Key Elder Law Dollar Amounts – Medicaid / SSI Supplements / Medicare / SS Benefits

Last Updated: 11/29/2022 (unless otherwise noted)

Below are figures for 2023 that are frequently used in the elder law practice, including the figures for spousal impoverishment, penalty divisors, and more, for Virginia, MD, and DC. Medicare premiums and co-pays, Social Security Disability, and Supplemental Security Income are also covered.

Medicaid Figures:

Medicaid is the primary funding source for long-term care for millions of disabled and elderly middle-class Americans, providing vital long-term care coverage to those who qualify for the benefit.

Although the federal government establishes general guidelines for the program, states design, implement, and administer their own Medicaid programs. The federal government matches state expenditures on medical assistance based on the federal medical assistance percentage, which can be no lower than 50 percent. In fiscal year 2019, total Medicaid spending was $616 billion — all of which is of course funded by your tax dollars. If you are smart enough to do legal planning to get some of these tax dollars back to pay for your long-term care when you need it, it’s ethically no different than income tax planning, when you try to get the biggest income tax refund every year.

Virginia/Maryland/DC Medicaid Numbers

Divestment Penalty Divisors (To be Adjusted on July 1, 2023)

Northern Virginia Penalty Divisor: $9,032.00/month – Northern Virginia (Alexandria, Arlington, Fairfax, Falls Church, Loudoun, Manassas, Prince William)
Rest of Virginia Penalty Divisor: $6,422/month
DC Penalty Divisor: $12,731.91/month
Maryland Penalty Divisor: $10,190/month

Individual Resource Allowance

VA: $2,000
DC: $4,000
MD: $2,500

Married Couple Resource Allowance

VA: $4,000
DC: $6,000
MD: 3,000 per spouse; after 6 months, $2,500 per spouse.

Monthly Personal Maintenance Allowance

VA: $40 (Community-Based Care PMA is 165% of SSI Level (rounded up to the nearest dollar, so $1,388 for 2022 based on SSI Level of $841 – click here – M1470.410)
DC: $70
MD: $83

Shelter Standard

VA: $646.50
DC: $646.50
MD: $646.50

Standard Utility Allowance

VA: $402
DC: $345
MD: $431

Medicaid Home Equity Cap

Minimum: $688,000
Maximum: $ 1,033,000.00

Community Spouse Resource Allowance

Minimum Community Spouse Resource Allowance (except in Alaska and Hawaii): $ 29,724
Maximum Community Spouse Resource Allowance (except in Alaska and Hawaii): $148,620

Community Spouse Monthly Maintenance Needs Allowance

Minimum Monthly Maintenance Needs Allowance (except in Alaska and Hawaii): $2,288.75
Maximum Monthly Maintenance Needs Allowance (except in Alaska and Hawaii): $ 3,715.50

For CMS’s complete chart of SSI and Spousal Impoverishment Standards, click here.


SSI Supplements:

Virginia Auxiliary Grant Figures for Assisted Living Facilities:
As of 1/1/2022: Northern Virginia Income Limit: $1,850 (+ $20 income exclusion)
As of 1/1/2022: Rest of Virginia Income Limit: $1,609 (+ $20 income exclusion)
Personal Maintenance Allowance: $82

DC Optional State Supplemental Payment (OSSP) Program for Assisted Living Facilities:
As of 1/1/2022: Income Limit for individuals: $1,501
As of 1/1/2022: Income Limit for married couple: $2,917

Maryland Assisted Living Subsidy:
Recipients must be in need of the nursing home level of care.
Net monthly income may not be higher than 60 percent of the State median income.
The maximum subsidy paid directly to the provider is $1000/month.​
$130/month personal allowance deduction


Veterans Aid and Attendance Figures:

Click here for all Veterans Aid and Attendance Figures and Rules.


Gift and Estate Tax:

Gift Tax Annual Exemption in 2023:  $17,000 (up from $16,000 in 2022)

Gift Tax Lifetime Exemption in 2023:  $12.92 million (up from 12.06 million in 2022)


Medicare:

Medicare is the federal government program that provides health insurance if you are 65+, under 65 and receiving Social Security Disability Insurance (SSDI) for a certain amount of time, or under 65 and with End-Stage Renal Disease (ESRD). Medicare has been protecting the health and well-being of American families and saving lives for five decades.

