When will you be eligible to receive Social Security retirement benefits?
If you were born before 1938, you will be eligible to receive full retirement benefits at the age of 65. Full retirement age is gradually increasing. For people born in 1960 and later, full retirement age is 67. Many people are electing delayed retirement and can get increased benefits if they defer taking Social Security benefits until age 70. You may retire as early as age 62 but your benefits will be permanently reduced based on the number of months you receive checks before you reach full retirement age. Your spouse who is not qualified on his or her own account will qualify for benefits equal to one-half of your full benefit if your spouse begins collection at age 65. If your spouse elects to receive payments at an earlier age (between 62 and 64), the benefit amount is reduced unless your spouse is caring for a child who is either under age 16 or disabled. For more information go to www.ssa.gov/.
Are benefits available for divorced spouses?
If you were married for at least 10 years to a worker who qualifies for Social Security, you may receive benefits based on the Social Security record of your former wife or husband. No payments can be made until both the worker and the divorced spouse are age 62 or older.
What about benefits for widows and widowers?
If a widow or widower is disabled, benefits may begin at age 50. Benefits may begin at any age if the widow or widower is caring for a child who is either under age 16 or permanently disabled. If a widow or widower is neither disabled nor caring for a qualified child, the widow or widower may begin receiving reduced benefits as early as age 60 and full benefits at age 65. In addition, most widows and widowers are eligible for a one-time payment of $255 on the death of their spouse.
How do you apply for Social Security?
You may sign up for benefits either by telephone (800) 772-1213 or in person at any Social Security office. For more information go to www.ssa.gov/.
What is Medicare?
Medicare is the health insurance program available to most people who are age 65 or older. You are eligible at age 65 if you are eligible to receive Social Security or Railroad Retirement benefits, even if you have elected to not begin receiving such benefits, but have worked long enough to be eligible for them (for example, you chose not to receive Social Security at age 62 and your regular retirement age for Social Security is 66), or if you would be entitled to Social Security benefits based on your spouse’s (or divorced spouse’s) work record and that spouse is at least age 62, or if you worked long enough in a federal, state, or local government job to be insured for Medicare. Disabled individuals may qualify for Medicare before their 65th birthday if they have received Social Security disability benefits for 24 months. For more information go to www.medicare.gov/.
What medical expenses are covered by Medicare?
Medicare is divided into four parts. Parts A and B are each designed to pay for a different kind of health care cost. Part A, Medicare Hospital Insurance, helps pay for inpatient care in a hospital or skilled nursing facility, home health care, and hospice care. Medicare Part B helps pay for doctors’ services and many medical services and supplies that are not covered by the Hospital Insurance part of Medicare. Payments may be made under Part B for approved charges for physicians’ services, outpatient hospital and surgery, transportation by ambulance, durable medical equipment, outpatient physical therapy and speech pathology, and other services. All persons who are age 65 and older who are eligible for Social Security or Railroad Retirement cash benefits automatically qualify for Part A. Individuals age 65 or over who do not automatically qualify may individually purchase the Hospital Insurance provided by Part A. Any person who is qualified for Part A coverage will be automatically enrolled in Part B, and a monthly premium will be deducted from their monthly Social Security benefit. Persons who are not automatically covered may voluntarily enroll and make quarterly premium payments.
Part A Hospital services have a deductible and co-insurance payment.
There is also a co-insurance amount for skilled nursing facility cases. There are significant coverage criteria for skilled nursing home care, and there also are limitations on the number of days covered. As a result, nursing home coverage under Medicare is extremely limited.
Individuals covered by Medicare also remain responsible for an annual medical insurance deductible under Part B. After the deductible is met, Medicare generally will pay 80 percent of the approved charges for covered services for the remainder of each year.
Medicare Part C is the Medicare Advantage Program, formerly called Medicare + Choice. In Wisconsin, beneficiaries can choose to receive their Medicare benefits through the original Medicare (Parts A and B) or through a Medicare HMO (Part C) if one is available in the beneficiary’s county. Leaving “fee-for” service Parts A and B to instead select Part C is completely voluntary. Beneficiaries should seek out consumer advice before doing so, by calling the Medigap Helpline, (800) 242-1060 or go to longtermcare.state.wi.us.
