Social Security.

Transcription

1 Social Security

2 History of Social Security Programs 1935 Retirement Insurance 1939 Survivors Insurance 1956 Disability Insurance 2

3 Other Programs 1965 Medicare Program 1972 Supplemental Security Income 2003 Medicare Part D Prescription Drug Coverage 3

4 Who Gets Benefits from Social Security? 55 million people 5/2011 4

5 How Do You Qualify for Retirement Benefits? You need to work to earn Social Security credits Each $ 1,120 in earnings gives you one credit You can earn a maximum of 4 credits per year 5

6 Your Age At The Time You Elect Retirement Benefits Affects the Amount If You re a Worker and Retire Age 62 - lower monthly payment At full retirement age - full benefit Past Full Retirement Age - Even higher monthly payment 6

7 Social Security s Disability Definition: A medical condition or impairments preventing substantial work for at least 12 months, or expected to result in death. The determination also considers age, education & work experience. 7

8 Supplemental Security Income (SSI) Who Can Get SSI? Age 65 or older Blind any age Disabled any age Limited income Limited resources Noncitizens must meet special requirements to qualify 8

9 Applying for Benefits You can apply online for benefits by visiting 9

10 What s New in 2011? Randomization of Social Security Numbers No Longer Based on Geographical Area Issue Numbers that Start with 8 Issue All Number Starting with 7 Temporary reduction in the Employee s FICA rate from 6.2% to 4.2% in

11 SSA Employer Page 11

12 Business Services Online File W-2s Notices via Acknowledge notices Verify Employee Names and SSNs 12

13 What is SSNVS? Employers can verify the name and SSN of a hired employee with Social Security (SSA) over the Internet Cannot be used for tax filing purposes Verifies if name & Social Security number match SSA s records not identity 13

14 What is SSNVS? (cont.) 6 possible No-Match Codes returned Provides an indicator if Social Security number belongs to a deceased person SSNVS registration also allows you to verify names and SSNs over the telephone or

15 What To Do If An SSN Fails Verification? Compare submitted information Ask employee to verify the information View Social Security card Ask employee to check with any local Social Security office Document your efforts 15

16 Reminders! A mismatch is not a basis, in and of itself, to take any adverse action against an employee (i.e. laying off, suspending, firing, or discriminating). Company policy should be applied consistently to all workers. Any employer that uses the mismatch information to take adverse action against a worker may violate State or Federal law. The information from SSNVS does not make a statement regarding a worker s immigration status. 16

17 SSA Employer Contacts Employer Website Business Services Online (BSO) Employer Reporting Assistance BSO Technical Assistance Employer Services Liaison Officers 17

18 Who Can Get Medicare? 65 & older -or- 24 months after entitlement to Social Security disability benefits -or- Amyotrophic Lateral Sclerosis -or- Permanent kidney failure and receive maintenance dialysis or a kidney transplant -or- Exposure to Environmental Health Hazards (New Legislation) 18

19 Part A - Hospital Insurance Medicare Coverage Covers most inpatient hospital expenses 2011 Deductible $ 1,132 Part B - Medical Insurance Covers 80% doctor bills & other outpatient medical expenses after 1 st $ 155 in approved charges 2011 Standard Monthly Premium $ Part D - Medicare Prescription Drug Plan Covers a major portion of prescription drug costs for Medicare beneficiaries Enroll With Medicare prescription drug provider not SSA Annual enrollment period expanded beginning 2011 to October 15 through December 7 19

20 When Can I Sign Up for Medicare Part B? Medicare Enrollment Periods: Initial at age 65 Special if still working General January-March 54

21 Extra Help Could Further Reduce Medicare Prescription Drug Costs Extra Help is available for beneficiaries with limited resources and income to help pay for the related to a Medicare prescription drug plan. The Extra Help is estimated to be worth about $4,000 per year. 21

22 Understanding Medicare CMS Boston Regional Office Richard Hoover 22

23 Program Basics What is Medicare Who is Eligible The Four Parts of Medicare What is not Covered 23

24 What is Medicare? Health insurance for three groups of people 65 and older Under 65 with certain disabilities Any age with End-Stage Renal Disease (ESRD) Administration Centers for Medicare & Medicaid Services Enrollment Social Security Administration for most Railroad Retirement Board (RRB) 24

25 Part A Hospital Insurance Part B Medical Insurance Part C Medicare Advantage Plans Medicare has Four Parts Helps cover inpatient care in hospitals and skilled nursing facilities, hospice and home health care. Helps cover doctors services, outpatient care, home health care and some preventive services. Another way to get Medicare benefits. Combines Parts A and B. Usually includes Part D coverage. Run by private insurance companies approved by and under contract with Medicare. You have choices in how you get your drugs. Run by private insurance Medicare health and drug coverage Part D Medicare Prescription Drug Coverage Helps cover the cost of prescription companies approved by and under contract with Medicare. 25

26 Your Medicare Coverage Choices A. Original Medicare (Part A and Part B) B. Medicare Advantage (Part C) and Other Medicare Plans C. Medicare Prescription Drug Coverage (Part D) 26

