Your Estate (Large or Small) Is Worth the Human Interaction

Thursday, April 28, 2011

It Doesn’t Have To Cost A Lot

Today a gentleman called our office looking for a quote on a simple will. He had called various other offices in town, and he was feeling discouraged by the high prices they wanted to charge him. In fact, one firm quoted him a whopping $1600 for a simple will!

This man easily could have decided on one of several courses of action at that point: give up, realizing he was priced out of the peace of mind this type of planning can provide, or try to go at it himself with tools available from the Internet, stores, and untrained associates.

A Modern Trend: Going It Alone

People are turning to online and store-bought (or “canned”) estate planning tools (wills, powers of attorney, and even trusts) in higher numbers. To a large extent, these documents do a fair job of protecting a person’s assets. But there are several advantages of going through an attorney, even for the simplest estate planning processes.

The Human Obligation

It must first be understood that when you call an attorney’s office, you are calling a human being who has various interests, which include a desire to gain your business, an ethical obligation to advise you fully, and — hopefully — a personal motivation to do good by you. Admittedly, the attorney is not in business to feel good, but rather to make a living. I call this the human “obligation.”

Using an online service such as www.legalzoom.com will not provide you with the human element of motivation to get things right. Instead, those services rely on the knowledge you are able to gain in your late-night Google searches to piece together your estate plan. If you know exactly what you’re doing, then you will not have any trouble. But if you are doubtful, talk to a knowledgeable estate attorney’s office. They will have ideas that are personalized to your unique situation, and no computer can offer that.

The Human Interaction

Second, estate planning is a very “human” practice. As opposed to litigation or even family law, this is not a practice where paperwork and pleadings are passed from one side of the adversarial “v.” to the other (i.e. Smith v. Johnson), like a heated tennis match. Rather, estate planning is an intimate process where the client expresses her greatest hopes, dreams, and desires, and the attorney helps the client find ways to accomplish them.

Third, consulting with an attorney can help you accomplish goals that are creative and altruistic. Alan Augulis, estate planning attorney, recently published an online article called “The Human Side Of Estate Planning”. His ideas are instructive and thought-provoking:

“Protecting and then maximizing the assets that you intend to pass along to your loved ones certainly is important, but your worth as a human being cannot measured on a spreadsheet.

“And by the same token, that worth cannot be imparted to the people that you love in a purely financial manner. Yet, once you are gone you are gone and you will no longer be there to provide your family members with one-on-one guidance or leadership by example.

“Until they perfect that cryogenics thing there is not much any of us can do about our mortality, but you can plan your estate in a creative manner that has instructive value. One tool that you can use that can potentially help to paint a picture worth a thousand words is the incentive trust.

“When you create an incentive trust you name a beneficiary as you would with any trust, but you attach stipulations that must be met before distributions from the trust are made. These vehicles are often used to guide a younger heir toward education, or to lure a loved one away from destructive behavior. But incentive trusts could be used for another purpose as well.

“You could choose to require a loved one to complete some form of community service as a stipulation of the trust. If you were to carefully choose the specific service in an effort to expose this family member to one of life’s realities that they may not otherwise experience it could have a profound positive impact on this person at a very deep level.

“In the end, your beneficiary may well gain a layer of depth of character to match the added financial security that you have provided. Such an approach may not on the surface seem to be universally necessary or appropriate. But you would be hard pressed to find a single individual who could not benefit from an experience of giving that lied outside of his or her comfort zone.”

Adapted from http://augulislawfir … ide-estate-planning/

It’s Worth Your Time

I am glad that gentleman called our office today. I quoted him a much lower figure for a simple will and powers of attorney for health care and asset management. It became clear to me right away that this man had limited means, but he wants to protect his precious, simple assets and make sure they end up in the right hands. And he didn’t want a lot of complication or expense.

If you want a human being to help you plan your estate to accomplish your deepest hopes and desires, then please call Farrell, Fraulob & Brown at (916) 442-5835.

Q&A: The Social Security Administration Appeals Council

Friday, April 22, 2011

Q: What is the “APPEALS COUNCIL”?

A: The Appeals Council is the administrative appeal body within the Social Security Administration that is responsible for reviewing the decisions of the Administrative Law Judges. They are responsible for handling appeals of Administrative Law Judge decisions and handle reviews of decisions on their OWN motion.

Q: What does it mean to be ‘Reviewed by the Appeals Council’ on its OWN Motion?

A: Most people don’t realize that even if you get approved by an Administrative Law Judge for benefits, that decision is subject to review by the Appeals Council. In any judicial process, every judge must answer to a judge who is higher than he/she. The Appeals Council reviews all decisions (randomly) to ensure that the judges are rendering the proper decision.

Q: What happens after this review by the “Appeals Council”?

