This presentation was given on 12/14/21 to help professional and lay caregivers understand how to help seniors in issues involving public benefits, including Social Security, SSI, Medicare, Institutional Medicaid and Medicare Savings Programs.

1. PUBLIC BENEFITS
for
CAREGIVERS

2. Jan Neal
Jan Neal Law Firm, LLC
207 N 4th St, Opelika, AL 36801
(334) 745-2779
1-800-270-7635
www.janneallaw.com

3. THE ROLE OF THE SENIOR CAREGIVER
IN IDENTIFYING PUBLIC BENEFITS
Benefits for which seniors might qualify have become complex and confusing over the years,
sometimes resulting in benefits left on the table and seniors losing benefits they previously qualified
for.
Caregivers can play a critical role in helping those they care for identify qualification for and ways to
protect critically important benefits.
Benefits.gov (formerly GovBenefits.gov) was one of the earliest “E-Government” initiatives to launch
in 2002 and was established as the official benefits website of the U.S. government. It may be found
at https://www.benefits.gov/. This is a tool designed to help individuals identify benefits for which
they might qualify, but it is a tool that requires a great deal of patience and comfort with technology.
It takes a checklist approach for eligibility and is not designed to help the user understand the big
picture. In other words, it is not a replacement for basic public benefit knowledge needed by seniors
and their caregivers.

4. Understanding rights and responsibilities for those who draw benefits is important in order to keep
from making mistakes that result in ineligibility or having to pay back overpaid benefits.
We will look at income programs of Social Security (SS) and Supplemental Security Income (SSI) and
how those benefits, while vastly different from an eligibility perspective, can both provide health
care coverage. Sometimes these programs overlap, and so does healthcare coverage from the
different programs.
Government benefits generally fall into two categories: means-tested (or needs-based) and
entitlement. Means-tested benefits require the client to qualify financially, while entitlement benefits
are not in any way related to income or assets. It is essential to understand the difference in the two
types of benefits.
SS is not means-tested, rather benefits are an entitlement. In other words, if you paid into the system
and meet the requirements to draw benefits, you are entitled to draw those benefits.
SSI is means-tested. The person drawing benefits can only have limited income and resources to be
eligible, so these are non-earned benefits.
MEANS TESTED VS NON-MEANS TESTED BENEFITS

5. WHERE DO WE LEARN THIS STUFF?
Sadly, basic information about public benefits, much less complex information, is seldom taught in
professional educational settings. Many people enter the workforce and learn case by case. The only
problem with a sink or swim approach is that the clients are the ones who sink when help is not
available.
No matter what service is being provided to a senior, you can be a life-saver if you can spot problems
and potential benefits to help the senior find the resources and information he or she needs at a given
time.
It is important to learn as much as possible through educational forums like this one you are attending
today and to self-teach as much as possible.
This training is very limited in scope but should provide you with information about your strengths and
weaknesses in understanding some basic public benefits to allow you to find more information about
those areas about which you know the least.
A good training source is https://www.benefits.gov/categories and other resources are offered later in
this presentation.

6. Stages of Planning with Required Benefit Knowledge
• Any time a senior is having trouble paying his or her bills
Identifying any benefits for which the senior might qualify
• When a person is already drawing benefits
how to keep existing benefits
• When a person younger than 65 becomes disabled
how to access income
how to obtain health insurance coverage
• When a person approaches SS and Medicare Age (60+)
when and how to apply for SS
when and how to apply for Medicare or Medicaid
• When a person is in physical or mental decline and the need for long-term care is possible in the next
five years
understanding when and how much Medicare will pay for long-term care
when and how to apply for Medicaid to pay for long-term care

7. SOCIAL SECURITY
MassMutual recently gave a 12-question true/false quiz to 1,500 people ages 55 to 65 who have not yet
claimed their Social Security benefits.
Only 3% of the respondents were able to answer all of the questions correctly.
35% of the respondents failed the quiz altogether.
18% received a D grade.

8. 1. If I take benefits before my full retirement age, they will be reduced for early filing.
2. If I am receiving benefits before my full retirement age and continue to work, my benefits might be
reduced based on how much I make.
3. Once I start collecting Social Security, my benefit payments will never change.
4. If I have a spouse, he or she can receive benefits from my record even if he or she has no individual
earnings history.
5. If I have a spouse and he or she passes away, I will receive both my full benefit and my deceased
spouse’s full benefit.
6. The money that comes out of my paycheck for Social Security goes into a specific account for me and
remains there, earning interest, until I begin to receive Social Security benefits.
7. Under current Social Security law, full retirement age is 65 no matter when you were born.
8. As a divorced person, I might be able to collect Social Security benefits based on my ex-spouse’s
earnings history.
9. Under current law, Social Security benefits could be reduced for everyone in 2035.
SOCIAL SECURITY TEST

9. 10. If I file for retirement benefits and have dependent children age 18 or younger, they also may qualify
for Social Security benefits.
11. If I delay taking Social Security benefits past the age of 70, I will continue to get delayed retirement
credit increases each year I wait.
12. I must be a U.S. citizen to collect Social Security retirement benefits.

