South& Central& Alabama& Development& Commission& Area&Agency&on&Aging&Aging&and Disability& Resource& Center& (ADRC)&State& Health& Insurance& Program& (SHIP)&

Alabama&Benefit&Checklist&Assembled&by&Jan&Neal&

This& publication& has& been& created& or& produced& by& South& Central& Alabama& Development& Commission,& Area& Agency& on& Aging,& Aging& and Disability& Resource& Center& (ADRC)& with& financial& assistance,& in& whole& or& in& part,& through& a& grant& from& the& Centers& for& Medicare& and& & Medicaid& Services,& the& Federal& Medicare& agency.&

Effective 07-01-14

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Table&of&Contents&

SSI&and&Community&Medicaid………................................................4&

Institutional&Medicaid&and&Community&Medicaid&Waiver……..….4&

Medicare&Savings&Programs&(MSP):&QMB,&SLMB,&QIP1………. .......5&

Medicare&Standard&A&&&B&Cost&Sharing………. ............................... 6&

Medicare&Higher&Income&A&&&D&Cost&Sharing………....................... 7&

Medicare&Late&Enrollment&Penalties……..........................................…...8&

Low&Income&Subsidies….......................................................................……..8&

Social&Security&Retirement&Age……....................................................….11&

Social&Security&Early&Retirement&Benefit&Reductions……........….12&

Social&Security&Early&Retirement&Earned&Income&Offset……...….12&

Social&Security&Disability&Substantial&Gainful&Activity………. ..... 13&

Alabama&Elderly&Simplified&Application&Project……… ................14&

Gift&and&Estate&Tax……… ................................................................14&

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SSI and Community MedicaidBenefit Eligibility Standard

SSI Retirement and Disability

Single Monthly Income/Resources $741/$2000

Married Monthly Income/Resources $1102/$3000

Medicaid at Home SSI eligibility SSI eligibility

Medicare Buy-In for Medicare A, B & D

SSI eligibility SSI eligibility

Effective Date/Change Date

01-14/01-15

Institutional Medicaid/Community Medicaid WaiverBenefit/Penalty Eligibility Standard

Nursing Home Medicaid

Single Person Income/Resources $2163 (with income over $2163 MQIT needed)/ $2000

Married Couple Income/Resource Set Aside $2163 (only income of spouse being institutionalized counts)/First $27,000 set aside for community spouse, resources over $50,000, ½ set aside for spouse up to cap of

Effective Date/Change Date

Single Standard 01-14/01-15 Married Spousal Resource Set Aside Standard

.01-14/01-15

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$117,240Monthly Spousal Allotment

$1966.25 07-14/07-15

Transfer Penalty 1 month for every $5500 transferred 01-14/01-15Home exclusion Equity at or below $543,000 01-14/01-15

Medicare&Savings&Programs&(MSP)Benefit Eligibility Standard

MSP Program Single Income/Resources (includes $20 disregarded)

Married Income/Resources (Includes $20 disregarded)

QMB Pays for: ~uncovered Medicare expenses to replace purchase of Medicare supplemental policy; ~Medicare Part B premium ~Medicare Part D premium up to State Standard*

$993 $1331

SLMB Pays for: ~Medicare Part B

$1187 $1593

Effective Date/Change Date

02-18-14/03-15

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premium

QI-1 Pays for: ~Medicare Part B premium

$1333 $1790

MedicareMedicare Part Premium Deductible Copayment

A 0 if eligible for SS (Retirement benefits; 24 months of disability) or RR or paid Medicare Tax with Civil Service; $426 per month with fewer than 30 qrts.; $234 per month with 30 – 39 quarters

$1216 per admission to hospital during a spell of illness

$304 per day for days 61 – 90; $608 per day for days 91 – 150 lifetime reserve

Skilled nursing facility $152 per day for days 21 - 100

B $104.90 per month standard premium if drawing in 2012

Premium for higher income beneficiaries below

$147.00 20%

Effective Date/Change Date

01-14/01/15

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Medicare Part B Premium for Higher Income Beneficiaries Based on Two Year’s Prior Yearly Reported Income

Individual Tax Return Filed

Joint Tax Return Filed

Married with Separate Tax Return

Part B Premium Amount

$85,000 or less $170,000 or less $85,000 or less Standard $104.90

Over $85,000 up to $107,000

Over $170,000 up to $214,000

N/A $146.90

Over $107,000 up to $160,000

Over $214,000 up to $320,000

N/A $209.80

Over $160,000 up to $214,000

Over $320,000 up to $428,000

Over $85,000 up to $129,000

$272.70

Over $214,000 Over $428,000 Over $129,000 335.70

Effective Date/Change Date

01-14/01/15

Medicare Part D Premium for Higher Income Beneficiaries Based on Two Year’s Prior Yearly Reported Income

