Lee Ann Torrans Social Security Strategy

The Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 impacted Social Security disability claims and Medicare plan selection services.

Social Security Disability Insurance (SSDI) take months and years. The average wait nationally is 14 1/2 months. Delaware has the shortest wait, less than 10 months, while Michigan's 576 days ranked second to Ohio's lag.

There 1.7 million people in the SSDI backlog and awaiting a decision on their claim for benefits. These individuals often have limited or no source of income and few healthcare coverage options. In addition, more than 7 million people who rely on SSDI benefits are eligible for Medicare, following a 24-month waiting period.

People with disabilities will benefit from the elimination of the pre-existing condition clause.

Children and Pre-existing Conditions

This year children with pre-existing conditions cannot be denied health insurance coverage. This extends to adults in 2014 when state-run health insurance exchanges, which will have to cover pre-existing conditions, are established.

State Run High Risk Health Insurance Pools

In June 2010, the legislation creates temporary state-run high-risk insurance pools to offer coverage to individuals with pre-existing medical conditions who have not had insurance for at least six months. Most states have high-risk insurance pools already, but all states are required to establish these pools as of June, or the U.S. Department of Health and Human Services will create one for them. People living in states with a high-risk insurance pool can go to their state insurance commission Web site to learn more, or visit the National Association of State Comprehensive Health Insurance Plans’ Web site for a complete listing at http://www.naschip.org/states_pools.htm.

If you were denied private coverage because of a pre-existing condition will have to wait six months to be eligible.

Medicare Advantage Plans Frozen (Which Covers Pre-existing)

For 2011, the legislation freezes payments to Medicare Advantage plan providers at 2010 rates and further reduces payments over time to bring them in line with traditional Medicare.

Medicare Advantage plans have become increasingly popular because they generally offer more coverage options and are more affordable than traditional Medicare with Medigap supplemental coverage.

Medicare Advantage plans also have always been required to cover most pre-existing conditions, whereas Medigap plans are not required to cover pre-existing conditions and often exclude or limit coverage. As a result, Medicare Advantage plans often have been a better choice for people with disabilities. However, the reduced subsidies to providers under the legislation may reduce the number of insurers offering Medicare Advantage plans, and consumers may see premium increases or reductions in plan coverage benefits.

People with disabilities may be caught in a position where they’re unable to afford a Medicare Advantage plan and unable to secure coverage under Medigap.

Expanding Medicaid coverage

Between now and 2014, when expanded Medicaid programs are required in each state, states can choose to apply to the federal government to receive additional Medicaid funding and expand their community health centers. Expansion could take on a variety of forms: an increase in staff, supplies and other resources or increasing the income limit to encompass more people. People can learn more about their state’s Medicaid offerings, when states will be expanding their coverage and how to apply by contacting their local Medicaid office. Contact information is available athttp://www.medicare.gov/contacts/organization-search-criteria.aspx

State Health Insurance Assistance Program (SHIP) or State Medical Assistance Program.

In 2014 when Medicaid expansion is required, Medicaid in every state will cover people under age 65 who have income of 133 percent of the federal poverty line ($29,326.50 for a family of four in 2010). This is especially important to lower-income individuals applying for SSDI who have limited income and no coverage.

Asset value requirements for Medicaid eligibility is determined by each state; among states that have asset value requirements, the maximum asset value generally ranges from $2,000 to $4,000 for single people and $4,000 to $6,000 for couples. This excludes someone’s home, one car and their retirement savings, if they are under age 60; however, retirement savings are considered if they are 60 or older. As a result, someone no longer able to work because of their disability who had accumulated more than the allowable assets under Medicaid would have to chip away at this savings before becoming Medicaid eligible.

Expanding long-term care options

Starting in January 2011, the Community Living Assistance Services and Supports (CLASS) Act expands community living assistance options through a voluntary insurance program. Paid for through a payroll deduction of about $75 a month, all working adults will be enrolled automatically, unless they choose to opt-out. After a five-year vesting period, people with mobility issues are eligible for a cash benefit of at least $50 a day on average to buy non-medical services and support. Assistance may include caregiver support, adult day care and home modifications to support daily living, such as installing shower grab bars.Removing limits on insurance coverage.

Starting later this year, individual policyholders no longer will be subject to lifetime caps or have their coverage dropped, except in instances of fraud. Individuals who already have been dropped from their insurance will be eligible for the high-risk pools. In 2014, annual limits are removed and people with health problems can no longer be denied coverage or charged higher premiums; limits also are placed on how much premiums can increase as people age.

Reducing prescription drug costs.

Effective immediately, Medicare recipients who have a gap in prescription drug coverage will receive a one-time, $250 rebate to supplement their medical expenses. Medicare Part D plan participants who have hit the donut hole will receive a $250 check. The first checks will go out in June to people who already reached the gap in early 2010. Additional checks will go out as people reach the donut hole, according to the U.S. Department of Health and Human Services. Although details are still being worked out, these checks likely will be processed through prescription drug plans. Individuals who hit the donut hole but do not receive a check should contact their prescription drug plan to learn how to receive their rebate. Starting next year, pharmaceutical companies are required to provide a 50-percent discount on brand-name prescription drugs for Medicare beneficiaries facing theprescription drug donut hole with additional subsidies phased in through 2020 to close the gap.Adding free preventive care under Medicare.

Starting in 2010, Medicare beneficiaries can make free preventive care visits to their healthcare providers, without any copayments or deductibles. People with disabilities may have frequent appointments with specialists; this provision helps ensure basic health needs are addressed.

The information provided is not intended as a substitute for legal or other professional services. Legal or other expert assistance should be sought before making any decision that may affect your situation.

Lee Ann Torrans
Attorney at Law
6532 LBJ Freeway
Dallas, Texas 75240

http://socialsecuritystrategy.com

ltorrans@gmail.com

214-500-5410 (cell)
214-231-2886 (E-fax)

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