Extended Period of Eligibility

To encourage disabled individuals to attempt to work, Congress enacted section 303 of the 1980 amendments that provided a re-entitlement period under title II to an individual who completes 9 months of trial work and continues to have a disabling impairment. This provision, referred to as the extended period of eligibility (EPE), provides that an individual can be re-entitled to benefits any time during the re-entitlement period that his or her work activity falls below the SGA level. The EPE re-entitlement period begins with the month immediately following completion of the trial work period and ends 36 months later (or 15 months later if the beneficiary is not entitled to benefits after 12/1987). However, if the beneficiary is not engaging in SGA when the re-entitlement period ends, the EPE provision allows benefits to continue until SGA is performed (or medical cessation is determined). When an SGA disability cessation determination is made within the EPE, the termination month is the first month of substantial gainful activity (SGA) after the 36-month re-entitlement period ends. When a disability cessation has not already been determined, the termination month is the third month after the first month of SGA after the 36-month period. If an individual's payments stop because disability has ceased due to work activity and, subsequently, but within the EPE re-entitlement period, his/her earnings fall below SGA, benefits may be reinstated if all other entitlement factors are met. A new application, and disability determination, is not required to reinstate payments in these cases. The extended period of eligibility does not change the definition of disability. A beneficiary is eligible for payments as long as he/ she continues to meet the definition of disability. The EPE does not limit the payment of disability benefits after disability ceases; e.g., an individual whose disability ceases is eligible for title II payments for the month of cessation and 2 additional months. The main effect of the EPE provision is that it permits benefit reinstatement during the re-entitlement period when a beneficiary's benefits have stopped because of SGA and the beneficiary's earnings subsequently fall below SGA levels (see DI 13010.215 B).

Compassionate Allowances

Compassionate allowances are a way of quickly identifying diseases and other medical conditions that invariably qualify under the Listing of Impairments based on minimal objective medical information. Compassionate allowances will allow Social Security to quickly target the most obviously disabled individuals for allowances based on objective medical information that we can obtain quickly.

List of Conditions:

1	Acute Leukemia
2	Adrenal Cancer - with distant metastases or inoperable, unresectable or recurrent
3	Alexander Disease (ALX) - Neonatal and Infantile
4	Amyotrophic Lateral Sclerosis (ALS)
5	Anaplastic Adrenal Cancer - with distant metastases or inoperable, unresectable or recurrent
6	Astrocytoma - Grade III and IV
7	Bladder Cancer - with distant metastases or inoperable or unresectable
8	Bone Cancer - with distant metastases or inoperable or unresectable
9	Breast Cancer - with distant metastases or inoperable or unresectable
10	Canavan Disease (CD)
11	Cerebro Oculo Facio Skeletal (COFS) Syndrome
12	Chronic Myelogenous Leukemia (CML) - Blast Phase
13	Creutzfeldt-Jakob Disease (CJD) - Adult
14	Ependymoblastoma (Child Brain Tumor)
15	Esophageal Cancer
16	Farber's Disease (FD) - Infantile
17	Friedreichs Ataxia (FRDA)
18	Frontotemporal Dementia (FTD), Picks Disease -Type A - Adult
19	Gallbladder Cancer
20	Gaucher Disease (GD) - Type 2
21	Glioblastoma Multiforme (Brain Tumor)
22	Head and Neck Cancers - with distant metastasis or inoperable or uresectable
23	Infantile Neuroaxonal Dystrophy (INAD)
24	Inflammatory Breast Cancer (IBC)
25	Kidney Cancer - inoperable or unresectable
26	Krabbe Disease (KD) - Infantile
27	Large Intestine Cancer - with distant metastasis or inoperable, unresectable or recurrent
28	Lesch-Nyhan Syndrome (LNS)
29	Liver Cancer
30	Mantle Cell Lymphoma (MCL)
31	Metachromatic Leukodystrophy (MLD) - Late Infantile
32	Niemann-Pick Disease (NPD) - Type A
33	Non-Small Cell Lung Cancer - with metastases to or beyond the hilar nodes or inoperable, unresectable or recurrent
34	Ornithine Transcarbamylase (OTC) Deficiency
35	Osteogenesis Imperfecta (OI) - Type II
36	Ovarian Cancer - with distant metastases or inoperable or unresectable
37	Pancreatic Cancer
38	Peritoneal Mesothelioma
39	Pleural Mesothelioma
40	Pompe Disease - Infantile
41	Rett (RTT) Syndrome
42	Salivary Tumors
43	Sandhoff Disease
44	Small Cell Cancer (of the Large Intestine, Ovary, Prostate, or Uterus)
45	Small Cell Lung Cancer
46	Small Intestine Cancer - with distant metastases or inoperable, unresectable or recurrent
47	Spinal Muscular Atrophy (SMA) - Types 0 And 1
48	Stomach Cancer - with distant metastases or inoperable, unresectable or recurrent
49	Thyroid Cancer
50	Ureter Cancer - with distant metastases or inoperable, unresectable or recurrent

