Benefits training


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Benefits training

  1. 1. The “Wonderful” World of Benefits!
  2. 2. How do you feel? <ul><li>When your client says “I need help with…” (Social Security, housing, Medicaid, Medicare, etc) which emoticon represents how you feel? </li></ul>
  3. 3. Maybe the emoticons don’t cut it! <ul><li>Do you want to pick up everything on your desk and run? </li></ul><ul><li>Or jump with frustration and pull your hair out after an hour on the phone with Medicare? </li></ul>
  4. 4. End the frustration! <ul><li>Relax! </li></ul><ul><li>Get ready for “Benefits Made Simple”! </li></ul>
  5. 5. Who does what? <ul><li>There are 3 categories of benefits. </li></ul><ul><li>Federal </li></ul><ul><li>State </li></ul><ul><li>Local </li></ul><ul><li>And it is important to remember that their computer systems DO NOT communicate on a regular basis! </li></ul>
  6. 6. Federal Benefits <ul><li>The federal government controls all Social Security programs. The benefit programs that fall into this category are: </li></ul><ul><li>Social Security Disability Insurance (SSDI) </li></ul><ul><li>Supplemental Security Income (SSI) </li></ul><ul><li>Medicare (A,B,C, & D) </li></ul>
  7. 7. Federal Benefits Dissected <ul><li>Social Security Disability Insurance (SSDI) </li></ul><ul><li>This program provides a monthly disability benefit for anyone deemed disabled by the Social Security Administration AND they meet the following rules for being fully insured under the SSDI program. </li></ul>
  8. 8. Insured for Disability Status <ul><li>To qualify for SSDI a person must have at least 6 Social Security credits but not more than 40 and they must have at least 1 credit for each year after they turned 21. </li></ul><ul><li>A credit is earned for each $1050 in reported income. The maximum credits that are given in one year, regardless of income, is 4. </li></ul>
  9. 9. The next step… <ul><li>If the person is determined to be fully insured they must then meet ONE of the following rules: </li></ul><ul><li>Have at least 20 credits from the previous 10 years. </li></ul><ul><li>Became disabled prior to age 31 </li></ul><ul><li>Had a period of disability prior to 31; or </li></ul><ul><li>Be statutorily blind </li></ul>
  10. 10. Medically Disabled <ul><li>If a person meets the previous requirements, they must now meet SSA criteria concerning medical impairments. </li></ul><ul><li>The listing of what SSA considers to be a medical impairment is listed at: </li></ul><ul><li> </li></ul><ul><li>The person also must NOT be working or must be earning less than $980 a month. </li></ul>
  11. 11. Another way to qualify <ul><li>An individual over the age of 18 who has a disability that began prior to age 22, is not married, and is the dependant of a person who meets the fully insured requirements, may be entitled to SSDI benefits based on the Social Security record of the parent. This only applies if the parent is disabled, retired, or deceased. </li></ul>
  12. 12. Supplemental Security Income <ul><li>Better known as SSI, this benefit is also administered by the Social Security Administration but is very different from SSDI. </li></ul><ul><li>SSI is a federally administered income assistance program to provide payments to needy persons who are aged, disabled, or blind but do not have the work history to make them eligible for SSDI. </li></ul>
  13. 13. Eligibility requirements for SSI <ul><li>A person must: </li></ul><ul><li>Have little or no income: and </li></ul><ul><li>Have resources of less than $2,000 </li></ul><ul><li>Be disabled or blind, 65 years of age or older; and </li></ul><ul><li>Apply for any other benefit programs the person may be eligible to receive; and </li></ul><ul><li>Not be working or working but earning less than $980 a month. </li></ul>
  14. 14. What counts as resources? <ul><li>In determining initial and ongoing SSI eligibility a person is not allowed to have more than $2,000 in resources at any time. This includes: </li></ul><ul><li>Money in bank accounts </li></ul><ul><li>Stocks and other investments </li></ul><ul><li>Real Estate other than home of residence </li></ul><ul><li>Expensive jewelry and other expensive property </li></ul>
  15. 15. Resources that do NOT count <ul><li>A house and the land that it is on if the person resides in it </li></ul><ul><li>A car or truck of reasonable value and the vehicle is used for transport to work </li></ul><ul><li>Combined life & burial insurance up to $1,500 </li></ul><ul><li>A burial plot for the individual & immediate family members </li></ul><ul><li>$2,000 worth of personal belongings </li></ul><ul><li>Retroactive SSI or SSDI benefit payments are not counted as a resource for 9 months beginning the month the payment is received. </li></ul>
