South Central Alabama Development Commission& Aging&and Disability& Resource& Center& (ADRC)&
Alabama&Benefit&Checklist& Assembled&by&Jan&Neal& Effective 03-01-16 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.&
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 Medicaid Effective Date/Change Date
Benefit
Eligibility Standard
SSI Retirement and Disability
Single Monthly Income/Resources $753/$2000
Married Monthly Income/Resources $1120/$3000
Medicaid at Home
SSI eligibility
SSI eligibility
Medicare Buy-In for Medicare A, B & D
SSI eligibility
SSI eligibility
01-16/01-17
Institutional Medicaid/Community Medicaid Waiver Benefit/Penalty
Eligibility Standard
Nursing Home Medicaid
Single Person Income/Resources $2199 (with income over $2199 MQIT needed)/ $2000
Effective Date/Change Date Married Couple Income/Resource Set Aside $2199 (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
Single Standard 01-16/01-17 Married Spousal Resource Set Aside Standard 07-15/07-16
4&
$119,220 Monthly Spousal Allotment Transfer Penalty Home exclusion
$1991
07-15/07-16
1 month for every $5800 transferred Equity at or below $552,000
01-16/01-17 01-16/01-17
Medicare&Savings&Programs&(MSP) Benefit
Effective Date/ Change Date
Eligibility Standard
03-16/02-17 MSP Program
Single Income/Resources (includes $20 disregarded)
QMB $1010 Pays for: ~uncovered Medicare expenses to replace purchase of Medicare supplemental policy; ~Medicare Part B premium ~Medicare Part D premium up to State Standard* SLMB $1208 Pays for: ~Medicare Part B
Married Income/Resources (Includes $20 disregarded) $1355
$1622
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premium QI-1 Pays for: ~Medicare premium
$1357 Part
$1823
B
Medicare Medicare 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; $411 per month with fewer than 30 qrts.; $226 per month with 30 – 39 quarters $104.90 per month standard premium if drawing in 2015 (otherwise $121.80) Premium for higher income beneficiaries below
$1288 per admission to hospital during a spell of illness
$322 per day for days 61 – 90; $644 per day for days 91 – 150 lifetime reserve
B
Effective Date/Change Date 01-16/01/17
Skilled nursing facility $161 per day for days 21 100 $166.00
20%
6&
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
$85,000 or less
$170,000 or less
Over $85,000 up to $107,000 Over $107,000 up to $160,000 Over $160,000 up to $214,000 Over $214,000
Over $170,000 up to $214,000 Over $214,000 up to $320,000 Over $320,000 up to $428,000 Over $428,000
Married with Separate Tax Return $85,000 or less
Part B Premium Amount
Effective Date/Change Date
Standard $121.80
01-16/01/17
N/A
$170.50
N/A
$243.60
Over $85,000 up to $129,000 Over $129,000
$316.70 389.80
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
$85,000 or less
$170,000 or less
Married with Separate Tax Return $85,000 or less
Part D Premium Amount
Effective Date/Change Date
Your plan premium
01-16/01/17
7&
Over $85,000 up to $107,000 Over $107,000 up to $160,000 Over $160,000 up to $214,000 Over $214,000
Over $170,000 up to $214,000 Over $214,000 up to $320,000 Over $320,000 up to $428,000 Over $428,000
N/A N/A Over $85,000 up to $129,000 Over $129,000
$12.70 + your plan premium $32.80 + your plan premium $52.80 + your plan premium $72.900 + your plan premium
Medicare Late Enrollment Penalties Part B Late Enrollment Penalty Part D 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 1% of the “national base beneficiary premium” ($34.10 in 2016) X the number of full, uncovered months eligible without coverage or creditable coverage = amount added to monthly cost of Part D
Permanent 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 C.LIS (Full Subsidy)
01-16/01-17
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 Married Income/Resources Income/Resources Living Together 1010.00/<7280 1356.67/<10,930 Each additional person in the home for whom applicant provides more than one-half of personâ&#x20AC;&#x2122;s support add 346.67 C. 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 Married Income/Resources Income/Resources Living Together 1356.50/<7280 1824.50/<10,930
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LIS (Partial Subsidy)
Each additional person in the home for whom applicant provides more than one-half of personâ&#x20AC;&#x2122;s support add 468.00 A. People eligible for Medicare at or below $140% of the poverty level with limited resources below (75% subsidy) Single Married Income/Resources Income/Resources Living Together 1406.00/<12,120 1891.33/<24,250 Each additional person in the home for whom applicant provides more than one-half of personâ&#x20AC;&#x2122;s support add 485.33 B. People eligible for Medicare at or below 145% of the poverty level with limited resources (50% subsidy) Single Married Income/Resources Income/Resources Living Together $1455.50/<12,140 1958.17/<24,250 Each additional person in the home for whom applicant provides more than one-half of personâ&#x20AC;&#x2122;s support add 502.67 C. People eligible for Medicare at or below 150% of the poverty level with limited resources below (25%
10&
subsidy) Single Income/Resources 1505.00/<12,140
*Premium State Standard
Married Income/Resources Living Together 2025.00/<24,250
Each additional person in the home for whom applicant provides more than one-half of personâ&#x20AC;&#x2122;s support add 520.00 $31.32
Effective Date/Change Date 01-16/01-17
Social Security Normal Retirement Age (NRA) Born
NRA
Effective Date/Change Date Permanent
1937 and prior
65
1938
65 and 2 months
1939
65 and 4 months
1940
65 and 6 months
1941
65 and 8 months
11&
1942
65 and 10 months
1943 â&#x20AC;&#x201C; 1954
66
1955
66 and 2 months
1956
66 and 4 months
1957
66 and 6 months
1958
66 and 8 months
1959
66 and 10 months
1960 and later
67
SS Early Retirement Benefit Reduction Category based on NRA NRA 66 (born 1943 or later) NRA after 66 (born after 1954)
Reduction of benefits when retire at 62 25%
Reduction of benefits when retire at 63
Reduction of benefits when retire at 64
20%
13.3%
Reduction of benefits when retire at 65 6.7%
Effective Date/Change Date 01-16/01-17
30%
Early Retirement Earned Income Offset
12&
Category Based on NRA
Exempt Amount
SS Offset Penalty
Exempt Earnings for early retirees/workers whose NRA IS NOT in 2016 Exempt Earnings for early retirees/workers whose NRA IS in 2014 and earnings predated reaching NRA
$15,720
Withholding of $1.00 in benefits for every $2.00 earned over $15,720
$41,880
Withholding of $1.00 in benefits for every $3.00 earned over $41,880
Effective Date/Change Date 01-16/01-17
SSD Substantial Gainful Activity (SGA) Category Based on Disability
Allowable Mo. Earnings
Non-blind
$1130.00
Blind
$1,820.00
Effective Date/Change Date 01-16/01-17
13&
Alabama Elderly Simplified Application Project (AESAP) Food Assistance for 60+ Household Size
Gross Income Limit
Net Income Limit
Effective Date/Change Date 10-1-15/09-30-16
1
$1276
$981
2
$1726
$1328
3 4 5 6 7 8 Each Additional Member
$2177 $2628 $3078 $3529 $3980 $4430 $ 451
$1675 $2021 $2368 $2715 $3061 $3408
Gift and Estate Tax $5,450,000 Federal Estate Tax Exemption and Lifetime exclusion for gifts Annual Gift Exclusion $14,000
2016/2017
2016/2017
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