A: Four things can happen after their review.
One, the Appeals Council can determine that the Judge made the right decision.
Two, the Appeals Council can determine that the Judge made a PARTIALLY right decision and send the decision back to the Judge to correct it.
Three, the Appeals Council can determine that the Judge made a wrong decision and send the decision back to the Judge to correct it.
Four, the Appeals Council can make its own decision and not send the case back to the judge.

Q: If the Appeals Council pulls the case for review on its own, how long do they have to make a decision?

A: Typically, the AC will indicate that they must make their decision within 110 days. During those 110 days, your ability to obtain any benefits approved by the SSA will be held until they make their decision.

Q: How long after getting a Favorable decision from SSA will you have to wait in order to determine if the AC will pull it for review?

A: The AC can pull a case for review at any time. However, the AC recognizes that people have waited for a long time to obtain benefits so they tend to move quickly in making their decision.

Q: What happens after 110 days if they haven’t made their decision?

A: After 110 days, the claimant has the option of requesting the SSA to go ahead and process their favorable decision from the Administrative Law Judge. This way, the claimant can receive their benefits while waiting for their review from the AC.

Q: Can the AC reject the ALJ decision and take the benefits back?

A: It is possible. If the AC determines that the ALJ was wrong and sends the case back to the ALJ, the ALJ can reverse his/her decision. Unfortunately, this means that you may have to reimburse Social Security for any benefits that you may have obtained.

Q: What if the Judge denies my case, can I appeal to the AC?

A: The AC is the final administrative decision maker. If the judge denies your case, the next level is to ask for a Review of the Judge’s decision with the AC.

Q: How long will it take to get a decision from the AC regarding my appeal of my denial from the judge?

A: Unfortunately, this question doesn’t have a simple answer. Most people don’t realize that the Appeals Council handles decisions for the entire country. As a result, it takes a while (6 to 12 months) for the Appeals Council to make their decision.

Q: If the AC denies my appeal, is that the end of my case?

A: No, you can file a Civil Action in the United States District Court. In essence, you would be suing the Social Security Administration for getting the decision.

The Social Security processes can confusing. Call (916) 442-5835 if you have been denied SSDI benefits.

Tags: administrative appeals judge, administrative law judge, appeals council, civil action, continuing disability review, favorable decision, fully favorable decision, partially favorable decision, social security administration, unfavorable decision, united states district court

(adapted from http://legalbeat.an … y-favorable-decision)

Benefits, Benefits, Benefits: Sorting It All Out

Thursday, April 14, 2011

Most people are utterly confused — and for good reason — about all the different kinds of income and benefits available from the workplace and the government. It is a tangled web of information, bureaucracy, and headache.

The following should help you understand the basics of each type of income replacement benefits.

SSDI - Social Security Disability Insurance

Social Security Disability Insurance pays benefits to you and certain members of your family if you are “insured,” meaning that you worked long enough and paid Social Security taxes. Independent contractors should pay Social Security taxes to qualify for this benefit.

After receiving these benefits for 2 years, you automatically qualify for Medicare. Your checks will be reduced to cover the Medicare share of cost. If you would rather not receive Medicare benefits, you must notify the Social Security Administration.

SSDI benefits are subject to an offset for any other income received. For example, if you are receiving TD benefits (see below), then you will not receive your full SSDI benefit per the TD offset, under what is referred to as the “80% rule”. This rule simply means that your combined benefits from SSDI/SSI/SDI/TD/PD cannot exceed 80% of your highest regular pre-disability earnings in the last 3 months (1 quarter) preceding your disability.

http://www.ssa.gov/dibplan/index.htm

SSI - Supplemental Security Income

Supplemental Security Income pays benefits based on financial need. It is designed to help aged, blind, and disabled people, who have little or no income; and it provides cash to meet basic needs for food, clothing, and shelter. It is not meant to be a primary or sole source of income; hence the term “supplemental”.

A person receiving SSI is eligible to continue working without jeopardizing SSI benefits, provided the other income is below a certain amount, and provided the person has limited resources. California allows a person to make $1000 per month of other income without affecting SSI benefits.

http://www.ssa.gov/ssi/

SDI - State Disability Insurance

Are you out of work due to a non-industrial injury, illness, or pregnancy related condition? Disability Insurance (DI) provides partial wage replacement to eligible workers who are unable to work because of a disability.

Disability is defined as any mental or physical illness or injury which prevents you from performing your regular or customary work according to California Unemployment Insurance Code, Section 2626.

The Disability Insurance Branch of the California Employment Development Department (EDD) administers three disability insurance plans:

State Plan. The majority of employees in California are covered by this plan, and most of the information provided on the Disability Insurance portion of this site pertains to the State Plan.

Voluntary Plan. This is a private plan that employers and employee groups may apply to EDD for approval of a Voluntary Plan if the majority of employees and the employer agree to do so. If covered by a Voluntary Plan, the provisions of this site may not apply to you. Obtain information about your coverage and file a voluntary plan claim through your employer.

