How often do I see charts showing that the income limit for SSI is $623/934?  Very often.  And it leaves me wondering how many people rely on a simple number to assume that a person will not qualify for SSI.  The problem is that SSI is an easy benefit to define, but it is not so readily easy to determine whether a particular person should apply.  

SSI is a federal benefit for persons 65 and over, blind or younger than 65 and disabled (unable to engage in substantial, gainful employment). A person with low income and resources who becomes aged or disabled and did not pay into the Social Security system, or did pay into the system but who has very low Social Security or did not earn enough quarters, will qualify for SSI to bring his or her income up to an amount known as the federal benefit rate (FBR). The FBR, which is adjusted for inflation every January, is set for 2007 at $623 for single persons and $934 for couples.  VA Aid and Attendance does not count.  The resource limits are $2000 for single persons and $3000 for couples.  Up to $1500 in burial insurance or the face value of insurance, an automobile and home property does not count.  If a person qualifies for even one dollar of SSI, he or she will qualify for Medicaid coverage to pay for routine and necessary health care while living in the community (not to be confused with Medicaid to pay for long-term care).

But here is the catch - many people do not know that they qualify for SSI due to how income is defined.  After certain deductions from income are allowed, the countable income must fall below the federal benefit rate. 

In determining whether someone should apply for SSI, the first question is whether he or she is married to know the income limit beneath which his or her income must fall, and the second is the source of income (is it earned, is it VA Aid and Attendance?).   

If the person does not have earned income, then the only income deduction available is the first $20 worth of unearned income.  So a person with unearned income can actually have income as high as $642 or $953 (single or couple) because after subtracting $20 from those amounts, the income will fall $1 below $623 or $934, qualifying that person for $1 worth of SSI.  

If a person has earned income, he or she can have even higher income and qualify for SSI because the first $65 worth of earned income plus one-half of the remainder is completely disregarded. 

Example:  Single person X receives $300 worth of Social Security monthly.  He is on Medicare and has Medicare Part B.  Add $93.50 to his unearned income because that amount has been deducted from his Social Security check to pay for the Part B premium.  His gross unearned income is $393.50.  His monthly gross earned income of $501per month.  Total income is $894.50.  After subtracting $65 from the gross earned income, the balance is $436.  Divide by 2 and this leaves $218 that is counted.  Add that to the $393.50 Social Security for a total of $611.50.  Subtract the $20 disregarded for a total countable income of $591.50.  The FBR is $623 - countable income of $591.50 = $31.50.  This person will qualify for $31 per month of SSI to bring countable income up to the $623 federal benefit rate.

Use this quick test:

• Monthly gross earned income
• Subtract $65.00
• Divide by 2
• Add gross unearned income
• Subtract $20.
• Does the person's countable income fall below the applicable FBR?

In the late 1980’s SSI regulations changed to allow a person to give away property to become eligible for SSI benefits.  Several years ago regulations changed back to the old rule that assesses a transfer penalty on transfers of property for less than fair market value.

Apply for SSI at your local Social Security office.
 
 

The Department of Health and Human Services (HHS) reports that today one in six Americans, or 44 million people, is age 60 years or older, including four million people age 85 and older. Since 1965 America has legislatively recognized that the future would present greater and greater numbers of individuals in this category, and in response passed the Older Americans Act (OAA) to create a system to deliver the service needs by older Americans and their families.

The Older Americans Act established the U.S. Administration on Aging (AoA) within the Department of Health and Human Services and provided state grants for planning, research and service delivery. Later amendments created a system of dividing the country into area agencies on aging to provide for local service planning and administration of funding provided for delivery of services.

The OAA was most recently reauthorized in the fall of 2006. The stated goals of the act are to assist older Americans to secure equal opportunity to income; physical and mental health care; suitable housing; restorative services; community-based services; employment opportunity; retirement in health, honor and dignity; participation in meaningful civic, cultural, educational, training and recreational opportunities; low-cost transportation; immediate benefit from proven research to sustain and improve health and happiness; freedom, independence, and the free exercise of individual initiative in planning and managing their own lives; and protection against abuse, neglect, and exploitation. (42 U.S.C. 3001).