10. SOCIAL SECURITY ANSWERS
1. True
2. True
3. False
4. True
5. False
6. False
7. False
8. True
9. True
10. True
11. False
12. False

11. TEST SSI
1. The income of a spouse who is separated from the SSI applicant counts toward the income limit.
2. The income of a divorced spouse living in the home with the SSI applicant will count toward the income limit.
3. All earned income counts for SSI eligibility.
4. Mary is on SSI. Money spent by Mary’s daughter to pay her telephone or medical bills will not count as income
for SSI eligibility.
5. If John, and SSI recipient, inherits land worth $35,000 and deeds it to his nephew he will be penalized by being
ineligible for SSI for 44.08 months.
6. When someone applies for SSI Social Security looks back five years to see if assets were transferred for less
than fair market value is five years.
7. If Dorothy, an SSI recipient moves in with her son’s family and pays no rent she may lose up to one-third of her
SSI benefits.
8. Fred lives in a small home on a one acre plot attached to another 100 acres of land he owns valued at
$300,000. He cannot qualify for SSI due to the value of the 100 acres he owns
9. If Toni, a 55 year old SSI Disability recipient, is penalized for transferring property and that penalty is longer
than 12 months, she will have to reapply after the penalty ends, including reestablishing her disability.
10. If you receive an SSI overpayment notice and request an appeal within 10 days from the date you receive the
notice, your current SSI payments will continue until Social Security makes a determination.

12. ANSWERS SSI
1. False
2. False
3. False
4. True
5. False
6. False
7. True
8. False
9. True
10. True

13. TEST MEDICARE
1. If I retire at age 62 I will be eligible for Medicare coverage.
2. If I become eligible for Social Security Disability I will be eligible for Medicare coverage back to the date of
qualification.
3. If I am under age 65 and am on kidney dialysis or have a kidney transplant I can qualify for Medicare Part A
premium free.
3. If I do not need any drugs at the time I apply for Medicare I can delay signing up for a drug plan without
consequences at a later date if my drug expenses increases.
4. I can initially apply for Medicare during a seven month window.
5. If I did not work and pay Medicare tax I may still qualify for Medicare on my spouse’s account.
6. Medicare Part C is the part of Medicare that pays for durable medical equipment.
7. The cost of your Medicare Part B premium is based on your income.
8. Medicare Part B covers 85 percent of approved medically necessary outpatient services and supplies.
9. Medicare drug plans are sold only as stand-alone drug plans.
10. During the COVID-19 pandemic Medicare beneficiaries, including those on Medicare Advantage plans, cannot be
billed for lab tests and related charges for COVID testing.

14. 1. False
2. False
3. True
4. True
5. True
6. False
7. True
8. False
9. False
10. True
MEDICARE ANSWERS

15. TEST LIS/MSP
1. Low Income Subsidies (LIS) are benefits to supplement seniors with cash payments to raise income
levels above the poverty level.
2. The Medicare Savings Programs (MSP) are administered by Medicaid to assist low income
Medicare beneficiaries to pay for the cost of health care.
3. Low Income Subsidy (LIS) benefits will reduce prescription drug costs for seniors.
4. QMB, SLMB and QI-1 are different types of Medicare Savings Plans.
5. LIS eligibility is based on income and resources.
6. MSP eligibility is based on income and resources.
7. Application for LIS is made at Social Security.
8. Application for MSP is made at Medicaid.
9. If a person qualifies for QMB, he needs to continue purchasing a Medicare Supplemental Policy.
10. People who qualify for LIS are allowed to switch health care plans during Open Enrollment and
an additional three times per year.