Elective Coverage. Employers and self–employed persons, including general partners, individuals in family employment not subject to the California Unemployment Insurance Code may elect coverage. For additional information on Elective Coverage or to apply for Elective Coverage, contact the Elective
Coverage Unit at 916-654-6288.

http://www.edd.ca.go … bility_insurance.htm

Unemployment Insurance - Employment Development Department (EDD)

The Unemployment Insurance Program, commonly referred to as UI, provides weekly unemployment insurance payments for workers who lose their job through no fault of their own. The UI program is 100% funded by employers who pay taxes on wages paid to employees.

http://www.edd.ca.go … ployment/default.htm

TD - Temporary Disability

Temporary disability is a benefit payable if a job-related injury or illness results in an inability to work for more than 3 calendar days. In cases where hospitalization is required, the employee is disabled as a result of a criminal act of violence or, the loss of time exceeds 14 days, temporary disability is paid for the first three days. The waiting period starts the first day following the date of injury. No charge is made for absence on the day of injury.

The waiting period need not consist of consecutive days. Portions of days of absence for doctor’s appointments or because the employee is unable to work subsequent to date of injury may be accumulated to full days and charged to the waiting period.

Most disabled state employees qualify for Industrial Disability Leave. See SAM Section 2583.11. Industrial Disability Leave may be paid in lieu of temporary disability. In many cases the disabled, sate employee will be able to choose between Industrial Disability Leave or temporary disability with or without supplementation by their leave credits. Those disabled employees who qualify for and choose temporary disability are allowed to use any accrued sick leave, vacation time, or excess time credits to make up the difference between the temporary disability payments and normal salary. (Government Code Section 19863.) The maximum weekly temporary disability payment is $266 for injuries occurring on or after January 1, 1990.

Hours lost subsequent to a full work release for such things as routine doctor’s appointments or therapy may not be accumulated and reported to the State Fund as full days lost for purposes of temporary disability. However, under certain conditions, employees may qualify for temporary partial disability payments. See SAM Section 2583.12.

The benefit normally ceases when the employee returns to work or the medical condition has stabilized. See SAM Section 2583.10 for an exception to this rule.

http://sam.dgs.ca.go … /TOC/2500/2583.1.htm

PD - Permanent Disability

When the injured’s condition has stabilized (the treating physician says it will get no better nor worse), the employee may be entitled to permanent disability payments.

Permanent disability payments are due if there are lasting effects from the job-related injury or illness. Permanent disability payments are not supplemented with leave credits.

If an employee is released from temporary disability compensation and starts receiving permanent disability compensation, then he/she may still be able to return to work at his/her prior position. This decision is based upon the medical restrictions placed upon the individual by the treating physician in the final report. If an employee receiving permanent disability is not able to return to work, the department is required to initiate one of the actions outlined in Government Code 19991.4.

Medicare

The Centers for Medicare & Medicaid Services (CMS) administers Medicare, the nation’s largest health insurance program, which covers nearly 40 million Americans. Medicare is a Health Insurance Program for people age 65 or older, some disabled people under age 65, and people of all ages with End-Stage Renal Disease (permanent kidney failure treated with dialysis or a transplant).

Medicare consists of four parts: A, B, C, and D.

Part A

Medicare Part A (Hospital Insurance)

What Is Part A (Hospital Insurance)?
Part A is hospital insurance that helps cover inpatient care in hospitals, skilled nursing facility, hospice, and home health care.

How Much Does Part A Cost?
Most people don’t pay a Part A premium because they paid Medicare taxes while working. This is called “premium-free Part A.”

If you aren’t eligible for premium-free Part A, you may be able to buy Part A if you meet one of these conditions:

You’re 65 or older, you’re entitled to (or enrolling in) Part B, and you meet the citizenship or residency requirements.
You’re under 65, disabled, and your premium-free Part A coverage ended because you returned to work. (If you’re under 65 and disabled, you can continue to get premium-free Part A for up to 8.5 years after you return to work.)
In most cases, if you choose to buy Part A, you must also have Part B and pay monthly premiums for both. If you have limited income and resources, your state may help you pay for Part A and/or Part B.

How Do I Get Part A?
Some people automatically get Part A. Learn how and when you can sign up for Part A.

What Does Part A Cover?
To find out if Part A covers something specific, visit Your Medicare Coverage. In general, Part A covers:

Inpatient care in hospitals (such as critical access hospitals, inpatient rehabilitation facilities, and long-term care hospitals)
Inpatient care in a skilled nursing facility (not custodial or long term care)
Hospice care services
Home health care services
Inpatient care in a Religious Nonmedical Health Care Institution
Note: Staying overnight in a hospital doesn’t always mean you’re an inpatient. You’re considered an inpatient the day a doctor formally admits you to a hospital with a doctor’s order. Being an inpatient or an outpatient affects your out-of-pocket costs. Always ask if you’re an inpatient or an outpatient. Read “Are You a Hospital Inpatient or Outpatient? If You Have Medicare – Ask!” for more information.

http://www.medicare. … benefits/part-a.aspx

Part B

What Is Part B (Medical Insurance)?
Part B helps cover medically-necessary services like doctors’ services, outpatient care, home health services, and other medical services. Part B also covers some preventive services. Check your Medicare card to find out if you have Part B.

