Social Security and Medicare Answer Book, Fourth Edition

Social Security and Medicare Answer Book provides the specific guidance you need so you can ensure your clients receive maximum benefit under the law. Get answers to vital questions such as:

• Does the 2010 health care reform legislation change the benefits under Part B?
• How has the Social Security Administration revised the disability determination process?
• What is the amount of an individual's Social Security benefit?
• Does my client need insurance to supplement Medicare?
• Does Medicare cover long-term care?
• What level of retirement income will be needed to supplement Social Security?
• At what point are benefits lost if an individual continues to work beyond retirement age?
• And many more!

Social Security and Medicare Answer Book contains separate, in-depth sections devoted to:

• Social Security: You'll find detailed explanations of the types of benefits available, who qualifies, how to apply, and what to do if you are denied benefits. You'll learn how to calculate benefits and when and how benefits may be lost.
• Medicare Part A: You'll find detailed explanations of the coverage and rules for each of the categories covered under Part A, namely, inpatient hospital care, skilled nursing facilities, home health services, and hospice care.
• Medicare Part B: You'll get full details on the specific services covered under Part B, including outpatient and partial hospitalization, home health services, nurse-midwife services, dental/eye care services, mental health services, and prescription drugs.
• Medicare Advantage: Sometimes called Medicare Part C (formerly Medicare + Choice), you'll get in-depth explanations of the expanded range of choices potentially available to Medicare beneficiaries including provider-sponsored organizations, private fee-for-service plans, and medical savings accounts.
• Medicare Part D: Learn the details of the best known feature of the sweeping Medicare reforms providing for the voluntary prescription drug program.

Social Security and Medicare Answer Book has been updated to include:

• An updated Introduction, including the current financial status for Social Security and Medicare and the future outlook for both
• Social Security account statements
• Electronic payment of benefits
• Reduction of FICA taxes for 2011
• Final rules about claiming Social Security retirement benefits and then suspending payments
• Updated average monthly Social Security benefit payments
• Demonstration project for alternative test for being insured for disability benefits
• Final rules on stepchild's benefits
• Regulations for improving the disability determination process
• Rules finalized regarding time and place of administrative law judge hearings
• Income-based premiums for Medicare Part B
• MMSEA Section 111 Mandatory Reporting GHP User Guide
• Time frame under health care reform for filing Medicare benefits claim for fee-for-service services
• Final rule for review of end-stage renal disease determinations
• Proposed rule regarding providing beneficiaries with written contact information for QIOs and state agencies
• Medicare Advantage program proposed rule, capitation rates, and CMS annual Call Letter
• Annual coordinated election period
• Medicare Advantage regulations as a result of health care reform legislation
• Changes to the coverage gap for Part D plans
• Income-related monthly adjustment for enrollees in Part D plans
• Legal challenges to the Patient Protection and Affordable Care Act
• Multi-payer Advanced Primary Care Practice Demonstration Project
• New section on Accountable Care Organizations
• Updated premium and benefit amounts, statistics, cases, and regulations throughout

