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Is Medicare Means-tested Public Benefit

A Variation In Premium Categories Over Time

Medicare Coverage and Payment of Virtual Services

Because each subsequent yearâs Part B and Part D premiums are based on a new yearâs income tax return, there is no guarantee that a household will remain in the same premium category over time. shows the transition matrix between premium categories in adjacent waves from 2006â2014, when income reported in the prior year had implications for the Part B premium. Because showed that over 90% of respondents are in the first category in each year, it is not surprising that the probability of staying in that category two years later is about 97%. The other 3% have increases in premiums that range from 40% to over 200% . For the premium categories in which an income-related premium is being charged, the probabilities of staying in the same category are much lower, ranging from 17 to 29%. The most likely outcome in all cases is that those paying an income-related premium will not be paying that income-related premium in two years, with even 43% of those in the highest premium category falling to the lowest category.

Table 4.

Transition Matrix between Medicare Part B Premium Categories, 2006â2014

Premium Category in Current Year Premium Category in the Next Survey Wave
12.90 28.57

Authorâs tabulations from the Health and Retirement Study, 2006â2014. The sample includes all respondents who are receiving health insurance through Medicare in the survey year. Observations are weighted using respondent weights. A total of 43,746 pairs of respondent-years are tabulated.

Public Income Support Cuts Poverty Nearly In Half

Public income support in the United States comes from programs that are not limited to people with low incomes, such as Social Security and unemployment insurance, and from means-tested programs, which are targeted by income. The means-tested programs include traditional income assistance, such as that provided by the Temporary Assistance for Needy Families and Supplemental Security Income programs, and near-cash benefits, such as food assistance and housing subsidies, which are not provided in cash but are used to pay regular monthly bills. Certain tax credits, such as the Earned Income Tax Credit , are also means-tested.

TABLE 1: Public Benefits Examined in this Report

Income Supports

  • Rental Assistance

Refundable Tax Credits

  • Child Tax Credit

Veterans Payments

To examine the combined effect of these programs, we analyzed Census Bureau data on families disposable income that is, their incomes after subtracting income and payroll taxes and adding all cash income assistance, food assistance, housing subsidies, and energy assistance benefits. This analysis accounts for all of the public benefits listed in Table 1, including cash payments, tax credits, and near-cash assistance. An analysis of Census data for 2003 shows that:

The Impact Of Sponsorship On Eligibility

Under the 1996 welfare and immigration laws, family members and some employers eligible to file a petition to help a person immigrate must become financial sponsors of the immigrant by signing a contract with the government . Under the enforceable affidavit , the sponsor promises to support the immigrant and to repay certain benefits that the immigrant may use.

Congress imposed additional eligibility restrictions on immigrants whose sponsors sign an enforceable affidavit of support. When an agency is determining a lawful permanent residents financial eligibility for TANF, SNAP, SSI, nonemergency Medicaid, or CHIP, in some cases the law requires the agency to deem the income of the immigrants sponsor or the sponsors spouse as available to the immigrant. The sponsors income and resources are added to the immigrants, which often disqualifies the immigrant as over-income for the program. The 1996 laws imposed deeming rules in certain programs until the immigrant becomes a citizen or secures credit for 40 quarters of work history in the U.S.

Domestic violence survivors and immigrants who would go hungry or homeless without assistance are exempt from sponsor deeming for at least 12 months. Some programs apply additional exemptions from the sponsor-deeming rules. The U.S. Department of Agriculture has issued helpful guidance on the indigence exemption and other deeming and liability issues.

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Public Benefits: Easing Poverty And Ensuring Medical Coverage

When individuals and families experience crises such as job loss, illness, disability, or divorce, they may face the prospect of falling into poverty and losing health insurance coverage. Various government assistance programs are designed to lessen these hardships. These programs also provide support when families work but have low earnings and when people reach retirement age.

An examination of Census data shows that as a whole, the U.S. public benefits system, sometimes referred to as the safety net, has the following effects on poverty and health insurance status.

  • It cuts the number of Americans living in poverty almost in half.
  • It reduces the severity of poverty for those who remain poor. Without these programs, these families would have average disposable income equal to 29 percent of the poverty line. With the programs, their average income rises to 57 percent of the poverty line.
  • It provides health care coverage to tens of millions of individuals who otherwise would be uninsured.

There are two principal categories of public benefit programs those that provide benefits regardless of income and those that limit assistance to people with low or modest incomes. The first category of programs includes the major social insurance programs such as Social Security, unemployment insurance, and Medicare. Programs in the second category are often referred to as means-tested programs.