How Much Does Part B Cost?
If you have Part B, you pay a Part B premium each month. Most people will pay the standard premium amount. Social Security will contact some people who have to pay more depending on their income. If you don’t sign up for Part B when you are first eligible, you may have to pay a late enrollment penalty.

How Do I Get Part B?
Some people automatically get Part B. Learn how and when you can sign up for Part B.

What Does Part B Cover?
To find out if Part B covers something specific, visit Your Medicare Coverage. Part B covers two types of services:

Medically-necessary services — Services or supplies that are needed to diagnose or treat your medical condition and that meet accepted standards of medical practice.
Preventive services — Health care to prevent illness (like the flu) or detect it at an early stage, when treatment is most likely to work best.

http://www.medicare. … benefits/part-b.aspx

Part C

What is a Medicare Advantage Plan (Part C)?
A Medicare Advantage Plan (like an HMO or PPO) is another Medicare health plan choice you may have as part of Medicare. Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by private companies approved by Medicare.

If you join a Medicare Advantage Plan, the plan will provide all of your Part A (Hospital Insurance) and Part B (Medical Insurance) coverage. Medicare Advantage Plans may offer extra coverage, such as vision, hearing, dental, and/or health and wellness programs. Most include Medicare prescription drug coverage (Part D).

Medicare pays a fixed amount for your care every month to the companies offering Medicare Advantage Plans. These companies must follow rules set by Medicare. However, each Medicare Advantage Plan can charge different out-of-pocket costs and have different rules for how you get services (like whether you need a referral to see a specialist or if you have to go to only doctors, facilities, or suppliers that belong to the plan for non‑emergency or non-urgent care). These rules can change each year.

Different Types of Medicare Advantage Plans
Health Maintenance Organization (HMO) Plans
Preferred Provider Organization (PPO) Plans
Private Fee-for-Service (PFFS) Plans
Special Needs Plans (SNP)
There are other less common types of Medicare Advantage Plans that may be available:

HMO Point of Service (HMOPOS) Plans— An HMO plan that may allow you to get some services out-of-network for a higher cost.
Medical Savings Account (MSA) Plans—A plan that combines a high deductible health plan with a bank account. Medicare deposits money into the account (usually less than the deductible). You can use the money to pay for your health care services during the year.
How Much Does a Medicare Advantage Plan Cost?
In addition to your Part B premium, you usually pay one monthly premium for the services included. Each Medicare Advantage Plan can charge different out of-pocket costs. Your out-of-pocket costs in a Medicare Advantage Plan depend on:

Whether the plan charges a monthly premium.
Whether the plan pays any of your monthly Part B premium.
Whether the plan has a yearly deductible or any additional deductibles.
How much you pay for each visit or service (copayments or coinsurance).
The type of health care services you need and how often you get them.
Whether you follow the plan’s rules, like using network providers.
Whether you need extra benefits and if the plan charges for them.
The plan’s yearly limit on your out-of-pocket costs for all medical services.
What Does a Medicare Advantage Plan Cover?
In all types of Medicare Advantage Plans, you’re always covered for emergency and urgent care. Medicare Advantage Plans must cover all of the services that Original Medicare covers except hospice care. Original Medicare covers hospice care even if you’re in a Medicare Advantage Plan. Medicare Advantage Plans aren’t supplemental coverage. Medicare Advantage Plans may offer extra coverage, such as vision, hearing, dental, and/or health and wellness programs. Most include Medicare prescription drug coverage (Part D).

How Do I Get a Medicare Advantage Plan?
Not all Medicare Advantage Plans work the same way, so before you join, take the time to find and compare Medicare Health Plans in your area. Once you understand the plan’s rules and costs, you may be able to join by completing a paper application, calling the plan, or enrolling on the plans website. Medicare also has information on quality to help you compare plans.

A Few Extra Things You Should Know about Medicare Advantage Plans
New—Making changes to your coverage after December 31 Between January 1–February 14, 2011, if you’re in a Medicare Advantage Plan, you can leave your plan and switch to Original Medicare. If you switch to Original Medicare during this period, you will have until February 14 to also join a Medicare Prescription Drug Plan to add drug coverage. Your coverage will begin the first day of the month after the plan gets your enrollment form.

