Social Security Benefits to Edge Up 1.7 Percent

November 11, 2012

The nation’s elderly and disabled Social Security recipients will receive a 1.7 percent increase in payments in 2013. This is expected to raise the average monthly payment for the typical retired worker by $21.  The increase is less than half of last year’s 3.6 percent  cost-of-living adjustment (COLA).

In any case, the modest rise will be partially offset by Medicare’s premium increases for 2013, which will be announced soon.  Most Medicare recipients have their premiums deducted from their Social Security payments.  The same COLA will apply to pensions for federal government retirees and most veterans.

“While this modest increase will help, much of the COLA will be consumed by health care and prescription costs, which continually outpace inflation,” said Nancy LeaMond, executive vice president of AARP.  “Every day, retirees and other beneficiaries struggling to make ends meet still feel like they’re falling further behind.”

The COLA by the Numbers

Starting in January 2013, the average monthly Social Security retirement payment will rise from $2,240 to $1,261 a month for individuals and from $2,014 to $2,048 for couples. The 1.7 percent increase will apply to both elderly and disabled Social Security recipients, and individuals who receive both disability and retirement Social Security will see increases in both types of benefits.  The maximum Social Security benefit for a worker retiring at full retirement age, which is age 66 for those born between 1943 and 1954, will be $2,533 a month.

The Social Security COLA also raises the maximum amount of earnings subject to Social Security taxation to $113,700 from $110,100.  This means that those earning incomes above $113,700 will pay no tax on any income above that threshold.

The COLA increases the amount early retirees can earn without seeing a cut in their Social Security checks.  Although there is no limit on outside earnings beginning the month an individual attains full retirement age, those who choose to begin receiving Social Security benefits before their full retirement age may have their benefits reduced, depending on how much other income they earn.

Early beneficiaries who will reach their full retirement age after 2013 may now earn $15,120 a year before Social Security payments are reduced by $1 for every $2 earned above the limit. Those early beneficiaries who will attain their full retirement age in 2013 will have their benefits reduced $1 for every $3 earned if their income exceeds $40,080 in the months prior to the month they reach their full retirement age.

For 2013, the monthly federal Supplemental Security Income (SSI) payment standard will be $710 for an individual and $1,066 for a couple.

For a complete list of the 2013 Social Security changes, go to: http://www.socialsecurity.gov/pressoffice/factsheets/colafacts2013.htm

For more ElderLawAnswers information on Social Security, click here.

To discuss elder law issues with an attorney, please call the Elder Law Center at 630-844-0065 or contact us via email. The Elder Law Center is located in Aurora, IL, Kane County, in the Chicago Western Suburbs.

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Medicare to End ‘Improve or You’re Out’ Standard for Coverage of Skilled Services

November 11, 2012

In a major change in Medicare policy, the Obama administration has provisionally agreed to end Medicare’s longstanding practice of requiring that beneficiaries with chronic conditions and disabilities show a likelihood of improvement in order to receive coverage of skilled care and therapy services. The policy shift will affect beneficiaries with conditions like multiple sclerosis, Alzheimer’s disease, Parkinson’s disease, ALS (Lou Gehrig’s disease), diabetes, hypertension, arthritis, heart disease, and stroke. (See companion article, “Who Will Benefit From the New Medicare Policy Change?”.)

For about 30 years, home health agencies and nursing homes that contract with Medicare have routinely terminated the Medicare coverage of a beneficiary who has stopped improving, even though nothing in the Medicare statute or its regulations says improvement is required for continued skilled care.  Advocates charged that Medicare contractors have instead used a covert “rule of thumb” known as the “Improvement Standard” to illegally deny coverage to such patients. Once beneficiaries failed to show progress, contractors claimed they could deliver only “custodial care,” which Medicare does not cover.

In January 2011, the Center for Medicare Advocacy and Vermont Legal Aid filed a class action lawsuit, Jimmo v. Sebelius, against the Obama administration in federal court aimed at ending the government’s use of the improvement standard.  After the court refused the government’s request to dismiss the case, and the administration lost in similar individual cases in Pennsylvania and Vermont, it decided to settle.  

As part of the proposed settlement, which the federal judge must still formally approve, Medicare will revise its manual that contractors follow to clarify that Medicare coverage of skilled nursing and therapy services “does not turn on the presence or absence of an individual’s potential for improvement” but rather depends on whether or not the beneficiary needs skilled care, even if it would simply maintain the benefidiary’s current condition or slow further deterioration.

In addition, under the settlement Medicare beneficiaries who received a final denial of Medicare coverage after January 18, 2011 (the date the lawsuit was filed) are entitled to a review of their claim denial.  

“The Jimmo settlement provides hope for thousands of older and disabled people with chronic and long-term conditions who will now have a fair opportunity to get access to Medicare and necessary health care,” Judith Stein, Executive Director of the Center for Medicare Advocacy, told ElderLawAnswers.    

In an article about the accord, the New York Times notes that Medicare’s coverage of skilled care for beneficiaries with chronic conditions “could also provide relief for families and caregivers who often find themselves stretched financially and personally by the need to provide care.”

Although the Times quotes a trustee of the Medicare program that the change will cost Medicare more money, it could also save some money because physical thereapy and home health care may help keep beneficiaries out of more expensive institutions like nursing homes and hospitals.    

For more on the lawsuit, click here.

To discuss elder law issues with an attorney, please call the Elder Law Center at 630-844-0065 or contact us via email. The Elder Law Center is located in Aurora, IL, Kane County, in the Chicago Western Suburbs.