Legal assistance is one of many services required to accomplish the goals of the OAA. The Act requires state plans to contain assurances that area agencies on aging will give priority to legal assistance related to income, health care, long-term care, nutrition, housing, utilities, protective services, defense of guardianship, abuse, neglect, and age discrimination.  Services are available to individuals 60 and over, and although no income tests are used for OAA legal assistance, the act requires that these priority services be targeted to older Americans with greatest economic and social need. Prohibited activities by OAA legal assistance providers include criminal and fee-generating cases.  There is no charge for services, but recipients must be given an opportunity to make a donation to the program.

Besides counsel and advice and representation, a component of OAA Legal Assistance is community legal education designed to educate seniors and caregivers on topics of particular interest to seniors.

Regulations that have been promulgated over the years require area agencies to select providers who demonstrate the capacity to provide effective administrative and judicial representation in the areas of law affecting older adults with economic or social need and shall; demonstrate the capacity to provide support to other advocacy efforts such as the ombudsman and the adult protective services programs; demonstrate the capacity to provide services effectively to older adults and persons with disabilities and to older adults who are institutionalized, isolated, and homebound; demonstrate the capacity to provide services in the principal language spoken by individuals of the area; and assure that other legal activities will not be a conflict of interest or interfere with their professional contracted responsibilities (45 CFR 1321.71).

To see if Davis & Neal provides Legal Assistance in the region where you live, see our Area Agency on Aging Partners at this site. 

I frequently receive calls from persons who are 60 - 64 with no health insurance.  Sometimes the person never did have coverage; sometimes the individual took Social Security Retirement Benefits early at age 62 with the misguided notion that he or she would also get Medicare; then again sometimes the person was on SSI and Medicaid, not eligible for Social Security Disability benefits when, at age 62, he or she was required to apply for Social Security Retirement benefits which was high enough to disqualify the person for further SSI.  Though disabled persons on Social Security Disability will qualify for Medicare after 24 months of eligibility for SSD, it is surprising how many people do not realize that Medicare is not a retirement benefit one can get until he or she turns 65 (or full retirement age which is higher for persons born in 1937 and later).  It is not unusual to run across a person who lost a job at age 59, qualified for COBRA coverage for 18 months and then finds himself without health insurance coverage at age 60.  This is a devastating problem for a person in that age category.  What to do? Alabama Health Insurance Plan may be a solution for some (AHIP).

HIPAA (Health Insurance Portability and Accountability Act) provides protections for persons who lose employer group health insurance coverage by requiring guarantee issue coverage with no pre-existing conditions.  To comply with HIPAA protections, Alabama guarantees these HIPAA protections through a state high-risk pool.

AHIP, while not guaranteeing coverage for  all high risk individuals who cannot get health insurance, is specifically for those who had coverage through their employer, and those benefits have run out.  AHIP offers two types of plans, a traditional indemnity plan through Blue Cross and Blue Shield of Alabama and a managed care plan through United HealthCare.  Both plans cover doctor visits, prescription drugs, hospital care and emergency care while away from home, but they differ in how services are provided and the premium cost.

To qualify for AHIP a person must have had previous coverage through a group health, government or church plan; with previous coverage not ending because of fraud or failure to pay premiums; with benefits exhausted without eligibility for any other coverage (to include spouse group plan coverage); with no break in coverage greater than 63 days.  

Costs are high for this coverage.  For instance, at the time this entry is written, a 60 year old, non-smoking female can obtain traditional individual coverage with a $1000 deductible for $739 per month (with a $2500 deductible, $493 per month).  A female smoker will pay $782 for traditional individual coverage with a $1000 deductible and $520 per month with a $2500 deductible.  The non-smoking female will pay $667 for managed care, and the smoking female will pay $704 for the managed care plan.         

Persons who find themselves in the eligibility category can call toll-free 1-877-619-2447 for more information about AHIP or to request an enrollment package.  It is important to be ready to make a decision once continued coverage ends, not only due to the risk of being uninsured, but due to the 63 day limit on break in coverage to qualify for AHIP coverage.  

Welcome to the alaelderlaw blog where we will look at issues of particular relevance to seniors and their caregivers.