During this period, you can’t do the following:

Switch from Original Medicare to a Medicare Advantage Plan.
Switch from one Medicare Advantage Plan to another.
Switch from one Medicare Prescription Drug Plan to another.
Join, switch, or drop a Medicare Medical Savings Account Plan.
As with Original Medicare, you still have Medicare rights and protections, including the right to appeal.
Check with the plan before you get a service to find out whether they will cover the service and what your costs may be.
You must follow plan rules, like getting a referral to see a specialist or getting prior approval for certain procedures to avoid higher costs. Check with the plan.
You can join a Medicare Advantage Plan even if you have a pre existing condition, except for End-Stage Renal Disease.
You can only join a plan at certain times during the year. In most cases, you’re enrolled in a plan for a year.
If you go to a doctor, facility, or supplier that doesn’t belong to the plan, your services may not be covered, or your costs could be higher, depending on the type of Medicare Advantage Plan.
If the plan decides to stop participating in Medicare, you‘ll have to join another Medicare health plan or return to Original Medicare.

http://www.medicare. … benefits/part-c.aspx

Part D - Prescriptions

Medicare prescription drug coverage is insurance run by an insurance company or other private company approved by Medicare. There are two ways to get Medicare prescription drug coverage:

Medicare Prescription Drug Plans. These plans (sometimes called “PDPs”) add drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private Fee-for-Service (PFFS) Plans, and Medicare Medical Savings Account (MSA) Plans.

Medicare Advantage Plans (like an HMO or PPO) are other Medicare health plans that offer Medicare prescription drug coverage. You get all of your Part A and Part B coverage, and prescription drug coverage (Part D), through these plans. Medicare Advantage Plans with prescription drug coverage are sometimes called “MA-PDs.”
If you decide not to join a Medicare drug plan when you’re first eligible, and you don’t have other credible prescription drug coverage, you will likely pay a late enrollment penalty.

How Much Does Medicare Prescription Drug Coverage Cost?
Each plan can vary in cost and drugs covered. The Medicare Drug Plan Finder can help you find and compare plans in your area.
Your Part D monthly premium could be higher based on your income. This includes Part D coverage you get from a Medicare Prescription Drug Plan, or a Medicare Advantage Plan or Medicare Cost Plan that includes Medicare prescription drug coverage. If your modified adjusted gross income as reported on your IRS tax return from 2 years ago (the most recent tax return information provided to Social Security by the IRS) is above a certain amount, you will pay a higher monthly premium. For more information, visit Social Security’s website.

Many people qualify to get Extra Help paying their Medicare prescription drug costs but don’t know it. Most who qualify and join a Medicare drug plan will get 95% of their costs covered. Don’t miss out on a chance to save. Extra Help and other programs (like Medicare Savings Programs) may help make your health care and prescription drug costs more affordable.

How Do I Get Medicare Prescription Drug Coverage?
To join a Medicare Prescription Drug Plan, you must have Medicare Part A or Part B. To join a Medicare Advantage Plan, you must have Part A and Part B. You must also live in the service area of the Medicare drug plan you want to join.

Remember, costs and coverage varies with each plan. Check out the Medicare Drug Plan Finder can help you find and compare plans in your area. Medicare also has information on quality to help you compare plans.

If you have employer or union coverage, call your benefits administrator before you make any changes, to before you sign up for any other coverage. If you drop your employer or union coverage, you may not be able to get it back. You also may not be able to drop your employer or union drug coverage without also dropping your employer or union health (doctor and hospital) coverage. If you drop coverage for yourself, you may also have to drop coverage for your spouse and dependants.

Once you choose a Medicare drug plan, you may be able to join by completing a paper application, calling the plan, or enrolling on the plan’s Web site or on the Medicare Drug Plan Finder. You can also enroll by calling 1-800-MEDICARE (1-800-633-4227). TTY users should call 1‑877-486-2048. When you join a Medicare drug plan, you will have to provide your Medicare number and the date your Part A and/or Part B coverage started. This information is on your Medicare card. Note: Medicare drug plans aren’t allowed to call you to enroll you in a plan. Call 1-800-MEDICARE to report a plan that does this.

How Does My Other Insurance Work with Medicare Drug Coverage?
If you have other insurance, find it below to understand how it works with, or is affected by, Medicare prescription drug coverage.

Employer or Union Health Coverage
This is health coverage based on your, your spouse’s, or other family member’s current or former employment. If you have prescription drug coverage based on employment, the employer or union will notify you each year to let you know if your drug coverage is creditable. Keep the information you get.
If you join a Medicare drug plan, you, your spouse, or your dependants may lose your employer or union health coverage. Call your benefits administrator for more information before making any changes to your coverage.

COBRA
This is a Federal law that may allow you to temporarily keep employer or union health coverage after the employment ends or after you lose coverage as a dependent of the covered employee.

There may be reasons why you should take Part B instead of COBRA. However, if you take COBRA and it includes creditable prescription drug coverage, you will have a special enrollment period to join a Medicare drug plan without paying a penalty when the COBRA coverage ends. Talk with your State Health Insurance Assistance Program (SHIP) to see if COBRA is a good choice for you.

