] Remember to compare these figures to countable income: Apply the general $20 disregard and, if applicable, the earned income disregard (subtract $65 and ½ of the remaining earned income). FEDERAL BENEFIT RATE STATE SUPPLEMENT TOTAL PAYMENT LIVING ARRANGEMENT Indiv. /Couple Indiv./Couple Indiv./Couple Own household $ / $1, $83.78 / $ $ / $1, of another $ / $ $83.78 / $ $ / $ SSI-E $ / $1, $ / $ $ / $1, Asset limits: $2,000 individual / $3,000 couple. WISCONSIN MEDICAID (Medical Assistance) Remember to compare all Medicaid figures to countable income: Apply the general $20 disregard and, if applicable, the earned income disregard (subtract $65 and ½ of the remaining earned income). CATEGORICALLY NEEDY: [based on COLA for 2015] Step 1: Basic income limit + applicant s actual shelter costs (capped at limits below) = personal income limit. Step 2: Compare applicant s countable income to personal income limit. If countable income is < personal income limit, applicant is eligible. Living arrangement Basic income limit-- Start here Add actual shelter costs, up to maximum Maximum personal income limit Asset limit Individual $ $ $ $2,000 Couple $ $ $1, $3,000 MEDICALLY NEEDY: MA Deductible Program [based on COLA for 2015] Living arrangement Monthly net income limit Asset limit Individual $ $2,000 Couple $ $3,000 Deductible period is six months long; Deductible amount is the difference between the applicant s (and spouse if applicable) countable monthly income and the Medically Needy income limit, multiplied by six. 1

2 MEDICARE SAVINGS PROGRAMS [EFF. 02/01/15] Income eligibility QMB SLMB SLMB+ (QI-1) Assets (100% FPL) (120% FPL) (135% FPL) Individual $ $1, $1, $7,280 Couple $1, $1, $1, $10,930 MEDICAL ASSISTANCE PURCHASE PLAN (MAPP) [EFF. 02/01/15] Living arrangement Monthly income limit--- eligibility (250% FPL, applicant s income + spouse s income) Income threshold required (150% FPL, applicant s gross income only) Asset limit* (applicant only) Individual $2, $1, $15,000 Couple $3, $1, n/a * 50% of applicant s yearly gross earnings may be deposited into Independence Accounts which will not count toward the $15,000 limit. BADGERCARE+ [EFF. 02/1/15] Population Income Limit (based on household size of 1) Asset limit Pregnant Women* $36, (306% FPL) n/a Children under 19 years of age* $36, (306% FPL) n/a Parents/Caretaker Relatives $11, (100% FPL) n/a Childless Adults years of age $11, (100% FPL) n/a *Children and pregnant women with income above the limit can become eligible by meeting a deductible. WISCONSIN MEDICAID INSTITUTIONALIZED PERSONS Income limit for institutional care eligibility: $2,199 [300% of SSI Fed. Ben. Rate eff. 01/01/15} Private pay SNF cost: Average Monthly/ $7, / Average Daily/ $ [12/1/14 retroactive 07/01/14] Personal needs allowance: $45 / mo. ($30 / mo. if only source of income is SSI). Unmarried individual and institutionalized spouse asset limit: $2,000. Spousal impoverishment prevention protections Assets: [Eff. 01/01/15] Couple s combined assets Community spouse may keep $0 - $50,000 ALL $50,001 - $100,000 $50,000 $100,001 - $238,440 HALF $238,440+ $119,220 Spousal impoverishment prevention protections Income: Community Spouse Income Allowance (CSIA): $2, [eff. 07/01/14] Maximum monthly spousal income allowance: $2, [eff. 01/01/15], if actual shelter costs exceed $ / mo. [eff. 07/01/14]. 2

3 MEDICAID COMMUNITY LONG-TERM CARE PROGRAMS [Eff. 01/01/15 based on COLA for 2015] MA Waiver Groups Income limits Asset limits each person Group A (categorically needy) Personal income limit $2,000 Group B (special income limit) $2,199 $2,000 (100% - 300% SSI limit) Group C (medically needy) Income above 300% of SSI FBR, but countable income below $ $2,000 Basic needs allowance: $913 (eff. 01/01/15) Maximum personal maintenance allowance: $2,199 (eff. 01/01/15) See Spousal Impoverishment protections above. SENIORCARE [EFF. 02/01/15] Age 65+ Level 1 (160% FPL) Level 2a (160% - 200% FPL) Level 2b ( % FPL) Level 3 (> above 240% FPL) Annual income limit (individual) $18,832 $18,833-$23,540 $23,541 - $28,248 $28,249 + Annual income limit (couple) $25,488 $25,489 - $31,860 $31,861 - $38,232 $38,233 + Deductible (annual) none $500 per person $850 per person $850 per person, after spend-down met Co-pay (generic/brand name) $5/$15 each Rx $5/$15 each Rx $5/$15 each Rx $5/$15 each Rx Discount prices on covered drugs Yes SeniorCare rate until SeniorCare rate until SeniorCare rate until deductible met deductible met deductible met Spend-down, joint amount (annual) none none none Difference between annual income and 240% FPL; Retail price until spend-down met. FOODSHARE WISCONSIN [Eff. 10/01/14] Size Gross income limit (categorical eligibility) 200% FPL Gross income limit (change reporting required if household member(s) have earnings) 130% FPL Max. benefit /mo. 1 $1,946 $1,265 $194 2 $2,622 $1,705 $357 Size Net income limit 100% FPL Asset Limit Max. benefit /mo. 1 $973 $3,250 $194 2 $1,311 $3,250 $357 Elder = age 60+. Income limit: Gross income is less than or equal to 200% FPL or, if gross income exceeds 200% of FPL, the net income of the EBD household is less than or equal to 100% of the FPL Asset limit: There is NO ASSET LIMIT for households with gross income less than or equal to 200% FPL; for households qualifying by way of net income, there is a household asset limit of $3,250. 3