Individual Tax Return Filed

Joint Tax Return Filed

Married with Separate Tax Return

Part D Premium Amount

$85,000 or less $170,000 or less $85,000 or less Your plan premium

Effective Date/Change Date

01-14/01/15

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Over $85,000 up to $107,000

Over $170,000 up to $214,000

N/A $12.10 + your plan premium

Over $107,000 up to $160,000

Over $214,000 up to $320,000

N/A $31.10 + your plan premium

Over $160,000 up to $214,000

Over $320,000 up to $428,000

Over $85,000 up to $129,000

$50.20 + your plan premium

Over $214,000 Over $428,000 Over $129,000 $69.30 + your plan premium

Medicare Late Enrollment PenaltiesPart B Late Enrollment Penalty

10% per each full 12 – month period eligible without coverage X cost of Medicare Part B premium at time of sign up = amount added to monthly cost of Part B premium

Permanent

Part D Late Enrollment Penalty

1% of the “national base beneficiary premium” ($32.42 in 2014; $31.17 in 2013) X the number of full, uncovered months eligible without coverage or creditable coverage = amount added to monthly cost of Part D

Permanent

Enrollment Periods

Standard Part D Premiums

Low Income Subsidy (Extra Help purchasing Medicare Part D)Benefit Categorical Eligibility Effective Date/Change Date

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calculate income: add income (gross earned income or net from self-employment minus 65 divided by 2) + all other income calculate resources: do not count home, adjoining land, household personal property, vehicles or life insurance A. People eligible for Medicare and Medicaid who live in nursing facilities or receive home and community based waiver

NOTE: Automatically receive benefit and pay no monthly premium*, no annual deductible and no copayments for drugs.

B. People eligible for Medicare and Medicaid who apply and income is at or below 100% of the poverty level with limited resources (100% subsidy)Single Income/Resources

Married Income/Resources Living Together

992.50/<13,440 1330.83/<26,860Each additional person in the home for whom applicant provides more than one-half of person’s support add 338.33C. People eligible for Medicare and Medicaid who apply and income is at or below 135% of the poverty level with limited resources (100% subsidy)Single Income/Resources

Married Income/Resources Living Together

C.LIS (Full Subsidy)

1332.88/<13,440 1789.63/<26,860

01-14/01-15

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Each additional person in the home for whom applicant provides more than one-half of person’s support add 456.75A. People eligible for Medicare at or below $140% of the poverty level with limited resources below (75% subsidy)Single Income/Resources

Married Income/Resources Living Together

1381.50/<13,440 1855.17/<26,860

Each additional person in the home for whom applicant provides more than one-half of person’s support add 473.67B. People eligible for Medicare at or below 145% of the poverty level with limited resources (50% subsidy)Single Income/Resources

Married Income/Resources Living Together

$1430.13/<13,440 1920.71/<26,860

Each additional person in the home for whom applicant provides more than one-half of person’s support add 490.58

LIS (Partial Subsidy)

C. People eligible for Medicare at or below 150% of the poverty level with limited resources below (25%

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subsidy)

Single Income/Resources

Married Income/Resources Living Together

1478.75/<13,440 1986.25/<26,860

Each additional person in the home for whom applicant provides more than one-half of person’s support add 507.50

*Premium StateStandard

$31.30 Effective Date/Change Date

01-14/01-15

Social Security Normal Retirement Age (NRA)

Born NRA

1937 and prior 65

1938 65 and 2 months

1939 65 and 4 months1940 65 and 6 months1941 65 and 8 months

Effective Date/Change Date

Permanent

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1942 65 and 10 months1943 – 1954 661955 66 and 2 months1956 66 and 4 months1957 66 and 6 months1958 66 and 8 months1959 66 and 10 months1960 and later 67

SS Early Retirement Benefit ReductionCategory based on

NRAReduction of

benefits when retire at

62

Reduction of benefits when

retire at 63

Reduction of benefits when

retire at 64

Reduction of benefits when

retire at 65

NRA 66 (born 1943 or later)

25% 20% 13.3% 6.7%

NRA after 66 (born after 1954)

30%

Effective Date/Change Date

01-13/01-14

Early Retirement Earned Income Offset

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Category Based on NRA

Exempt Amount SS Offset Penalty

Exempt Earnings for early retirees/workers whose NRA IS NOT in 2014

$15,480 Withholding of $1.00 in benefits for every $2.00 earned over $15,480

Exempt Earnings for early retirees/workers whose NRA IS in 2014 and earnings predated reaching NRA

$41,400 Withholding of $1.00 in benefits for every $3.00 earned over $41,400

Effective Date/Change Date 01-14/01-15

SSD Substantial Gainful Activity (SGA)

Category Based on Disability

Allowable Mo. Earnings

Non-blind $1070.00

Blind $1,800.00

Effective Date/Change Date 01-14/01-15

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Alabama Elderly Simplified Application Project (AESAP) Food Assistance for 60+

Household Size Gross Income Limit Net Income Limit

1 $1245 $958

2 $1681 $1293

3 $2116 $16284 $2552 $19635 $2987 $22986 $3423 $26337 $3858 $29688 $4294 $3303Each Additional Member

$ 436 $ 335

Effective Date/Change Date

10-1-13/10-01-14

Gift and Estate TaxFederal Estate Tax Exemption and Lifetime exclusion for gifts

$5,340,000 2014/2015

Annual Gift Exclusion $14,000 2014/2015