Key Elder Law Dollar Amounts – Medicaid / Auxiliary Grant / Medicare / SS Benefits

Last Updated: 11/22/2019 (unless otherwise noted)

Below are figures for 2020 that are frequently used in the elder law practice, including the figures for Virginia Medicaid spousal impoverishment, Medicare premiums and co-pays, Social Security Disability, and Supplemental Security Income.

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.

When it comes to key dollar amounts, the amounts that changed in July 2019 are denoted below:
Virginia/Maryland/DC Medicaid Numbers
Every July, states publish the figures to be used when determining Medicaid eligibility for a married couple, and the limits on income that can be kept by an individual or the well spouse remaining in the home. This year’s figures are as follows:

Divestment Penalty Divisors

Northern Virginia Penalty Divisor: $9,032.00 – Northern Virginia (Alexandria, Arlington, Fairfax, Falls Church, Loudoun, Manassas, Prince William)
Rest of Virginia Penalty Divisor: $6,422
DC Penalty Divisor: $12,803.91
Maryland Penalty Divisor: $9,125

Individual Resource Allowance
VA: $2,000
DC: $4,000
MD: $2,500

Married Couple Resource Allowance
VA: $3,000
DC: $7,000
MD: $3,000.00 each for first 6 months – $2,500.00 each after 6 months, $2,500 each (if separate rooms or facilities)

Monthly Personal Income Allowance for Nursing Home Residents
VA: $40
DC: $70
MD: $82

Shelter Standard
VA: $617.25
DC: $609
MD: $618

Standard Utility Allowance
VA: $303
DC: $305
MD: $420

Medicaid Home Equity Cap
Minimum: $585,000
Maximum: $878,000

Community Spouse Resource Allowance
Minimum Community Spouse Resource Allowance (except in Alaska and Hawaii): $25,284
Maximum Community Spouse Resource Allowance (except in Alaska and Hawaii): $126,420

Community Spouse Monthly Maintenance Needs Allowance
Minimum Monthly Maintenance Needs Allowance (except in Alaska and Hawaii): $2,113.75
Maximum Monthly Maintenance Needs Allowance (except in Alaska and Hawaii): $3,160.50

For CMS’s complete chart of the 2019 SSI and Spousal Impoverishment Standards, click here.

Virginia Auxiliary Grant Figures and Facilities:
Effective July 1, 2019: Northern Virginia: $1,486
Effective July 1, 2019: Rest of Virginia: $1,292
Personal Needs Allowance throughout the State: $82

List of Assisted Living Facilities that Accept Virginia Auxiliary Grant

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

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.

On November 8, 2019, the Centers for Medicare & Medicaid Services (CMS) released the 2020 premiums, deductibles, and coinsurance amounts for the Medicare programs. The announcement came following the Social Security Administration set a 1.6% cost-of-living adjustment to benefits in 2020.

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.

Below are the numbers that have changed for the coming year:

Medicare Deductibles, Premiums and Co-pays

Medicare Part A Deductible
2020: $1,408 deductible for each benefit period
2019: $1,364 deductible for each benefit period

Medicare Part A Premium
If you are one of the small number of people who don’t qualify for free Part A coverage and decide to purchase it on your own, you’ll pay:
2020: $458 each month
2019: $437 each month

Co-payment for hospital stay, days 61-90
2020: $352 per day
2019: $341 per day

Co-payment for hospital stay, days 91 and up
2020: $704 per day
2019: $682 per day

Co-payment for skilled nursing facility stay, days 21-100
2020: $176 per day
2019: $170.50 per day

Medicare Part B Premiums/Deductibles (brief 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 premiums, deductibles, and copayment rates are adjusted according to the Social Security Act. For 2020, the Medicare Part B monthly premiums and the annual deductible are higher than the 2019 amounts. The standard monthly premium for Medicare Part B enrollees will be $144.60 for 2020, an increase of $9.10 from $135.50 in 2019. The annual deductible for all Medicare Part B beneficiaries is $198 in 2020, an increase of $13 from the annual deductible of $185 in 2019.

The increase in the Part B premiums and deductible is largely due to rising spending on physician-administered drugs. These higher costs have a ripple effect and result in higher Part B premiums and deductible.
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Social Security and Supplemental Security Income

Based on the increase in the Consumer Price Index (CPI-W) from the third quarter of 2018 through the third quarter of 2019, Social Security and Supplemental Security Income (SSI) beneficiaries will receive a 1.6 percent COLA for 2020. Other important 2020 Social Security information is as follows:

Retirement Earnings Test Exempt Amounts

Under full retirement age*
2020: $18.240/yr. ($1,520/mo.)
2019: $17,640/yr. ($1,470/mo.)

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

The year an individual reaches full retirement age**
2020: $48,600/yr. ($4,050/mo.)
2019: $46,920/yr. ($3,910/mo.)

** The 7.65% tax rate is the combined rate for Social Security and Medicare. The Social Security portion (OASDI) is 6.20% on earnings up to the applicable taxable maximum amount (see below). The Medicare portion (HI) is 1.45% on all earnings. Also, as of January 2013, individuals with earned income of more than $200,000 ($250,000 for married couples filing jointly) pay an additional 0.9 percent in Medicare taxes. The tax rates shown above do not include the 0.9 percent.

Social Security Disability Thresholds

Non-Blind
2020: $1,260/mo.
2019: $1,220/mo.

Blind
2020: $2,110/mo.
2019: $2,040/mo.

Maximum Social Security Benefit: Worker Retiring at Full Retirement Age
2020: $3,011/mo.
2019: $2,861/mo.

SSI Federal Payment Standard

Individual
2020: $783/mo.
2019: $771/mo.

Couple
2020: $1,175/mo.
2019: $1,157/mo.

Estimated Average Monthly Social Security Benefits Payable in January 2020

All Retired Workers
2020: $1,503/mo.
2019: $1,479/mo.

Aged Couple, Both Receiving Benefits
2020: $2,531/mo.
2019: $2.491/mo.

Widowed Mother and Two Children
2020: $2,934/mo.
2019: $2,888/mo.

Aged Widow(er) Alone
2020: $1,422/mo.
2019: $1,400/mo.

Disabled Worker, Spouse and One or More Children
2020: $2,176/mo.
2019: $2,141/mo.

All Disabled Workers
2020: $1,258/mo
2019: $1,238/mo.