16. ANSWERS LIS/MSP
1. False
2. True
3. True
4. True
5. False
6. False
7. True
8. True
9. False
10. True

17. Test Institutional Medicaid
1. When a person applies for Medicaid to pay for long term care the agency will examine all his or her financial
transactions as far back as three years to determine if anything was given away or sold for less than fair market
value.
2. If a Medicaid applicant sells property the sales price should be the tax assessor’s appraised value or a commercial
appraisal if the tax value is over a year old.
3. An individual with income over the Medicaid income limit of $2382 cannot qualify for benefits.
4. When a married person applies for Medicaid the snapshot of countable assets owned by the couple is what they
owned on the date of application.
5. For married applicants the income that counts toward the income limit is the combined income of both spouses.
6. A relative can be required to pay for institutional care during the time the Medicaid application is pending.
7. Medicare will pay for nursing home care for 21 days with no copayments if he is hospitalized for three days prior
to admission to a nursing home and skilled care is ordered.
8. The Minimum Monthly Maintenance Needs allowance is the amount Medicaid will pay for a person’s care in a
nursing facility.
9. If Mary is admitted to a nursing home on June 1 and dies on June 27 Medicaid will pay for the 27 days she was a
nursing home patient.
10. Medicaid can pay as far back as two months prior to application if all eligibility requirements were met during
those two months.

18. ANSWERS MEDICAID
1. False
2. True
3. False
4. False
5. True
6. False
7. True
8. False
9. False
10. False

19. One of the most confusing areas is the intersection of Benefits and Health Care. Social Security
and Supplemental Security Income (SSI) intersect health care coverage in several ways.
A good rule to remember is:
• Social Security is married to Full Retirement Age (or reduced benefits at 62) or Disability, and
• SSI is married to age 65 or Disability (means based), and
• Medicare is married to Age 65 or 24 months following a finding of Social Security Disability,
• Medicaid is married to Supplemental Security Income (SSI), Medicare Savings Programs, Home
and Community Based Medicaid Waiver services or Institutional Medicaid (all means based).
HEALTH INSURANCE AND BENEFITS

20. EXAMPLES OF WHEN HELP MAY BE NEEDED
Frankly, it is a full time job acquiring and protecting a person’s public benefits requiring a good
deal of attention to detail and accountability. This is the reason it is so hard to be a lay caregiver.
Professional caregivers can help in numerous ways by spotting problems and directing the senior/caregiver
in need to the right source of information and help. Encouraging people to ask and then act rather than act
and then ask is a great service.
But in order to refer for help, the caregiver must first be able to spot a problem or potential problem
Times when a person needs advice and referral may be:
• When income or resources change
• When a family member dies
• When a move is planned
• When the sale of a house or car is planned
• When health is in decline and long-term care is in the future
• When a relative is taking money or encouraging the senior to give them money
• When health care needs are not being met (drugs cannot be purchased, routine medical care cannot be obtained
• When hunger is a reality
• When a SS or SSI overpayment notice is received
• When a Medicare claim has been denied

21. WHERE TO REFER
The M4A Aging and Disability Resource Center (ADRC) is a place to reach programs that assist with
many benefits including:
Caregiver Support: Information, Assistance, Education, Counseling, Respite, and Supplemental
Services.
Home & Community Based Services: In home services and care coordination to help older and
disabled individuals remain in their homes.
Insurance Counseling: Counseling, advocacy, and help with Medicare, Medicaid, Prescription
coverage, Long-Term Care, and Medicare Fraud.
Legal Services: Legal assistance with powers of appointment, access to public benefits, housing, and
healthcare. (must be 60 years of age or older)
Nutrition: Nutritious meals either delivered at home or in a congregate setting.
Ombudsman Services: Information and advocacy for residents of long-term care facilities and family
members.
Prescription Assistance: Assistance to obtain free or low cost prescription drugs from pharmaceutical
companies.
Senior Employment: A paid training program to help strengthen and improve skill set to secure
gainful employment. [age requirement]
Contact M4A Aging and Disability Resource Center (ADRC)
at https://m4a.org/
205) 670-5770

22. WHERE TO LEARN MORE
• PLANNING FOR DISABILITY
Guide to Alabama Advance Directives ebook,
Legal Issues For Caregivers ebook, and
Documents and Property Arrangements to Prepare for Death and Disability ebook
at https://janneallaw.com/ebooks/
Legal presentations at https://www.slideshare.net/jan_neal/presentations
Legal, Dementia, Elder Abuse and Caregiver presentations at M4A YouTube channel
• PLANNING FOR RETIREMENT BENEFITS
Social Security/SSI ebook and
When I’m 64, Getting Enrolled in Medicare ebook
at https://janneallaw.com/ebooks/