Medigap (Medicare Supplement Insurance) Policy with Prescription Drug Coverage
Medigap policies are no longer sold with prescription drug coverage, but if you have drug coverage under a current Medigap policy, you can keep it. But you may want to join a Medicare drug plan instead, because most Medigap drug coverage isn’t creditable.
If you join a Medicare drug plan, your Medigap insurance company must remove the prescription drug coverage under your Medigap policy and adjust your premiums. Call your Medigap insurance company for more information.

The types of insurance listed below are all considered creditable prescription drug coverage. If you have one of these types of insurance, in most cases, it will be to your advantage to keep your current coverage.

Federal Employee Health Benefits Program (FEHBP)
If you join a Medicare drug plan, you can keep your FEHBP plan, and your plan will let you know who pays first. For more information, contact the Office of Personnel Management at 1-888-767-6738, or visit the Office of Personnel Management website. TTY users should call 1-800-878-5707. You can also call your plan if you have questions.

Veterans Benefits
You may be able to get prescription drug coverage through the U.S. Department of Veterans Affairs (VA) program. You may join a Medicare drug plan, but if you do, you can’t use both types of coverage for the same prescription. For more information, call the VA at 1-800-827-1000, or visit the VA website. TTY users should call 1-800-829-4833.

TRICARE (Military Health Benefits)
Most people with TRICARE who are entitled to Part A must have Part B to keep TRICARE prescription drug benefits. If you have TRICARE, you aren’t required to join a Medicare drug plan. If you do, your Medicare drug plan pays first, and TRICARE pays second. If you join a Medicare Advantage Plan with prescription drug coverage, TRICARE won’t pay for your prescription drugs. For more information, call the TRICARE pharmacy contractor at 1 877 363 8779, or visit the TRICARE website. TTY users should call 1-877-540-6261.

Indian Health Services
If you get prescription drugs through an Indian health pharmacy, you pay nothing and your coverage won’t be interrupted. Joining a Medicare drug plan may help your Indian health provider with costs, because the drug plan pays part of the cost of your prescriptions. Talk to your benefits coordinator - they can help you choose a plan that meets your needs and explain how Medicare works with your health care system.

http://www.medicare. … benefits/part-d.aspx

Medicaid / MediCal

Medi-Cal is California’s Medicaid program. This is a public health insurance program which provides needed health care services for low-income individuals including families with children, seniors, persons with disabilities, foster care, pregnant women, and low income people with specific diseases such as tuberculosis, breast cancer or HIV/AIDS. Medi-Cal is financed equally by the State and federal government.

To see if you qualify, or to apply for MediCal, please click on the following link: http://www.dhcs.ca.g … es/MCIndividual.aspx[/code][/code][/code]

SSI for Children: Why and How

Thursday, April 7, 2011

This past week, we have received a larger-than-normal number of inquiries regarding Supplemental Security Income (SSI) for children. The following information will explain why SSI benefits are paid to minors, and how to apply for them.

WHY DO MINORS RECEIVE SSI BENEFITS?

Children can receive Supplemental Security Income (SSI) from birth through age 18 if they have a qualifying disability that is expected to last at least a year or result in death. Just as with adult SSI benefits, SSI for children is intended to supplement a child’s income when income and resources are low enough to qualify.

According to the Social Security Administration (SSA) website, www.ssa.gov, a state agency makes the determination whether the child qualifies for benefits. Various states have differing standards of disability and qualifying income levels. For example, in California, the qualifying household income (Substantial Gainful Activity, or SGA) of a single person in 2011 is $1000 per month.

Work Opportunities for Young People Who are Getting SSI
Many young people who get SSI disability benefits want to work. The following information may be helpful.

SSA does not count most of a child’s earnings when they figure the SSI payment. SSA counts even less of a child’s earnings if the child is a student.

SSA subtracts the cost of certain items and services that a child needs to work from his or her earnings in figuring the SSI payment.

If a child is age 15 or older, he or she can establish a Plan to Achieve Self-Support (PASS). With a PASS, a child can set aside income for a work goal. SSA will not count this income when they figure the SSI payment.

A child’s Medicaid coverage can continue even if his or her earnings are high enough to stop SSI payment, as long as the earnings are under a certain amount.

Social Security has two programs that can assist young people who get SSI disability benefits and want to go to work:

* Work Incentives Planning and Assistance (WIPA)
* Protection and Advocacy for Beneficiaries of Social Security (PABSS) program.[/i]

Your local Social Security office can provide more information about these programs. You can also find more information on our Work website, www.socialsecurity.gov/work/.

HOW TO APPLY FOR CHILDREN’S SSI

The process for applying for SSI on behalf of a minor is the same as for an adult applying for SSI. Please refer to this link for more information: http://ssa.gov/pubs/11000.html#part2

Facebook and Twitter Posts Can (And Will) Be Used Against You!

Thursday, March 31, 2011

You may not realize it, but an army of insurance claims adjusters and court staffers are silently perusing the social networks (Facebook, MySpace, Twitter, and a host of others) for evidence that you are not disabled. They look for text and pictures that depict you as being healthy and active, at least more so than you claimed when you filed your case.