The Centers for Medicare & Medicaid Services (CMS) recently released the cost-of-living-adjustment of 8.7% in 2022, which is used to determine 2023 premiums, deductibles, and coinsurance amounts for the Medicare programs.

Below are the Medicare amounts and how they have changed for the coming year:

Medicare Part A

Medicare Part A covers primarily inpatient hospital care. Most Medicare beneficiaries (99%) do not pay a premium for Medicare Part A, as long as they have at least 40 quarters of qualifying employment. The Part A inpatient hospital deductible covers beneficiaries’ share of costs for the first 60 days of Medicare-covered inpatient hospital care in a benefit period.

The Medicare Part A inpatient hospital deductible that beneficiaries pay if admitted to the hospital will be $1,600 in 2023, an increase of $44 from $1,556 in 2022. The Part A inpatient hospital deductible covers beneficiaries’ share of costs for the first 60 days of Medicare-covered inpatient hospital care in a benefit period. In 2023, beneficiaries must pay a coinsurance amount of $400 per day for the 61st through 90th day of a hospitalization ($389 in 2022) in a benefit period and $800 per day for lifetime reserve days ($778 in 2022). For beneficiaries in skilled nursing facilities, the daily coinsurance for days 21 through 100 of extended care services in a benefit period will be $200.00 in 2023 ($194.50 in 2022).

2023 Part A premium

No premium – for most beneficiaries who paid into Medicare through payroll taxes.

$278/month in 2023 – for those who worked / paid into Medicare between 7.5 and 10 years (up from $274/month in 2022)
$506/month in 2023 – for those with a work history of less than 7.5 years (up from $499/month in 2022)

2023 Part A deductible

2023: $1,600
2022: $1,556

(Covers up to 60 days in the hospital)

Daily coinsurance for 61st-90th Day

2023: $400
2022: $389

Daily coinsurance for lifetime reserve days

2023: $800
2022: $778

Skilled Nursing Facility coinsurance

2023: $200
2022: $194.50

Deductible is per benefit period, NOT per year. Once a beneficiary has been out of the hospital for at least 60 days, a new benefit period would start if and when they needed to be hospitalized again.

Supplemental coverage, including Medigap plans, will pay some or all of the Part A deductible on your behalf.

Medicare Part B Premiums/Deductibles (2023 Summary)

Medicare Part B covers physician services, outpatient hospital services, certain home health services, durable medical equipment, and certain other medical and health services not covered by Medicare Part A.

Each year the Medicare Part B premium, deductible, and coinsurance rates are determined according to the Social Security Act. The standard monthly premium for Medicare Part B enrollees will be $164.90 for 2023, a decrease of $5.20 from $170.10 in 2022. The annual deductible for all Medicare Part B beneficiaries is $226 in 2023, a decrease of $7 from the annual deductible of $233 in 2022.

The 2022 premium included a contingency margin to cover projected Part B spending for a new drug, Aduhelm, a drug for Alzheimer’s. The FDA approved Aduhelm last year despite an overwhelming vote from the advisory committee that the standard had not been met and many arguing that the drug was too expensive and didn’t work. Medicare later chose to limit coverage of the drug.

Lower-than-projected spending on both Aduhelm and other Part B items and services resulted in much larger reserves in the Part B account of the Supplementary Medical Insurance (SMI) Trust Fund, which can be used to limit future Part B premium increases. The decrease in the 2023 Part B premium aligns with the CMS recommendation in a May 2022 report that excess SMI reserves be passed along to people with Medicare Part B coverage.

Another change is that beginning in 2023, certain Medicare enrollees who are 36 months post kidney transplant, and therefore are no longer eligible for full Medicare coverage, can elect to continue Part B coverage of immunosuppressive drugs by paying a premium. For 2023, the immunosuppressive drug premium is $97.10.

