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Social Security and Medicare Answer Book, Sixth Edition by David A. Pratt Albany Law School Social Security and Medicare Answer Book, Sixth Edition by David A. Pratt Albany Law School

Social Security and Medicare Answer Book, Ninth Edition

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Social Security and Medicare Answer Book, Ninth Edition, is a comprehensive and accessible resource for attorneys, accountants, estate planners, financial planners, insurance agents, and others who counsel either older Americans or their younger counterparts who are planning for future retirement. It is also an excellent resource for individuals who want to achieve a better understanding of Social Security, Medicare, and Medicaid and how these exceptionally important programs affect them, now or in the future. An understanding of Social Security and Medicare benefits is an essential component of any retirement planning exercise. An informed estimate of the benefits that will be available under these public programs is a prerequisite to any determination of how much income will be required from private retirement programs and personal savings. The recent financial crises and the COVID-19 pandemic have underscored the importance of careful planning for retirement, and the need to understand Social Security and Medicare benefits.

Social Security and Medicare Answer Book addresses the key questions that arise under Social Security and Medicare and covers all developments, including the extensive Medicare and Medicaid changes under the Affordable Care Act (ACA) and subsequent statutory and regulatory developments. The book also includes a description of the most important features of Medicaid and discusses how Medicare and Medicaid benefits are coordinated. At the time of this writing (August 2020), there are no pending bills to “repeal and replace” the ACA, but further attempts to roll back its major provisions can be expected, and the Supreme Court will be hearing oral arguments on the constitutionality of the entire ACA after the November elections. Regulatory actions taken by the Trump administration have significantly affected both Medicare and Medicaid, and the outcome of the elections will have a profound effect on the future of Social Security, Medicare, and Medicaid.

The Ninth Edition of Social Security and Medicare Answer Book brings you up to date on the latest developments, including:

  • Social Security tax rates for employers and employees
  • Updates on the different types of benefits available under Social Security, the methods for calculating each type of benefit and circumstances in which benefits may be lost
  • Updated maximum retirement benefit at full retirement age (FRA) (see Q 5:20) and updated earnings exemption amounts for Social Security recipients below FRA
  • Effect of underreporting self-employment income on Social Security benefits • Description of a recent law (H.R. 4547) intended to strengthen oversight of the Representative Payee Program for beneficiaries who are incapable of managing their Social Security of Supplemental Security Income payments
  • A detailed explanation of the administrative and judicial review processes under Social Security and Medicare, including efforts to reduce backlogs in the appeals process
  • Updated Medicare Part B costs
  • Updated coverage of the eligibility requirements for, and benefits provided under, the four parts of Medicare
  • Coverage of Medicare Secondary Payer reporting, now required for prescription drug coverage
  • Discussion of likely changes to home health care, based on a Proposed Rule [CMS-1730-P]
  • Telehealth coverage under Medicare Part B
  • Discussion of recent regulations and rulings from the Internal Revenue Service, the Social Security Administration, and the Centers for Medicare and Medicaid Services, as well as a discussion of recent case law (throughout the 2021 Supplement).
  • Cost-of-living adjustments to Medicare premiums, co-payments, and deductibles
  • Description of the Executive Order on Protecting and Improving Medicare for Our Nation’s Seniors
  • Discussion of the “windfall elimination provision”
  • Unintended effect of Social Security coverage on tax deduction related to Health Savings Accounts
  • Discussion of likely changes to home health care, based on Proposed Rule CMS-1730-P
  • Legislation and regulatory actions taken in response to the COVID-19 pandemic, including guidance on health care coverage of testing and treatmentsrelated to the virus
  • Legislation and regulatory actions taken in response to the COVID-19 pandemic, including guidance on health care coverage of testing and treatments related to the virus
  • Notices from the Social Security Administration and Centers for Medicare & Medicaid Services detailing changes to key figures for 2021.

Note: Online subscriptions are for three-month periods.

Pages 990
Last Updated 05/03/2021
Update Frequency Semi-annually
Product Line Wolters Kluwer Legal & Regulatory U.S.
ISBN 9781543834970
SKU 10087297-7777
Publish Frequency Annually
Product Line Wolters Kluwer Legal & Regulatory U.S.
SKU 000000000010048359
Table of Contents
  • 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?
    • Conclusion
  • 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
    • Religious Denominations
    • Employees of Nonprofit Organizations
    • Hospital Interns
    • Student Nurses
    • Domestic Workers
    • Nonbusiness or Casual Employment
    • Farmers and Agricultural Labor
    • Students Working for a College or College Club
    • Distributors and Vendors of Newspapers or Magazines
    • Employees of the District of Columbia
    • Government Volunteer Programs
  • 3. Social Security Taxes and Earnings
    • Tax and Income Apportionment
    • Employers and Employees
    • Wages
    • Cash-Pay Test
    • Domestic Workers
    • Agricultural Workers
    • Nonprofit Organizations
    • 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
    • Proof of Entitlement
  • 6. Entitlement for Disability
    • Determining Disability
    • Earnings Records
    • 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
    • Initial Determination
    • Reconsideration
    • Hearing Before an Administrative Law Judge
    • Representatives’ Fees
    • Review by the Appeals Council
    • Applicable Law
    • Reopening a Decision
    • Reimbursement of Travel Expenses
    • Review by Federal District Court
  • 9. Loss of Benefits
    • Retirement Test
    • Excess Earnings
    • Death of a Beneficiary
    • Recipients of Dependent’s or Survivor’s Benefits
    • Types of Earnings Under the Retirement Test
    • Substantial Services Test
    • 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
    • Redeterminations
    • Reconsiderations
    • Reopenings
    • Expedited Access to Judicial Review
    • ALJ Hearings
    • Applicability of Medicare Coverage Policies
    • 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 Advantage Plans
    • Medicare Advantage Plans
    • Types of Plans and Procedures
    • Election of Plans and Termination of Enrollment
    • Benefits and Services
    • Premiums
    • Information About Medicare Advantage
    • 2010 Health Care Reform Legislation
  • 18. The Medicare Part D Prescription Drug Program
    • The Part D Prescription Drug Benefit
    • Prescription Drug Discount Cards and Transitional Assistance
    • Prescription Drug Coverage Under Part B
  • 19. Medicare Exclusions
    • General Exclusions
    • Services Provided to Specific Groups
    • Specific Services
    • Additional Covered Items and Services
    • Exclusion of Program Abusers
    • Medical Errors
  • 20. Medicare Supplemental (Medigap) Insurance
    • Benefit Plans
    • Choosing a Medigap or Other Policy
    • Cost of Medigap
    • Medicare SELECT
    • Open Enrollment
    • Regulating the Sale of Medigap Insurance
    • Filing and Payment of Claims
    • Protections for Consumers/Beneficiaries
    • Protections Against Loss of Medigap Coverage
    • Medigap Coverage and the Medicare Part D Drug Benefit
    • Private Contract
  • 21. Other Recent Medicare Changes
    • 2008 and 2009Medicare Legislation
    • 2010 Legislation
    • Medicare Part A
    • Early Retirees
    • Health Care Quality Improvement
    • Medicare Advantage
    • Medicare Supplement (Medigap) Policies
    • Medicare Part D
    • Medicare Part B Premiums
    • The Independent Medicare Advisory Board
    • Protection of Benefits
    • Preventive Services
    • Dual Eligible Beneficiaries
    • Accountable Care Organizations
  • Table of Cases
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