For example, a photograph depicting you on a jet ski will not bode well for your claim that your spinal injury keeps you from working. However, it might be a photo you added yesterday of a ski trip from 10 years ago. The person looking at your profile may not know that your skiing days are long gone, because the only date the viewer sees is yesterday’s date.

Some people are rather flippant about the seriousness of this issue. For example, one injured worker with a pending claim wrote the following and posted it to www.workerscompinsurance.com:

“Myself, I always just accepted that they would be veiwing my Facebook page, I would if I were them. But, I do see a couple holes in it; 1) There is no way they could justify obtaining your password for any reason. Just make the claim that you have had corespondance w/ your At or doctor via the private message function within your page. 2) I may post a picture today of me snowboarding that was taken 10 yrs. ago and if they wanna make something of it I invite. I will then embarras them. 3) These sites are predominately designed for entertainment w/ all the little fantasy games that are played on these sites etc… Anything I may post (comments, doctered pics etc…) lends itself to my personal entertainment and doesn’t have to true or “a matter of fact”. There are no legal or moral obligations that say I can’t skew facts for myself, as long as I don’t cause damage to anyone else etc… 4) Alot of people are relying entirely on sites like Facebook for their everyday e-mails and some other functions that a standard e-mail account would provide. It’s free and really not that much different from having a Yahoo account. You can share pics, blog, invite friends, all from a Yahoo account. So there is not reason why someone can’t justify using a Facebook page for their everyday corespondance to the rest of the world. I don’t doubt for a second that they will be allowed to view a lage part of these sites for their discovery, but I think at some point limitations will be imposed…”

http://www.workersco … r-Workers-Comp.-Case

This writer makes four flawed arguments.

1. Passwords are required to view your personal information on a social network.
Wrong! It is not entirely clear why a person would justify using Facebook to communicate with her doctor. It is true that social media allow the user to send and receive emails through their portals, but that system is quite similar to any other email provider, in that the inbox is password-protected, and no one but the sender and receiver are allowed to view the correspondence. Caution is advised when the posts are viewable by third parties. Anyone can post anything they like on their webpages, but that also means anyone can access what is in the public online view.

2. You can embarrass the insurance company or Social Security Administration
Wrong again! There is no way to embarrass a company or organization, because these entities have no feelings. You might attempt to embarrass a person, but that person alone is not the opposing party. Your online, public presence is documented, duplicable, and perfectly admissible against you. What your pictures from 10 years ago say is that you posted them yesterday. Unless you are wearing your aunt’s leg warmers from the 1980s, there will be no verifiable proof on the webpage of when the picture was taken.

3. Social networking sites are primarily used for entertainment.
Wrong a third time! In the first argument, the writer claims to be communicating with her doctor regarding important treatment issues through Facebook. Such an activity is not entertaining to the average person, unless that person is aspiring to a career in medicine and is not actually suffering from the effects of an illness or injury. Social media are what the user makes of them. Their flexibility and adaptability to the user are what makes them so pervasive in our “connected” society. Incidentally, it is possible to block your Facebook page from anyone not in your circle of friends by adjusting the privacy settings. But that is not a guarantee that your private content is safe.

4. Using Facebook for email is not different from using Yahoo or its equivalents.
Except it IS different! Facebook and other social media are designed to allow multiple channels of communication, email being only one such channel. For many people, the lines between the various methods of communicating become blurry, increasing the chance that you might inadvertently post your “private” email in a “public” place. The moral of the story is, use social media for being social, and use email to send and receive emails.

If you have a pending claim for benefits either on a workers’ compensation case or with the Social Security Administration, you should use common sense and plenty of caution when it comes to social media. Adjust your privacy settings. Be selective with the photos you choose to share. Tell the truth. Do what your mom taught you — “honesty is the best policy” — and you should be okay.

SSI for Adults: Who Qualifies and How

Thursday, March 24, 2011

WHO

(Kids can get SSI too. A separate blog post will discuss SSI benefits for children.)

Supplemental Security Income (SSI) is a federal benefit that makes monthly payments to adults who have low income and few resources and are:

*Age 65 or older;
*Blind; or
*Disabled.

The Social Security Administration (SSA) manages the SSI program. Even though Social Security manages the program, SSI is not paid for by Social Security taxes. SSI is paid for by U.S. Treasury general funds, not the Social Security trust funds.

Income
Income is money you receive such as wages, Social Security benefits and pensions. Income also includes such things as food and shelter. The amount of income you can receive each month and still get SSI depends partly on where you live. The current income limit in California is $1,000 per month.

Social Security does not count all of your income when they decide whether you qualify for SSI. For example, they do not count:

*The first $20 a month of most income you receive;
*The first $65 a month you earn from working and half the amount over $65;
*Food stamps;
*Shelter you get from private nonprofit organizations; and
*Most home energy assistance.