• Introduction
  • Social Security
  • Medicare
  • The Financial Condition of Social Security
  • The Financial Condition of Medicare
  • The Outlook for the Future
  • Reform Proposals
  • How Big Is the Social Security Financing Problem
• 1. Overview of the Social Security System
  • Function and Operation of the Social Security System
  • Social Security Benefits
• 2. Coverage Under the Social Security Act
  • Overview of Coverage
  • Defining Employer and Employee
  • Self-Employment Coverage
  • Officers, Directors, Partners, and Stockholders
  • Direct Sellers, Traveling Salespeople, and Commission Drivers
  • Manufacturers' Representatives
  • Life Insurance Agents
  • Crews on Fishing Boats
  • Railroad Employees
  • Foreign Students and Other Nonimmigrant Aliens
  • Members of the U.S. Uniformed Armed Forces
  • Federal Government Employees
  • Family Employment
  • State and Local Government Employees
  • Domestic Workers
• 3. Social Security Taxes and Earnings
  • Tax and Income Apportionment
  • Employers and Employees
  • Wages
  • Domestic Workers
  • Tips
  • Self-Employment Income
• 4. Benefits Programs
  • Retirement Benefits
  • Disability Benefits
  • Benefits for Dependents
  • Survivor's Benefits
  • The American Recovery and Reinvestment Act of 2009
• 5. Application for Benefits and Proof of Entitlement
  • Application for Benefits
  • Calculating Benefit Payment Amounts
  • Evidence for Benefits
• 6. Entitlement for Disability
  • Determining Disability
  • Evidentiary Requirements
  • Resumed Employment and Benefit Termination
  • Ticket to Work Act
• 7. Payment of Benefits
  • Calculation of Benefits
  • Maximum Family Benefit
  • Procedures for Payment of Benefits
  • Persons Who Can Receive Payments
  • Benefits Under Foreign Social Security Systems
  • Procedures for Payment of Benefits
  • The American Recovery and Reinvestment Act of 2009
• 8. Administrative Review Process
  • Hearing Before an Administrative Law Judge
  • Representatives' Fees
  • Review by the Appeals Council
  • Review by Federal District Court
• 9. Loss of Benefits
  • Retirement Test
  • Excess Earnings
  • Recipients of Dependent's or Survivor's Benefits
  • Earnings of Insurance Agents
• 10. Introduction to Medicare
  • How Medicare Works
  • The Four Parts of Medicare
  • Coverage and Claims
  • Obtaining Information
• 11. Eligibility for Medicare
  • Part A
  • Part B
• 12. Medicare Secondary Payer Rules
  • Other Insurance
  • Group Health Plans
• 13. Medicare Claims and Appeals
  • General Rules
  • Rules Relating to Part A Claims
  • Rules Relating to Part B Claims
  • Rules Relating to Medicare HMOs
  • Rules Relating to Medicare Advantage Organizations
  • Health Privacy
  • Additional Requirements Under ERISA
  • Rules Under the 2003 Medicare Legislation
  • Revised Rules Under the 2005 and 2009 CMS Regulations
  • General Rules Under the 2005 and 2009 CMS Regulations
  • Initial Determinations
  • ALJ Hearings
  • Medicare Appeals Council Review
  • The Recovery Audit Contractor (RAC) Program
  • Claims and Appeals Under the Medicare Advantage Program (Part C of Medicare)
  • Claims and Appeals Under the Medicare Prescription Drug Program (Part D of Medicare)
• 14. Medicare Financing
  • Financing of Medicare Part A
  • Financing of Medicare Part B
• 15. Benefits Under Medicare Part A
  • Inpatient Hospital Care
  • Skilled Nursing Facility Care
  • Home Health Services
  • Hospice Care
• 16. Benefits Under Medicare Part B
  • Specific Services Covered
  • Other Services
  • Paying for Services
• 17. Medicare Exclusions
  • General Exclusions
  • Services Provided to Specific Groups
  • Specific Services
  • Additional Covered Items and Services
  • Medical Errors
• 18. Medicare Supplemental (Medigap) Insurance
  • Benefit Plans
  • Choosing a Medigap or Other Policy
  • Cost of Medigap
  • Open Enrollment
  • Filing and Payment of Claims
  • Protections Against Loss of Medigap Coverage
  • Medigap Coverage and the Medicare Part D Drug Benefit
  • Private Contract
• 19. Medicare Advantage Plans
  • Types of Plans and Procedures
  • Election of Plans and Termination of Enrollment
  • Benefits and Services
  • Premiums
  • Information About Medicare Advantage
• 20. Changes Enacted by the 2003 Medicare Legislation and Subsequent Laws
  • The Part D Prescription Drug Benefit
  • Prescription Drug Coverage Under Part B
  • Enrollment in Part B
  • Medicare Advantage and Competition
  • Medicare Services
  • Medicare Administration
  • Medicare Appeals
  • Medigap Policies
  • Studies and Reports
  • Financial Impact
  • 2008 and 2009 Medicare Legislation
• Medicare Changes Under the 2010 Health Care Reform Legislation
  • The 2010 Legislation
  • Medicare Part A
  • Early Retirees
  • Health Care Quality Improvement
  • Medicare Advantage
  • Medicare Supplement (Medigap) Policies
  • Medicare Part D
  • The Independent Medicare Advisory Board
  • Protection of Benefits
  • Preventative Services
  • Dual Eligible Beneficiaries