Medicare Part D
BIn 2006, Medicare started offering insurance coverage (Medicare Part D) for prescription drugs. Every person with Medicare has a choice of at least two drug plans that cover both brand name and generic drugs.
Costs
Cost structures, including co-pays and deductibles, can vary greatly from plan to plan. If you join a Medicare prescription drug plan you will pay a monthly premium. Costs may be different depending on the drug plan you choose. Drug plans may vary in the prescription drugs covered, how much you have to pay, and the pharmacies you can use. When you join a drug plan, it’s important for you to choose one that meets your needs.
Generally, standard coverage works like this: - you pay a $295 deductible;
- you pay 25 percent of drug costs from $295 to $2,700; Medicare will pay 75 percent;
- you pay 100 percent of drug costs from $2,700 to $6,153.75;
- after your total drug costs reach $6,153.75 and you have paid $4,350 in out-of-pocket costs, you pay 5 percent of any costs above $6,135.75; Medicare will pay 95 percent.
The plans will vary, and often include optional amounts of deductable coverage, and have tax differences depending on any amount of co-insurance or co-payments in your particular planned coverage.
For 2009 the average nationwide monthly premium will be $28, although specific plan costs will vary greatly depending on the plan you choose and where you live. Generally, you will not want to select a plan with low premiums only, but rather look at the overall annual cost per year, including the cost for deductable, co-insurance, and co-payments.
You will have different options and costs depending on whether you have:
a. original Medicare Part A and B with stand alone prescription drug plan or
b. a Medicare advantage plan.
Eligibility and Enrollment
When an individual first becomes eligible for Medicare Parts A or B due to age or disability, he or she is eligible to participate in Medicare Part D. Individuals have a seven month Part D Initial Enrollment Period including the month of benefit eligibility. Thus the Part D Initial Enrollment Period (IEP) begins three months prior to the month of benefit eligibility and ends three months after the month of eligibility. An individual may enroll by contacting the plan sponsor directly or by contacting Medicare at 1-800-MEDICARE (1-800-633-4227) or go online to www.medicare.gov.
Medicare beneficiaries who choose not to participate in the Medicare Part D program when first eligible may be subject to a late enrollment penalty if they later choose to enroll in a Medicare Part D Plan.
Individuals who receive both Medicare and Medicaid benefits are automatically enrolled in a Medicare Part D Plan if they do not proactively choose a Medicare Part D Plan.
Beneficiaries may elect to enroll, disenroll, or switch Part D plans once a year during the annual coordinated election period. The annual coordinated election period for each coverage year runs from Nov. 15 through Dec. 31 of the preceding year. Beneficiaries who are dual–eligible, however, may change their plans at any time of year and as many times as they want per year.
It is important that you join a Medicare prescription drug plan when you are first eligible. If you need Medicare drug coverage, and you don’t enroll in a plan when you are first eligible, you may be required to pay a higher monthly premium.
If you have both Medicare and full Medicaid benefits, Medicare will provide your prescription drug coverage instead of Medicaid. If you had Medicare and full Medicaid benefits and did not choose a plan by Dec. 31, 2005, Medicare enrolled you in one.
If you have a Medigap (Medicare Supplement) policy with drug coverage, you will get a notice from your insurance company telling you whether your policy is as good as or better than Medicare prescription drug coverage. This notice will explain your rights and choices.
If you have prescription drug coverage from an employer or union, your employer or union will notify you about whether your drug coverage is as good as or better than Medicare prescription drug coverage. If it is, you can keep your current drug coverage, and if you decide to join a Medicare prescription drug plan later, your monthly premium won’t be higher. If you drop your current drug coverage and join a Medicare prescription drug plan, you may not be able to get your employer or union drug coverage back.
In most cases, if you are enrolled in a Medicare Advantage Plan (like an HMO or PPO), you will receive your Medicare prescription drug coverage through that plan.
For Additional Information
Each fall, Medicare will mail the Medicare & You handbook, which will list the Medicare prescription drug plans available in each service area. Personalized information to help you find a plan that meets your needs is available at www.medicare.gov or by calling 1-800-MEDICARE, 1-800-633-4227. TTY users should call 1-800-486-2048.
