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A Resource for You
This booklet is intended to give you basic information about entitlement and benefit programs. It contains a general description of each program, eligibility requirements, application procedures and your appeal rights.
The booklet is divided into two sections.
The first section is entitled "Income Maintenance Programs." This provides information about various sources of monthly income or programs that can supplement your current income. Social Security, Supplemental Security Income, and Food Stamps are examples of some income maintenance programs.
Section II, "Health Care Financing", covers programs which provide funding mechanisms to help pay medical costs and meet some long term care needs. Programs which can cover part of these expenses are Medicare, Medical Assistance and the Community Options Program. PartnerCare, Qualified Medicare Beneficiary, and Specified Low-Income Medicare Beneficiary programs are also available to help reduce your day-to-day medical costs.
There are many changes pending both at Federal and State levels, with Managed Care in the Medicare and Medical Assistance programs and Long Term Care Redesign in Wisconsin. These changes are in the early development stages, and we will probably see many proposed versions and many revisions before adoption of final program design. While many new changes will be forthcoming, the information provided in the 1997 Elder Rights and Benefits Booklet is the most up-to-date information available at the time of publication. This booklet is intended to provide the necessary information to access these complex and ever-changing programs.
View table of contents
View sample section on Social Security
The Elder Rights & Benefits Booklet is available to CWAG members for $10 and to non-members for $15. To order, e-mail us at cwag@midplains.net, or drop us a note at:
Coalition of Wisconsin Aging Groups
5900 Monona Dr., Ste. 400
Madison, WI 53716-3554
Elder Rights & Benefits Booklet Table of Contents
INTRODUCTION
I. INCOME MAINTENANCE PROGRAMS
- SOCIAL SECURITY (sample section)
- SOCIAL SECURITY DISABILITY
- SUPPLEMENTAL SECURITY INCOME
- SUPPLEMENTAL SECURITY INCOME -- EXCEPTIONAL EXPENSE SUPPLEMENT
- RAILROAD RETIREMENT
- VETERAN'S BENEFITS
- INTERIM ASSISTANCE PROGRAM
OTHER COMMUNITY PROGRAMS TO PROVIDE ADDITIONAL INCOME
- ENERGY ASSISTANCE PROGRAM
- PROPERTY TAX DEFERRAL LOAN PROGRAM
- HOMESTEAD CREDIT
- HOME EQUITY CONVERSION REVERSE MORTGAGE
II. HEALTH CARE FINANCING
- MEDICARE
- MEDICAL ASSISTANCE PROGRAM
- MEDICAL ASSISTANCE (MA) FOR PERSONS LIVING IN THE COMMUNITY
- MEDICAL ASSISTANCE DEDUCTIBLE PROGRAM
- MEDICAL ASSISTANCE ELIGIBILITY -- NURSING HOME
- MEDICAL ASSISTANCE FOR INDIVIDUAL/UNMARRIED NURSING HOME RESIDENTS
- MARRIED PERSONS -- MEDICAL ASSISTANCE SPOUSAL IMPOVERISHMENT PROVISIONS
- THE QUALIFIED MEDICARE BENEFICIARY PROGRAM
- SPECIFIED LOW-INCOME MEDICARE BENEFICIARIES -- (SLMB)
- PARTNERSHIP PROGRAM
- PATIENT ASSISTANCE PROGRAM
- PRIVATE INSURANCE -- MEDICARE SUPPLEMENTS OR "MEDIGAP" POLICIES
- FILING A COMPLAINT WITH THE INSURANCE COMMISSIONER ABOUT MEDICARE SUPPLEMENT INSURANCE
- COMMUNITY OPTIONS PROGRAM (COP)
III. GLOSSARY
- GLOSSARY OF MEDICAL ASSISTANCE TERMS
- GLOSSARY OF MEDICARE TERMS
RESOURCE LIST PERSONAL INFORMATION
Social Security (Sample Section)
INCOME MAINTENANCE PROGRAMS
(Public Benefits and Entitlement Programs)1. SOCIAL SECURITY
The Social Security Program is one of several public benefit programs established under the Social Security Act. All persons who work in "covered employment" in the United States participate in the Social Security Program. This entitlement provides monthly cash payments to workers who qualify on the basis of age or disability, and to spouses of qualified workers and their dependents. Social Security is not a needs-based program; payments are based on "insured status as a worker" rather than on financial need.