2023 Medicare Part B Premiums by Income

Since 2007, a beneficiary’s Part B monthly premium is based on his or her income. These income-related monthly adjustment amounts affect roughly 7% of people with Medicare Part B. The 2023 Part B total premiums for high-income beneficiaries with full Part B coverage are shown in the following table:

Premiums for high-income beneficiaries with full Part B coverage who are married and lived with their spouse at any time during the taxable year, but file a separate return, are as follows:

2021 Medicare Part D Premium by Income

Since 2011, higher income beneficiaries’ Part D monthly premiums are based on income. These income-related monthly adjustment amounts affect roughly 8% of people with Medicare Part D. These individuals will pay the income-related monthly adjustment amount in addition to their Part D premium. Part D premiums vary from plan to plan and roughly two-thirds of beneficiaries pay premiums directly to the plan, while the remaining beneficiaries have their premiums deducted from their Social Security benefit checks. Regardless of how a beneficiary pays their Part D premium, the Part D income-related monthly adjustment amounts are deducted from Social Security benefit checks or paid directly to Medicare.

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Social Security and Supplemental Security Income

2023 Social Security Changes

More than 70 million people depend on Social Security’s benefit programs, so annual changes to the program and its payouts are always highly anticipated. Substantially higher benefit checks have been a rarity in recent years. Based on the increase in the Consumer Price Index (CPI-W) from the third quarter of 2021 through the third quarter of 2022, Social Security and Supplemental Security Income (SSI) beneficiaries will receive an 8.7% Cost of Living Adjustment (COLA) for 2023! With inflation soaring in 2022, the extra money will help seniors and others make ends meet!

Besides the COLA increase, here are some other positive changes for 2023:

  • Maximum taxable earnings going up: In 2022, the maximum earnings subject to Social Security taxes was $147,000. That is, workers paying into the system are taxed on wages up to this amount, typically at the 6.2 percent rate. In 2023, the maximum earnings will increase to $160,200, meaning more of a worker’s income will be subject to the tax. This adjustment is due to an increase in average wages in the U.S.
  • Maximum Social Security benefit also set to increase: The maximum Social Security benefit for a worker retiring at full retirement age will also increase. It’s important to note that this maximum applies to those retiring at the full retirement age, which is 67 for anyone born after 1960. The maximum will be different for those who retire before the full retirement age, because benefits are reduced in that situation. The same applies for those who retire after the full retirement age, a strategy that can max out your benefit check.
  • Average benefit for spouses and disabled workers is increasing, too: The average benefit will increase across the board in 2023, and that includes benefits for people such as widows, widowers and the disabled.
  • Social Security adjusts earnings test exempt amounts: If you claim your retirement benefits before you hit full retirement age, Social Security will withhold some benefits from your check above certain levels of income. It’s what the program calls the retirement earnings test exempt amounts, and it can claim a serious chunk of your benefits if you’re still working.

Given the huge level of inflation that the U.S. economy has experienced over the last year, it’s not too surprising that Social Security saw one of its largest benefit adjustments ever. But that’s not the only change to the program, as other levels and thresholds have been adjusted to account for surging inflation, too. These are the Social Security Amounts for 2023:

Retirement Earnings Test Exempt Amounts

Under full retirement age*

2023: $21,240/yr. ($1,770/mo.)
2022: $19,560 /yr. ($1,630/mo.)

*One dollar in benefits will be withheld for every $2 in earnings above the limit.

The year an individual reaches full retirement age**

2023: $56,520/yr. ($4,710/mo.)
2022: $51,960/yr. ($4,330/mo.)

Social Security Disability Thresholds

Non-Blind:

2023: $1,470/mo.
2022: $1,350/mo.

Blind:

2023: $2,460/mo.
2022: $2,260/mo.

Maximum Social Security Benefit: Worker Retiring at Full Retirement Age

2023: $3,627/mo.
2022: $3,345/mo.

SSI Federal Payment Standard

Individual:

2023: $914/mo.
2022: $841/mo.

Couple:

2023: $1,371/mo
2022: $1,261/mo.

Estimated Average Monthly Social Security Benefits Payable in January 2023

All Retired Workers:

2023: $1,827/mo.
2022: $1,681/mo.

Aged Couple, Both Receiving Benefits:

2023: $2,972/mo.
2022: $2,734/mo.

Widowed Mother and Two Children:

2023: $3,520/mo.
2022: $3,238/mo.

Aged Widow(er) Alone:

2023: $1,704/mo.
2022: $1,567/mo.

Disabled Worker, Spouse and One or More Children:

2023: $2,616/mo.
2022: $2,407/mo.

All Disabled Workers:

2022: $1,483/mo.
2021: $1,364/mo.

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