For more information, Wisconsin residents over age 60 can contact the Coalition of Wisconsin Aging Groups (CWAG) at (608) 224-0660 or (800) 366-2990. Seniors in Milwaukee County also can call Legal Action of Wisconsin at (414) 278-1222 or go online to longtermcare.state.wi.us or to CWAG at www.cwag.org/resources/prescription or online at Legal Action of Wisconsin or www.legalaction.org.
When should an individual enroll in Medicare?
Each person who already has begun receiving cash benefits from Social Security, Disability, or Railroad Retirement automatically is enrolled in the Medicare program. If you are otherwise qualified but not receiving cash payments, you may enroll in Medicare through your local Social Security office at any time in the three months before your 65th birthday or at any time in the three months following your 65th birthday. Late enrollment may result in increased premiums.
Is there a state program to help seniors with prescription drugs?
SeniorCare is Wisconsin’s Prescription Drug Assistance Program for Wisconsin residents who are age 65 or older and who meet eligibility requirements. If you need help paying for prescription drugs, SeniorCare can help.
By making prescription drugs more affordable, SeniorCare makes it easier for seniors to obtain the medicine they need for a healthier life.
Eligibility requirements include:
- must be a Wisconsin resident,
- must be age 65 or older,
- must pay a $30 annual enrollment fee per person,
- only income is measured. Assets, such as bank accounts, insurance policies, home property, and so on, are not counted.
All program participants need to pay an out-of-pocket expense. All seniors are subject to certain out-of-pocket expense requirements depending on their annual income. There are different expense requirements and benefits based on your income and your spouse’s income, if your spouse lives with you.
If you think you might be eligible, contact your local aging agency for more information. Or call the SeniorCare Customer Service Hotline at (800) 657-2038 or visit www.dhs.wisconsin.gov/seniorcare (TTY and translation services are available).
What is Medicaid?
Medicaid – in Wisconsin, also known as Medical Assistance or M.A. – is a joint federal and state-run program that provides health coverage to persons with low income and few or no resources. Persons who are qualified for Supplemental Security Income (SSI) automatically qualify for Medicaid. Other individuals who fall into the category of “medically needy” also may qualify. Married individuals who need long-term care services also may qualify for Medicaid under special rules designed to avoid impoverishment of their spouses. Medicaid benefits are much more comprehensive than those under Medicare, both for acute care and long-term care. The Medicaid program encompasses a variety of other benefits, it also includes a variety of other benefit programs that may be available, including but not limited to Badger Care, Family Care, Medicaid purchase plans, and other specific programs or benefits. For more information, you can contact the Wisconsin Department of Health Services, online at www.dhs.wisconsin.gov/medicaid, or you can contact a Benefit Specialist in each county who can assist with people who are having problems in determining or receiving their private or government benefits. More information on the Benefit Specialist Program is available in each county, or online at www.dhs.wisconsin.gov/aging/genage/benspecs.htm.
What is a Durable Power of Attorney?
A Power of Attorney is a document you sign while you are competent that authorizes another person (your “agent”) to act for you. A Durable Power of Attorney allows that person to act even if you later become incompetent. You can create a durable power that will be effective when you sign it or after some triggering event, such as when two physicians state, in writing, that you are not capable of handling your affairs. The second option is called a “springing” power.
Name only someone you absolutely trust to follow your wishes and handle your finances honestly.
What can your agent do?
Depending on what you say in the Power of Attorney document, your agent may be able to sign legal documents in your place, buy and sell real estate for you, pay your bills, and take other financial actions on your behalf. If there is no specific authority to make gifts, the agent may not do so.
What about health care decisions?
Wisconsin law allows you to create a durable Power of Attorney for Health Care. You may use the standard form created by the law, or you may have an attorney write an individualized document for you. Either way, there are specific requirements about how the Power of Attorney for Health Care must be executed, just as there are with a will. In addition, the law restricts who may be your agent and who may be a witness to this document.
Is this Power of Attorney for Health Care the same as a Living Will?