A worker must have earned 40 quarters (be "fully insured") of covered employment to receive Social Security benefits. A worker must also be at least 62 years old in order to draw retirement benefits. These conditions also apply if dependents or spouses are to receive benefits. Your benefit will be reduced by 20% if you elect to take your Social Security benefit at age 62 and is prorated if you take your benefits at age 63 or 64.
Survivor's benefits are available to a surviving spouse or to a surviving divorced spouse if the individual was married for at least 10 continuous years to a fully insured worker. Reduced benefits can be drawn at age 60 if still single.
You may apply for Social Security at your local Social Security Administration Office. You may apply for your retirement benefits no sooner than three months prior to your 62nd birthday if you are taking early retirement. You may apply at any time after age 62, keeping in mind that you will receive a reduced benefit unless you retire at 65 or older. You should bring original or certified copies of your birth certificate to establish your identity and age, marriage certificate (if applying on your spouse's ecord), Social Security card, your most recent W-2 form or tax return if you are self-employed. If you do not have all the necessary documents, do not delay signing up for your benefit. The Social Security Administration can help you obtain the additional documentation you may need. Apply at your local Social Security Administration office.
Retirement Earnings Test - 1997
If you are drawing Social Security benefits and work, $1 will be withheld from Social Security Benefits for every $2 earned over $8,640 per year ($720 per month) if you are under 65. $1 will be withheld for every $3 earned over $13,500 per year ($1125 per month) if you are 65-69 years old. There are no earning restrictions for those 70 years old and over.
All recipients of any Social Security Administration benefits always have the right to appeal any determination made by SSA. There are four appeal levels for persons who disagree with determinations made by the Social Security Administration. [FN 1]
1. Reconsideration - A Request for Reconsideration is a paper review which must be mailed to the Social Security Office within 60 days of receiving the initial determination. New evidence may be submitted with a written explanation of why you disagree with this determination. You will receive a written response to your request.
2. Hearing - If you disagree with the Reconsideration determination, you may request an in-person hearing before an administrative law judge. The request for hearing form is available from the local Social Security Office. The completed form must be received by the local office within 60 days of receipt of the Reconsideration determination. You will receive a written decision from the Administrative Law Judge which explains his or her findings in your case. Any decision made by the judge is considered binding and final unless you file an appeal to the next level.
3. Appeals Council - The beneficiary can request an Appeals Council review of an Administrative Law Judge's hearing decision or dismissal. A written request must be filed at a Social Security office within 60 days after receiving a hearing decision. The Appeals Council has the right to refuse any further review of your claim. In most cases, this appeal will be handled as a paper review. The Council may permit oral arguments.
4. Judicial Review - An individual may obtain review of any final Social Security decision by filing a civil action in federal court within 60 days after Social Security mails a final decision.
For the first three appeal levels, you may appoint a non-attorney representative such as a trusted friend, relative or benefit specialist to assist you. You must complete an Appointment of Representative form which is available from your local SSA office. If you want representation at the Judicial Review level, you must retain an attorney.
OVERPAYMENTS
Occasionally, the Social Security Administration sends a beneficiary a "Notice of Overpayment" indicating that it believes Social Security has paid you more benefits than you were entitled to receive. If you believe you did not receive incorrect benefits, you can appeal the overpayment notice.
There is a "waiver" provision for overpayments from Social Security. Two criteria must be met to qualify for the "waiver" provision. First, you must prove that you were not at fault in causing the overpayment. If it is found that the overpayment was not your fault, it also must be shown that repayment would either cause you financial hardship or that repayment would be unfair.
If you need information or assistance with your appeal, contact the Benefit Specialist program in your county or an elder law attorney. If you need help finding the number of your county's Benefit Specialist Program, call the Bureau on Aging at (608) 266-2536.
To receive this publication in its entirety, call, write or e-mail: Coalition of Wisconsin Aging Groups 5900 Monona Drive - Suite 400 Madison, WI 53716 608-224-0660 1-800-488-2596 (toll free) E-mail: cwag@midplains.net
Last updated: August 14, 1997
By: Gail Schwersenska
[FN 1] At the present time, the Social Security Administration is looking at ways to streamline the appeals process. One of the proposals is to eliminate the reconsideration level of appeal. The Madison, Wisconsin Social Security Administration office is one of the sites chosen to participate in this pilot project.