If you are married, they also include part of your spouse’s income and resources when deciding whether you qualify for SSI. If you are younger than age 18, they include part of your parents’ income and resources. And, if you are a sponsored noncitizen, they may include your sponsor’s income and resources.

If you are a student, some of the wages or scholarships you receive may not count.

If you are disabled but work, Social Security does not count wages you use to pay for items or services that help you to work. For example, if you need a wheelchair, the wages you use to pay for the wheelchair do not count as income when SSA decides whether you qualify for SSI.

Also, Social Security does not count any wages a blind person uses for work expenses. For example, if a blind person uses wages to pay for transportation to and from work, the wages used to pay the transportation cost are not counted as income.

If you are disabled or blind, some of the income you use (or save) for training or to buy things you need to work may not count.

Resources (things you own)
Resources that SSA counts in deciding whether you qualify for SSI include real estate, bank accounts, cash, stocks and bonds.

You may be able to get SSI if your resources are worth no more than $2,000. A couple may be able to get SSI if they have resources worth no more than $3,000. If you own property that you are trying to sell, you may be able to get SSI while trying to sell it.

Social Security does not count everything you own in deciding whether you have too many resources to qualify for SSI. For example, they do not count:

*The home you live in and the land it is on;
*Life insurance policies with a face value of $1,500 or less;
*Your car (usually);
*Burial plots for you and members of your immediate family; and
*Up to $1,500 in burial funds for you and up to $1,500 in burial funds for your spouse.

Other rules you must meet
To get SSI, you must live in the U.S. or the Northern Mariana Islands and be a U.S. citizen or national. In some cases, noncitizen residents can qualify for SSI.

If you are eligible for Social Security or other benefits, you should apply for them. You can get SSI and other benefits if you are eligible for both.

If you live in certain types of institutions, you may get SSI.

If you live in a city or county rest home, halfway house or other public institution, you usually cannot get SSI. But there are some exceptions.

If you live in a publicly operated community residence that serves no more than 16 people, you may get SSI.

If you live in a public institution mainly to attend approved educational or job training to help you get a job, you may get SSI.

If you live in a public emergency shelter for the homeless, you may get SSI.

If you live in a public or private institution and Medicaid is paying more than half the cost of your care, you may get a small SSI benefit.

HOW

If you are applying for SSI, you can complete a large part of your ­application by visiting the Social Security Administration website at www.socialsecurity.gov. You also can call them toll-free at 1-800-772-1213 to ask for an appointment with a Social Security representative.

Parents or guardians usually can apply for blind or disabled children under age 18. In some cases, other third parties can apply for children.

You should bring certain items when you apply. Even if you do not have all of the things listed below, apply anyway. The people in the Social Security office can help you get whatever is needed. Please bring:

*Your Social Security card or a record of your Social Security number;
*Your birth certificate or other proof of your age;
*Information about the home where you live, such as your mortgage or your lease and landlord’s name;
*Payroll slips, bank books, insurance policies, burial fund records and other information about your income and the things you own;
*The names, addresses and telephone numbers of doctors, hospitals and clinics that you have been to, if you are applying for SSI because you are disabled or blind;
*Proof of U.S. citizenship or eligible noncitizen status.

You also should bring your checkbook or other papers that show your bank, credit union or savings and loan account number so SSA can deposit you benefits directly into your account. Direct deposit protects benefits from loss, theft and mail delay. The money is always on time and ready to use without making a trip to the bank.

A note for people who are blind or disabled

If you work, there are special rules to help you. You may be able to keep getting SSI payments while you work. As you earn more money, your SSI payments may be reduced or stopped, but you may be able to keep your Medicaid coverage.

You also may be able to set aside some money for a work goal or to go to school. In this case, the money you set aside will not reduce the amount of your SSI.

Blind or disabled people who apply for SSI may get free special services to help them work. These services may include counseling, job training and help in finding work.

Attorneys do not typically represent applicants in the initial application stage, because 1) the process is straightforward and all information requested in the application is known to the applicant or easily obtained by the applicant, and 2) attorneys cannot collect a fee for the initial application preparation unless paid out-of-pocket by the applicant.

However, attorneys (like us) do assist applicants on appeals of denied benefits in the reconsideration process and/or a hearing before an Administrative Law Judge.

Right to appeal

If you disagree with a decision made on your claim, you can appeal it. The steps you can take are explained in Your Right To Question A Decision Made On Your Supplemental Security Income (SSI) Claim (Publication No. 05-11008).

You have the right to be represented by an attorney or other qualified person of your choice. More information is in Your Right To Representation (Publication No. 05-10075).

The above information is available also at: http://ssa.gov/pubs/11000.html.

If you have received a letter denying your SSI benefits, please call (916) 442-5835 to discuss your case. Our attorneys have a combined 80+ years of experience in assisting injured and disabled persons get the benefits they deserve.