No. A Living Will is a declaration to physicians that you wish life-sustaining procedures or nonorally ingested nutrition and hydration to be withheld or withdrawn if you are in an incurable condition and your death is imminent or if you are in a persistent vegetative state. A Power of Attorney for Health Care appoints an agent to make most decisions related to your health care if and when you are unable to make those decisions yourself. If you specifically grant the power, your agent can decide to withhold or withdraw nonorally ingested nutritional support and fluid maintenance, admit you to a nursing home or community-based residential facility, and make other health care decisions.
If you have both a Living Will and a Power of Attorney for Health Care, the Power of Attorney for Health Care controls if there is any conflict between the two.
You should review your documents periodically to make sure that they are up to date.
What if you become incapacitated and you have not executed powers of attorney?
If you are no longer able to manage your property or care for yourself and you have not signed a Power of Attorney or appointed a financial or a health care agent, any interested individual (for example, a family member, agency, or health-care provider) may petition the court to appoint a guardian to act on your behalf. The guardian will be responsible for managing your financial assets (the “guardian of the estate”) and he or she also may be responsible for decisions related to your care (the “guardian of the person”). A single individual may serve as both guardian of the estate and person, or the court may appoint separate individuals.
How is a guardian appointed?
Any relative, state official, or other person may request that the court appoint a guardian. The person who is alleged to be incompetent must be informed of the petition for appointment of a guardian and of the scheduled time for hearing. The court will appoint a guardian ad litem to interview the individual and others, investigate, and make a recommendation to the court as to whether it is the individual’s best interests to have a guardian. The allegedly incompetent person also has the right to be represented by an attorney.
Where do you get the state forms?
You can get the forms from the Wisconsin Department of Health and Family Services Web site or by sending a stamped, self-addressed business-sized envelope to Living Will/Power of Attorney, Division of Public Health, P.O. Box 309, Madison, WI 53701-0309.
Elder Abuse
Elder abuse may include four distinct categories of abuse of a person who is age 60 or older, including:
a) abuse, including physical abuse, emotional abuse, sexual abuse, treatment without consent, unreasonable confinement, or restraints;
b) financial exploitation, including obtaining money or property by deceit, enticement, force, or compulsion;
c) neglect, including the failure of a caregiver to secure or maintain adequate care; and
d) self neglect, which is the failure of the older person to adequately care for himself or herself.
Wisconsin has a voluntary elder abuse reporting system. Each of Wisconsin’s counties has designated an elder adult at risk agency that provides a helpline.
For more information about the Elder Abuse Reporting Law, you can check www.cwag.org, or call the hotline toll free at 1-800-488-2596.
There is also a caregiver reporting system, which requires that certain facilities, agencies, or organizations must report misconduct committed by a caregiver against a client. More information can be found at www.dhfs.state.wi.us.
Benefit Specialists
Elderly benefit specialists are persons trained to help older people who are having problems with their private or government benefits. Benefit specialists can provide more information, and can suggest alternatives, explain legal actions, advocate on your behalf with other parties, or refer you to an appropriate attorney for legal action when necessary. Benefit specialists can provide assistance with a variety of programs including Medicare and Medicare Part D, Medicare supplemental insurance, SSI and Social Security, Medical Assistance, consumer problems, and a variety of other matters.
The benefit specialist program is supported with funds from the State of Wisconsin and the Federal Older Americans Act. There is no charge for the services. For more information go to www.dhs.wi.gov/aging/genage/benspecs.htm or www.cwag.org/legal/benefit-specialists/.
Burial Instructions
Beginning in 2008, Wisconsin law allows you to designate a representative to control disposition of your remains and to list special wishes you may have. More information is available at www.dhs.wi.gov/forms/advancedirectives, including a link to print the form.
Other Internet Resources of Interest
Veterans Benefits and Services
United States Department of Veterans Affairs, 1-800-827-1000 or www.vba.va.gov
Wisconsin Department of Veterans Affairs, 1-800-947-8387 or www.dva.state.wi.us/benefits
Longterm Care Ombudsman, longtermcare.state.wi.us/home/Ombudsman.htm
Elder Law Section of the State Bar of Wisconsin, www.wisbar.org/sections/elder
National Academy of Elder Law Attorneys, www.naela.org
AARP, www.aarp.org
Medicare Advocacy Center, www.medicareadvocay.org
Last updated: March 2009 |