23. • PLANNING FOR DEATH
Documents and Property Arrangements to Prepare for Death and Disability ebook and
Guide to Planning for Death ebook
at https://janneallaw.com/ebooks/
The following is a benefit checklist with eligibility numbers related to benefits in Alabama
• PLANNING FOR DISABLED RELATIVES
Alabama Family Trust at https://www.alabamafamilytrust.com/
• PLANNING FOR LONG-TERM CARE
The Medicaid Application Process ebook,
Qualifying for Alabama Medicaid for Long-Term Care ebook,
Integrating Long-Term Care Into Estate Planning ebook,
Guide to Planning for Long-Term Care ebook, and
Medicaid Estate Recovery ebook
at https://janneallaw.com/ebooks/

24. Alabama Benefit Checklist
Assembled by Jan Neal
Effective 02-2021
“This publication has been created or produced by the South Central Alabama Area Aging 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”
1

26. 3
Table of Contents
SSI and Community Medicaid ....................................................................4
Institutional Medicaid and Community Medicaid Waiver ............ 4
Medicare Savings Programs (MSP): QMB,SLMB,QI1….................. 5
Medicare Standard A&BCost Sharing…..............................................6
Medicare Higher Income B Cost Sharing… ........................................... 7
Medicare Higher Income D Cost Sharing …
…
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8
Medicare Late Enrollment Penalties….................................................. .8
Low Income Subsidies……………………………………………………….…..9
Social Security Retirement Age…...........................................................12
Social Security Early Retirement Benefit Reductions… .............. 13
Social Security Early Retirement Earned Income Offset….......... 13
Social Security Disability Substantial Gainful Activity…............... 14
Alabama Elderly Simplified Application Project… ...........................15
Gift and Estate Tax….....................................................................................15
Notes …
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1
6

27. 4
SSI and Community Medicaid
Benefit Eligibility Standard
Effective Date
January 01, 2021
SSI Retirement and
Disability
Single Monthly
Income/Resources
$814/$2000
Married Monthly
Income/Resources
$1211/$3000
Medicaid at Home SSI eligibility SSI eligibility
Medicare Buy-In for
Medicare A, B & D
SSI eligibility SSI eligibility
Institutional Medicaid/Community Medicaid Waiver
Benefit/Penalty Eligibility Standard Effective Date
Single Standard January 1,
2021
Married Spousal Resource
Set Aside Standard
January 1, 2021
Nursing Home
Medicaid
Single Person
Income/
Resources
$2382 (with
income over
$2382 MQIT
needed)/
$2000
Married Couple
Income/Resource Set
Aside
$2382 (only income of
spouse being
institutionalized counts)/
First $26,076 set aside
for community spouse,
resources over $50,000,
½ set aside for spouse
up to cap of $130,380

28. 5
Effective Date
Monthly Spousal
Allotment
$2178 July 1, 2021
Transfer Penalty 1 month for every $6,400 transferred January 1, 2021
Home exclusion Equity at or below $906,000.00 January 1, 2021
Medicare Savings Programs (MSP)
Benefit Eligibility Standard
Effective Date
February 1, 2021
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*
$1,094 $1,472
SLMB
Pays for:
~Medicare Part B
$1,308 $1,762

29. 6
premium
QI-1
Pays for:
~Medicare Part B
premium
$1,469 $1,980
Medicare
Medicare Part Premium Deductible Copayment Effective Date
A 0 if eligible for SS
(Retirement
benefits; 24 months
of disability) or RR
or paid Medicare
Tax with Civil
Service;
$471 per month
with fewer than 30
qtrs.; $259 per
month with 30 – 39
quarters
$1484 per
admission to
hospital during a
spell of illness
$371 per day
for days 61 –
90; $742 per
day for days 91
– 150 lifetime
reserve
Skilled nursing
facility $185.50
per day for days
21 - 100
January 1, 2021
B $148.50 per month
standard premium
$203.00 20%
Premium for higher
income
beneficiaries below

30. 7
Medicare Part B Premium 2021 for Higher Income Beneficiaries
Based on Two Year’s Prior (2019) Yearly Reported Income
Individual
Tax
Return Filed
Joint Tax
Return Filed
Married with
Separate Tax
Return
Part B
Premium Amount
Effective Date
January 2021
$88,000 or $176,000 or less $88,000 or less Standard $148.50
less
Over $88,000 Over $176,000 up N/A $207.90
up to to $222,000
$111,000
Over Over $222,000 up N/A $297.00
$111,000 to $276,000
up to
$138,000
Over Over $276,000 up N/A $386.10
$138,000 to $330,000
up to
$165,000
Over Over $330,000 up $88,000 - $412,000 $475.20
$165,000 to $750,000
up to
$500,000
$500,000 and $750,000 and $412,000 and $504.90
above above above
Part B Late
Enrollment
Penalty
10% per each full 12 – month period eligible without overage X cost
of Medicare Part B premium at time of sign up = amount added to
monthly cost of Part B premium
Permanent