  16. 16. Now that wasn’t so bad… <ul><li>So those are the two primary Government run programs. In a nutshell… </li></ul><ul><li>SSDI—For people with a significant work history in the previous 10 years. </li></ul><ul><li>SSI—For people who have little or no work history for previous 10 years and are financially in need. </li></ul>
  17. 17. Now for the fun—Medicare! <ul><li>Medicare is the federal insurance program provided to everyone receiving Social Security Benefits. </li></ul><ul><li>This does not include SSI. Only people receiving SSDI or Social Security retirement benefits are eligible for Medicare. </li></ul>
  18. 18. A, B, C, D, ……??? <ul><li>There are 4 Medicare programs. They are: </li></ul><ul><li>A—Hospital and long term care benefits </li></ul><ul><li>B—Physician and routine care benefits </li></ul><ul><li>C---Managed care covering all of the above AND prescription coverage </li></ul><ul><li>D---Prescription coverage </li></ul>
  19. 19. Who gets what for insurance? <ul><li>SSDI recipients are eligible to receive Medicare after 24 months of SSDI eligibility. </li></ul><ul><li>Part B will have a premium but many recipients are eligible for assistance through other programs for this premium. </li></ul><ul><li>SSI recipients are eligible for state funded Medicaid coverage. </li></ul>
  20. 20. Recap of Federal Benefits <ul><li>SSDI-Monthly Social Security Disability Insurance benefit for people with a disability AND a recent work history of at least 5 years. </li></ul><ul><li>SSI-Monthly Supplemental Security Income benefit for people with a disability who are financially needy. </li></ul><ul><li>Medicare—Federal insurance program for SSDI recipients </li></ul>
  21. 21. Confused yet? Wait, there’s more! <ul><li>Hopefully you now have a better understanding of benefits provided by the federal government. </li></ul><ul><li>What questions do you have about Federal benefits? </li></ul>
  22. 22. State of Vermont Benefits <ul><li>Supplement to SSI benefits </li></ul><ul><li>Medicaid insurance benefit </li></ul><ul><li>VPharm </li></ul><ul><li>VHAP </li></ul><ul><li>Food Stamps </li></ul><ul><li>Medicaid for the Working Disabled </li></ul><ul><li>Section 8 Housing Assistance </li></ul><ul><li>Fuel Assistance </li></ul>
  23. 23. VT benefits explained <ul><li>Vermont is one of only a few states to supplement the federal SSI cash benefit. The amount is small, average is about $60 a month. Recipients do not receive a separate check, this supplement is included in the recipients benefit check from the government. </li></ul>
  24. 24. Green Mountain Care <ul><li>Vermont has several medical insurance programs available to assist residents of varying income levels. These include: </li></ul><ul><li>Medicaid </li></ul><ul><li>VHAP </li></ul><ul><li>VPharm </li></ul><ul><li>Medicaid for the working disabled </li></ul><ul><li>Catamount Health Plans </li></ul>
  25. 25. Medicaid <ul><li>Medicaid is a state funded medical insurance program for low income Vermonters. </li></ul><ul><li>Anyone receiving SSI benefits as the only household income is automatically eligible for Medicaid. </li></ul><ul><li>Total household income must be less than $1,100 a month for one person to qualify. (exceptions for working disabled) </li></ul>
  26. 26. VHAP <ul><li>VHAP—Vermont Health Access Program </li></ul><ul><li>This is a comprehensive medical plan for individuals with income under $1,306 per month and with a disability or over the age of 65. </li></ul><ul><li>There is a premium for this program and it is income based. The premium runs between $7 and $49 each month. There may be some copays for medical/prescription services. </li></ul>
  27. 27. VPharm <ul><li>Vermont Pharmacy program </li></ul><ul><li>This program requires that an individual’s income is below $1800 per month and also requires a premium. </li></ul><ul><li>This is a benefit that covers prescription medications only </li></ul><ul><li>There is a premium for this benefit as well. </li></ul>
  28. 28. Other Vermont benefits <ul><li>Vermont also offers Catamount Health Insurance, VScript, Pharmacy assistance programs, and a new program that can help individuals afford their employer’s health insurance premiums. </li></ul><ul><li>For more information about all the Vermont Health Programs please visit </li></ul>
  29. 29. Medicaid for the Working Disabled <ul><li>This is a very under utilized benefit for people with disabilities who want to work but fear losing their medical benefits. </li></ul><ul><li>Vermont has a special Medicaid program where someone receiving SSDI benefits can work and still receive Medicaid benefits. </li></ul><ul><li>Household income for one person must be less than $2,100 with work and benefits combined. </li></ul><ul><li>This application MUST be mailed to Waterbury. </li></ul><ul><li>Use the regular Medicaid application but write “Medicaid for the Working Disabled” across the top of the application AND on the envelope. Local PATH offices are not equipped to process these applications. </li></ul>