27 Medicare Part A Hospital Insurance Costs Coverage Inpatient Hospital Stays Skilled Nursing Facility Care Home Health Care Hospice Care Blood 27

28 Hospital Stays Skilled Nursing Facility Care Home Health Care Services Hospice Care Blood Medicare Part A Helps Pay For Semi-private room, meals, general nursing, and other hospital services and supplies. Includes care in critical access hospitals and inpatient rehabilitation facilities. Inpatient mental health care in psychiatric hospital (lifetime 190-day limit). Semi-private room, meals, skilled nursing and rehabilitation services, and other services and supplies. Can include part-time or intermittent skilled care, and physical therapy, speech-language pathology, and occupational therapy. Includes drugs and medical, and support services from a Medicare-approved hospice. In most cases, if you need blood as an inpatient, you won t have to pay for it or replace it. 28

29 Paying for Hospital Stays For each benefit period in 2011 you pay $1,132 total deductible for days 1 60 $283 co-payment per day for days $566 co-payment per day for days (60 lifetime reserve days) All costs for each day beyond 150 days 29

30 Skilled Nursing Facility Care Must meet all conditions Require daily skilled services Not just long-term or custodial care Inpatient in a hospital 3 consecutive days or longer Admitted to the SNF within 30 days after leaving hospital Care is for a condition that was treated in the hospital Facility MUST be a Medicare participating SNF 30

31 Skilled Nursing Facility Coverage Semi-private room Meals Skilled nursing care Physical, occupational, & speechlanguage therapy Medical social services Medications, medical supplies/equipment Ambulance transportation (limited) Dietary counseling 31

32 Paying for Skilled Nursing Facility Care For each benefit period in 2011 you pay $0 for days 1 20 $ per day for days All costs after 100 days 32

33 Home Health Care Four conditions for home health coverage Doctor must make a plan for your care at home Must need specific skilled services Must be homebound Home health agency must be Medicareapproved 33

34 Home Health Care Coverage Part-time/intermittent skilled nursing care Physical, occupational & speechlanguage therapy Medical social services Some home health aide services Durable medical equipment, supplies 34

35 Hospice Care Special care for terminally ill and family Expected to live 6 months or less Focuses on comfort, not on curing the illness Doctor must certify for each period of care Two 90-day periods, then unlimited 60-day periods Hospice provider must be Medicareapproved 35

36 Covered Hospice Services Medical equipment and supplies Drugs for symptom control and pain relief Short-term hospital inpatient care (limited) Respite care in a Medicare-certified facility Up to 5 days each time with no limit to number of times Home health aide and homemaker services Social worker services Dietary counseling Grief counseling 36

37 Paying for Hospice Care In Original Medicare you pay Nothing for hospice care Up to $5 for prescription drugs for pain and symptom mgmt 5% for inpatient respite care Amount can change each year You generally pay 100% for room and board in a facility 37

38 Medicare Part B Medical Insurance Medicare and other coverage Coverage Part B costs Assignment 38

39 Part B Coverage Doctors services Outpatient medical/surgical services and supplies Diagnostic tests Outpatient therapy Outpatient mental health services Some preventive health care services Other medical services 39

40 Covered Preventive Services Health Reform Section 4103 One time Welcome to Medicare physical exam Physical Exam (yearly Wellness Exam ) Starts 2011 Abdominal aortic aneurysm screening* Bone mass measurement Cardiovascular disease screenings Colorectal cancer screenings Diabetes screenings EKG Screening* Flu shots Glaucoma tests Hepatitis B shots HIV Screening Mammograms (screening) Pap test/pelvic exam/clinical breast exam Prostate cancer screening Pneumococcal shots Smoking cessation 40

41 Paying for Part B Services In Original Medicare you pay Yearly deductible of $162 in % coinsurance for most services Some copayments Some programs may help pay these costs 41

42 Assignment Medicare doctors/providers/ suppliers Accept the Medicare-approved amount As full payment for covered services Only charge Medicare deductible/coinsurance amount They submit your claim to Medicare directly Applies to Original Medicare Part B claims We say accepts assignment 42

43 Providers who do NOT Accept Assignment May charge more than Medicareapproved amount Limit of 15% more for most services The limiting charge May ask you to pay entire charge at time of service Providers sometimes must accept assignment Medicare Part B-covered Rx drugs Ambulance providers 43

44 What is not covered by Medicare Part A or Part B 44

45 What s NOT Covered by Part A and Part B? Items and services Medicare doesn t cover include, but aren t limited to: Long-term care Routine dental care Dentures Cosmetic surgery Acupuncture Hearing aids and exams for fitting hearing aids 45

46 Original Medicare Run by the Federal government Provides your Part A and/or Part B coverage Go to any doctor or hospital that accepts Medicare You pay Part B premium (Part A free for most people) Deductibles, coinsurance or copayments Can buy a Medigap policy to help pay some of these costs Get Medicare Summary Notice (MSN) Can join a Medicare Rx Plan to add drug coverage 46

47 Medicare Card (front) Jane Doe 47