31. 8
Medicare Part D Premium 2021 for Higher Income Beneficiaries
Based on Two Year’s Prior (2019) Yearly Reported Income
Individual Tax
Return Filed
Joint Tax
Return Filed
Married with
Separate Tax
Return
Part D
Premium Amount
Effective Date
January 2021
$88,000 or less $176,000 or less $88,000 or less Your plan premium
Over $88,000
up to $111,000
Over $176,000 up
to $222,000
N/A $12.30 + your plan
premium
Over $111,000
up to $138,000
Over $222,000 up
to $276,000
N/A $31.80 + your plan
premium
Over $138,000
up to $165,000
Over $276,000 up
to $330,000
N/A $51.20 + your plan
premium
Over $165,000
up to $500,000
Over $330,000 up
to $750,000
Above $88,000
Less than $412,000
$70.70 + your plan
premium
$500,000 or
above
$750,000 and
above
$412,000 and
above
$77.10 + your plan
premium
Part D Late
Enrollment
Penalty
1% of the “national base beneficiary premium” ($33.06 in
2021 X the number of full, uncovered months eligible without
coverage or creditable coverage = amount added to monthly
cost of Part D
Permanent

32. 9
Low Income Subsidy (Extra Help purchasing Medicare Part D)
Benefit Categorical Eligibility Effective Date
calculate income: add income (gross earned income or net
from self-employment minus 65 divided by 2) + all other
income
January 1, 2021
calculate resources: do not count home, adjoining land,
household personal property, vehicles or life insurance
C.LIS (Full Subsidy) 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
1093.33/<9,470 1471.66/<14,960
Each additional person in the home for whom applicant provides
more than one-half of person’s support adds 378.33
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
Income/Resources
Married Income/Resources
Living Together
1469.00<9,470 1979.75/<14,960

33. 10
Each additional person in the home for whom
applicant provides more than one-half of
person’s support adds 510.75
LIS (Partial Subsidy) A. 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
1522.66/<14,790 2052.32/<29,520
Each additional person in the home for whom
applicant provides more than one-half of
person’s support adds 529.66
B. 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
$1576.66/<14,790 2124.91/<29,520
Each additional person in the home for whom
applicant provides more than one-half of
person’s support adds 548.58
C. People eligible for Medicare at or below 150% of
the poverty level with limited resources below (25%

34. 11
subsidy)
Single
Income/Resources
Married
Income/Resources
Living Together
1630.00/<14,790 2197.50/<29,520
Each additional person in the home for whom
applicant provides more than one-half of
person’s support adds 567.50
*Regional
Standard
$30.20 Effective Date
January 1, 2021

35. 12
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
1942 65 and 10 months
1943 – 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

36. 13
SS Early Retirement Benefit Reduction
Category based on
NRA
Reduction 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
Effective
Date/Change
Date
January 1, 2021
NRA 66 (born 1954
or later)
25% 20% 13.3% 6.7%
NRA after 66 (born
after 1954)
30%
Early Retirement Earned Income Offset
Category Based on
NRA
Exempt Amount SS Offset Penalty
Effective Date
January 1, 2021
Exempt Earnings for
early retirees/workers
whose NRA IS NOT
in 2021
$18,960 or $1,580 month Withholding of $1.00 in
benefits for every $2.00
earned over $18,960
Exempt Earnings for
early retirees/workers
whose NRA IS in
2021 and earnings
predated reaching
NRA
$50,520 or $4,210 month Withholding of $1.00 in
benefits for every $3.00
earned over $50,520

37. 14
SSD Substantial Gainful Activity (SGA)
Category Based on
Disability
Allowable Mo. Earnings
Effective Date
January 1, 2021
Non-blind $1,310.00
Blind $2,190.00

38. 15
Alabama Elderly Simplified Application Project (AESAP)
Food Assistance for 60+
Household Size Gross Income Limit Net Income Limit
Effective Date
October 1, 2020
1 $1383 $1064
2 $1868 $1437
3 $2353 $1810
4 $2839 $2184
5 $3324 $2557
6 $3809 $2930
7 $4295 $3304
8 $4780 $3677
Each Additional
Member
$486 $374
Gift and Estate Tax
Federal Estate Tax
Exemption and Lifetime
exclusion for gifts
23.4 million per couple
11.7 million per individual
January 1, 2021
Annual Gift Exclusion $15,000 January 1, 2021

39. 16
NOTES