4 If an elder (age 60+) or disabled household cannot purchase and prepare food separately, they can apply as a separate household if the combined gross monthly income of persons living w/ the elder/disabled person and his/her spouse does not exceed 165% FPL (1-$1,580; 2-$2,133; 3-$2,686; 4-$3,239). Do not count the income of the elder/disabled person and his/her spouse in this calculation. THE EMERGENCY FOOD 22 ASSISTANCE PROGRAM (TEFAP) (Commodities) [2015 FPL] Size Income limit at or below 185% FPL 1 $1,815/ mo. ($21,775/ yr.) 2 $2,456/ mo. ($29,471/ yr.) Home Energy+ (Fuel Assistance and Home Weatherization (WHEAP)) [Oct. 1, 2014 May 15, 2015] No age requirement Size Gross household income for last 3 months--at or below 60% SMI Gross monthly income (if applicable) at or below 60% SMI 1 $6, $2, / mo. 2 $8, $2, / mo. HOMESTEAD TAX CREDIT [2014 tax year] income limit: $24,680 Maximum credit: $1,168. Maximum property tax claimed: $1,460. If Medicare Part B is deducted from Social Security check, add the monthly amount into the total yearly income from Social Security. No age requirement. ORIGINAL MEDICARE [Eff. 01/01/2015] Part A Premium Deductible Fewer than 30 work credits $407/ mo. $1260 / benefit period work credits $224/ mo. $1260 / benefit period Medicare Part A Reimbursement and Beneficiary Cost-Sharing Hospital inpatient Beneficiary pays Medicare pays Days 1-60 $1260 / deductible per benefit period In full after deductible is met Days $315 / day All costs over $315 / day Days $630 / day All costs over $630 / day Skilled Nursing Facility services Days 1-20 $0 In full Days $157.50/ day (co-payment) Remaining balance Days 100+ All $0 Medicare Part B Annual deductible: $ (Beneficiary pays 20% of Medicare approved amount after deductible is met.) Monthly : Based on annual adjusted income from 2013 income tax returns. Late enrollment penalty may apply. Most people pay the Part B of $ each month. See table below to calculate the

5 Medicare Part B & D IRMAA Part B Married filing Single Married filing jointly separately Part D Premium $ $85,000 or less $170,000 or less $85,000 or less $0 + plan $ Above $85,000 up to Above $170,000 up to $ plan N/A $107,000 $214,000 $ Above $107,000 up to Above $214,000 up to $ plan N/A $160,000 $320,000 $ Above $160,000 up to Above $320,000 up to Above $85,000 up to $ plan $214,000 $428,000 $129,000 $ Above $214,000 Above $428,000 Above $129,000 $ plan Medicare Part D Base Beneficiary Premium (For use in Calculating the Late Enrollment Penalty) 2015 Plan Year: $33.13 Medicare Part D Low-Income Subsidy [2015 FPL] Asset: Full subsidy: $7,280*/ individual / $10,930*/ couple Partial : $12,140*/ individual/ $24,250*/couple * plus 1500 per person for burial expenses Below 100% FPL and dual eligible Below 135% FPL Subsidy for, no Below 150% FPL Partial subsidy for Size Subsidy for, no deductible deductible $66 deductible; 15% coinsurance $1.20 /3.60 co-payments $2.65/6.60 co-payments 1 $ / mo. / $11,770/ yr. $1, / mo./ $15,889.50/ yr. $1, / mo. / $17,655 / yr. 2 $1,327.50/ mo. / $15,930/ yr. $1, / mo./ $21,505.50/ yr. $1, / mo. / $23,895 / yr. Premium subsidy amount: 135% FPL: 100% subsidy 136% -140% FPL: 75% subsidy 141%-145% FPL: 50% subsidy 146% -149% FPL: 25% subsidy 150%FPL: no subsidy. SOCIAL SECURITY [Eff. 01/01/2015] Earnings per work credit: $1220 / mo. ($4,880 per year max four credits). Substantial gainful activity (SGA): $1090 / mo. ($1,820 / mo. if blind). Earnings limits while receiving Social Security Retirement benefits: Under full retirement age: $15,720 / yr ($1,310 / mo.): $1 in SSA benefits withheld for every $2 in earnings above limit. In year full retirement age attained: $41,880 / yr ($3,490 / mo); $1in SSA benefits withheld for every $3 in earnings above limit. Beginning month in which full retirement age attained: No earnings limit. VA DISABILITY PENSION [based on COLA for 2015] Maximum Annual Pension Rates Basic monthly pension Aid & Attendance Amount Single veteran $12, $ / mo. $ Veteran with one dependent $16, $1, / mo. $ Surviving spouse of wartime veteran $8, $ / mo. $