Vi Analysis Of Means Testing In The Affordable Care Act

Health Insurance

An important method of achieving nearly universal health insurance coverage through the ACA was to provide premium tax credits to individuals and families with incomes below 400% of the FPL, as defined by the Department of Health and Human Services each year. uses the HRS to track the percentage of the population between ages 50 and 62 who would have been eligible for premium tax credits from 2002 to 2014. The columns refer to different sample groups, depending on whether the respondent is working or not and separating out those who are uninsured from the full sample.

Table 6.

Across all respondents, about 41% were in households below 400% of their FPL from 2002 to 2008 before a noticeable jump in 2010 and later that reflects the impact of the Great Recession. Over those prerecession years, about 31% of working respondents and about 63% of nonworking respondents were below this threshold. Focusing next on just those who are currently without insurance from any source, about 75% are below 400% of the FPL, with about two-thirds of working respondents and over 80% of nonworking respondents having income below the threshold. After the Great Recession, all percentages are 5â7 percentage points higher. These high percentages suggest that, at least among those age 50â62 without insurance, more than three out of four will have enhanced opportunities to obtain coverage in any given year.

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How Do I Apply

Most people who apply for benefits do not need to apply in person. Texas has an online application for state benefits at YourTexasBenefits.com, or call 2-1-1 to find the office nearest you.

To apply for the Texas Womens Health Program, go to TexasWomensHealth.org or call 800-335-8957.

To apply for Social Security benefits, go toSSA.gov or apply in person to your local Social Security office. To find the office nearest you, visit the SSA website or call 2-1-1.

B Health Insurance Premium Tax Credits

The ACA established for the first time a formal system of premium support for individuals who purchase their health insurance through newly established state-level health insurance marketplaces. The premium support functions as a limit on the amount that an individual or family would have to pay for an insurance premium as a percentage of their annual income, implemented through premium tax credits. The income levels that determine eligibility for, and the amounts of, the premium tax credits are based on multiples of the FPL. The FPLs in 2016, which are the basis for premium levels in 2017, were $11,880 for an individual, $16,020 for a couple, and $24,300 for a family of 4.

Table 2.

Health Insurance Premiums as a Share of Income under ACA Premium Subsidies in 2017

Multiple of the Federal Poverty Level Premium as a Share of Income Implicit Tax Rate
9.69 9.69

Internal Revenue Service Instructions for Form 8962 for 2017, available at ., and Kaiser Family Foundation .

The implicit marginal tax rate over a range from X% to Y% of the FPL, where the premium as a share of income varies from a% to b% of income, is /. For adults in states that do not offer Medicaid coverage up to 100% of the FPL, the introduction of the premium subsidies at 100% of the FPL provides an incentive to earn income at that level, that is, a negative implicit tax rate.

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A Defining Medicare Average Earnings

Lifetime earnings subject to the Social Security payroll tax are already used to calculate Social Security benefits. The linking of health insurance or Medicare premiums to income could be based on an analogous concept of lifetime earnings subject to Medicare payroll tax, which could be termed the Medicare Average Earnings . Social Security benefits are based on the Average Indexed Monthly Earnings , which is the average of an individualâs highest 35 years of annual earnings subject to the Social Security payroll tax , with each year indexed for the growth in economy-wide covered wages until the year the worker reaches 60 years of age. The tax base for Medicare differs from that of Social Security. It includes employment not covered by Social Security, particularly some state and local government jobs. Since 1991, it has also included earnings above the Social Security maximum taxable earnings limit. The maximum taxable earnings subject to the Medicare tax was eliminated in 1994, after equaling the Social Security maximum prior to 1991 and exceeding the Social Security maximum from 1991 to 1993. As a starting point, the MAE could be the AIME , with earnings defined as those subject to the Medicare tax rather than only those subject to the Social Security tax. The MAE could be pooled across spouses for couples, matching this feature of current, taxable income for married couples who file a joint return.


A Affidavit Of Support

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The new affidavit is legally enforceable against the sponsor by the alien and by federal and state governments which provide any means-tested benefits, but not later than 10 years after an alien last receives any such benefit. The affidavit is enforceable with respect to means-tested benefits until the sponsored alien attains citizenship or accumulates 40 qualifying quarters.

The Affidavit was released by INS on October 20, 1997, as part of an Interim Rule with Request For Comments , and was effective December 19, 1997.

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Will Getting Health Insurance Through Medicaid Chip Or Health Insurance Marketplaces Affect An Individuals Ability To Obtain Lawful Permanent Resident Status Or Citizenship

Some people who apply for a green card or a visa to enter the U.S. must pass a public charge test which looks at whether the person is likely to become primarily dependent on the federal government as demonstrated by the use of cash assistance programs for income maintenance or government-funded institutionalized long-term care. In making this determination, immigration officials consider certain factors in their totality, including a persons age, family status, income and resources, health, education or skills, and their sponsors affidavit of support or contract. If immigration officials determine that a person is likely to become a public charge in the future, they can deny that person permission to come to the U.S. or deny their application for a green card or lawful permanent resident status.