  30. 30. Food Stamps <ul><li>Food stamp eligibility is based on many factors. </li></ul><ul><li>Income (Eligibility rises to 185% of poverty level as of January 1, 2009) </li></ul><ul><li>Rent & Utility Expenses </li></ul><ul><li>Medical Expenses (including OTC) </li></ul><ul><li>Number of people in the household </li></ul><ul><li>More info and an “estimator” can be found at </li></ul>
  31. 31. Housing Subsidy <ul><li>The most common housing subsidy is the Section 8 voucher program. </li></ul><ul><li>This program has a limited number of vouchers in several different programs. </li></ul><ul><li>Project based voucher </li></ul><ul><li>Individual voucher </li></ul><ul><li>State voucher </li></ul><ul><li>Local voucher </li></ul>
  32. 32. Voucher programs <ul><li>A project based voucher is when a client moves into a designated low-income housing project where all rents are based on household income. Rent does not exceed 30% of household income with additional exclusions for specific utilities. </li></ul><ul><li>An individual voucher is when a client is able to select an apartment of their choice as long as it meets the building code requirements of Vermont State Housing Authority AND the rent is within the allowable amount as designated by VSHA. </li></ul>
  33. 33. Vouchers continued <ul><li>State Vouchers—These vouchers are issued by the state Housing Authority and are usually individual vouchers that “travel” with the client. There is often a very long waiting list for any of the State Section 8 programs as demand clearly outweighs supply. </li></ul>
  34. 34. Vouchers continued <ul><li>Local vouchers—These are administered by the local housing authority. These most often are project based vouchers but there are a limited number of individual local vouchers as well. Again, the waiting list is very long but often it is faster to be accepted into a project based program than to wait for an individual voucher. </li></ul>
  35. 35. Fuel Assistance <ul><li>Fuel assistance is a Vermont benefit that has several components. It can be paid to renters, homeowners, and boarders. </li></ul><ul><li>Fuel assistance can be paid regardless of who is responsible for paying the heating bills in the home. </li></ul><ul><li>Fuel assistance can be used towards any type of fuel; oil, wood, pellets, electric, propane, etc. </li></ul>
  36. 36. Fuel Assistance eligibility <ul><li>There are 3 levels of eligibility to qualify for fuel assistance. </li></ul><ul><li>Seasonal Fuel (125% of poverty level) </li></ul><ul><li>Crisis Fuel (150% of poverty level) </li></ul><ul><li>Shareheat & Warmth (200% of poverty level) </li></ul><ul><li>Even if someone receives a housing subsidy, they could qualify for a fuel benefit. </li></ul><ul><li>If a person receives food stamps, applying for fuel assistance can increase their food stamp benefit. </li></ul>
  37. 37. Other programs <ul><li>There are other programs available to help in specific instances. Some include: </li></ul><ul><li>Lion’s Club—Assistance with eye care </li></ul><ul><li>Springfield Public Funds—Assistance with past due rent and on occasion, security deposits for utilities and/or rent. </li></ul><ul><li>SEVCA—Assistance with emergency fuel and assistance with past due electric bills. </li></ul><ul><li>Modest Needs—An online organization that helps a maximum of twice in a lifetime. Any need under $1000 qualifies. (You can apply for higher amounts but it’s rare to be funded for those.) </li></ul><ul><li>Precision Valley Free Clinic—free medical care and prescription vouchers. Also has limited funds to assist with dental care. </li></ul><ul><li>Visiting Nurse—Provides in home medical and personal care services depending on severity of disability. </li></ul><ul><li>PCA program—A personal care assistant program based on severity of disability. Program is run by Department of Aging and Disabilities. </li></ul>
  38. 38. Helpful websites <ul><li> </li></ul><ul><li> </li></ul><ul><li> </li></ul><ul><li> </li></ul><ul><li> </li></ul><ul><li> </li></ul><ul><li> </li></ul>
  39. 39. Had enough yet? <ul><li>As you can see, the world of benefits can be very complex and challenging. However by understanding the basics, especially who provides what service, navigating the benefits obstacle course becomes a little easier. </li></ul><ul><li>What questions do you have? </li></ul>
  40. 40. Thanks! <ul><li>Thank you for your patience and willingness to navigate the world of benefits. </li></ul><ul><li>As always, feel free to call or email me if you have questions. </li></ul><ul><li>[email_address] </li></ul><ul><li>(802) 886-4567 ext. 2617 </li></ul>