This information is based on analysis of federal regulations and is not legal advice. Get help deciding what is best for your family and consult with an immigration attorney if you can. You can use this online directory to search for local nonprofit organizations that provide legal help and advice:

Are Affidavits Of Support Enforceable

It depends on which type of affidavit the sponsor signed. There are two major types of affidavits. The nonenforceable affidavit of support , which was the main form used before December 19, 1997, is still used by some immigrants. The enforceable affidavit of support has been used since December 19, 1997. It is a binding contract by the sponsor for support of the immigrant and potentially for repayment of certain benefits received by the immigrant.

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Vi Affidavits Of Support And Attribution Of Income

Prior to the new welfare statute, affidavits of support signed for sponsored immigrants were not legally enforceable and time-limited deeming of sponsor income occurred in only three programs: SSI, Food Stamps, and AFDC. The new welfare statute requires a legally binding affidavit of support to be executed by a sponsor on behalf of most aliens seeking admission to the U.S., in order to establish that an alien is not excludable as a public charge. The statute requires sponsor-to-alien deeming procedures under programs providing Federal means-tested benefits until the immigrant with the new affidavit becomes a citizen, or has been credited with 40 qualifying quarters of coverage, and permits deeming for any State public benefits.

Fear Of Being Considered A Public Charge

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The immigration laws allow officials to deny an application for lawful permanent residence or to deny a noncitizen entry into the U.S. if the authorities determine that the person is likely to become a public charge. In deciding whether an immigrant is likely to become a public charge, immigration or consular officials review the totality of the circumstances, including the persons health, age, income, education and skills, employment, family circumstances, and, most importantly, the affidavits of support.

The Trump administration attempted to alter this policy dramatically by issuing rules that made it much more difficult for low- and middle-income families to immigrate, and that profoundly exacerbated the chilling effect on access to services. Multiple courts found that the rules were likely unlawful. The Biden administration dismissed the appeals of these decisions, allowed an order vacating the DHS rule to take effect, and formally withdrew the prior administrations DHS public charge rule.

Despite the restoration of longstanding public charge policy, widespread confusion and concern about the public charge rules remains, deterring many eligible immigrants and their US citizen family members from seeking critical services.

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When Can A Green Card Holder Access Medicare

LPRs who have been in the United States for five years are normally eligible to receive Medicare. This form of medical coverage is intended for people who are over the age of 65 or have certain qualifying disabilities. There are several different types of Medicare, including:

  • Part A, which covers major procedures such as hospitalizations or surgeries
  • Part B, which covers outpatient benefits such as doctor’s office visits, lab work, X-rays, and so on
  • Part C, which combines components of Part A and B and adds coverage for vision, dental, and more, and
  • Part D, which covers prescription medications.

Americans or LPRs who have worked 40 credit hours do not need to pay for Medicare Part A. However, if you are an LPR who has lived in the U.S. for five years but has not worked long enough to qualify, you can purchase Medicare Part A coverage and pay a monthly premium .

Both citizens and LPRs need to pay for Medicare parts B, C, and D.

Protect Your Clients Government Benefits And Preserve Settlement Proceeds

During the settlement process, a personal injury attorney needs to consider what government/public benefits their client is enrolled in and what they may be eligible for in the future. Several questions need to be asked. Have you considered Medicares interest in the settlement? How will the settlement proceeds be handled? Will a lump sum payment disqualify them from their government benefits? These questions need to be addressed because a clients settlement could have long-lasting financial implications.
When it comes to settling a case with public benefits there are many nuances to consider. Hiring a team of experts such as an Elder and Special Needs Law Attorney, a Structure Settlement Broker, a Medicare Set-Aside Allocator, and/or a Trust Advisor can assist you in protecting your clients benefits and preserving the settlement proceeds.

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Other Types Of Benefits And Programs For The Unemployed

Educational Help

Federal agencies offer many unemployment education and training programs. They are generally free or low cost to the unemployed.

Self-Employment Help

Self-employment assistance programs help unemployed workers start their own small businesses. Delaware, Mississippi, New Hampshire, New York, and Oregon offer this program.

Can Green Card Holders Receive Supplemental Nutrition Assistance Program Benefits

Medicare 101

SNAP is a federal program that provides money to states so that they can help people with limited income to purchase food. People who qualify for SNAP receive electronic debit cards for use in purchasing groceries .

Permanent residents under 18 years of age may qualify for SNAP benefits. In most cases, an LPR who is older than 18 will qualify for SNAP only after having credit for 40 quarters of work in the United States.

As with TANF, the “deeming rules” described above might result in ineligibility.

Some states have programs to supply food benefits instead of SNAP to LPRs who do not qualify for SNAP benefits.

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