How Long Does it Take to Get a Hearing?

Rank ODAR Office Processing Time
#5 Ft. Lauderdale 264 days
#38 Orlando 393 days
#87 Jacksonville 477 days
#90 Savannah 480 days
#118 Miami 592 days
#120 Tampa 593 days
#122 Atlanta 595 days
#132 Atlanta North 614 days
#145 Jackson 685 days

Picking a Medicare Drug Plan

THE SAVAGE TRUTH | Enrollment time is here again -- follow these steps to choose what works best

November 17, 2008

TERRY SAVAGE savage@suntimes.com

Here we go again. Starting today, seniors have six weeks to sign up for another year of Medicare Part D -- the prescription drug benefit -- that goes along with Medicare Part A (hospitalization), Part B (outpatient and doctor costs) and Medigap (the supplement that covers other costs including co-payments and deductibles).

It's a must-do project, even if you're among the few seniors who don't currently take prescription drugs. If you don't sign up when you first become eligible, there will be big penalties to pay once you do need some prescriptions -- and for sure you will need them at some point.

» Click to enlarge image

The Medicare.gov Web site sorts through all of the alternative plans to find you the best coverage at the least cost in a plan that is available at a pharmacy near you.

The only exceptions are those seniors who are covered by a comparable company or retiree prescription plan, or those who have signed up for an all-in-one Medicare Advantage plan. Some seniors have prescription drug access through the Veterans Administration, though they may want to choose an inexpensive Part D plan for drugs the VA does not cover.

For those who recently turned 65 and now qualify for Medicare, this will be the first time going through the process of choosing the least-expensive plan.

But every senior, even those currently enrolled and happy with their drug plan, should go through the process of reviewing the alternatives for 2009. That's because each year, the plans change the prices of the drugs they cover and may not even include the same medicines in the year ahead.

So here's my annual, step-by-step guide through the Medicare.gov Web site, the only place that can sort through all of the alternative plans to find you the best coverage at the least cost in a plan that is available at a pharmacy near you!

Finding your plan at Medicare.gov

Step 1. Get a complete list of all of the medicines and dosages you are now taking. The easiest way is to ask your pharmacist for this list, or simply line up all of your prescription bottles.

Step 2. Go to www.Medicare.gov. (If you don't have a computer, you can call 800-MEDICARE, and they will help you through this process over the telephone.)

Step 3. Click on the line near the top of the first page screen that says: "Medicare Prescription Drug Plans -- 2009 Plan Data."

Step 4. On the next page, click on the box that says "Find and Compare Plans."

Step 5. On the next page, you have a choice of either a "personalized" search or a "generalized" search. If you already have your red, white, and blue Medicare card, you can use the personalized search, in which you input your Medicare number and other information from your card. (You can use the generalized search to find and compare plans in your ZIP code.)

Step 6. On the next page, you can enter the drugs you are currently taking, and the dosages. Even if you do not take prescription drugs now, you must fill out this page, stating that fact. This list can be saved securely for your future visits to Medicare.gov.

You can either type in the names of your drugs, or search for them alphabetically. The most common dosage will automatically pop up, but you should be sure that is the dosage you are taking. The program will also let you know if there is a less-expensive generic available. When you've finished listing your prescriptions, click "continue" to move on to the next page where you can recheck the list of names and dosages. Then click "continue" again.

Step 7. You'll be asked if you have a specific pharmacy that you'd like to work with -- one that's within walking distance of your home, for example. Then click again.

Step 8. You've finally arrived at the most important page -- the one that lists all of the plans, ranked with the lowest total cost at the top of the list. You can select up to three plans to compare. You can click to see how you might lower your cost, perhaps by switching to a generic. Or the program might suggest an alternative but less-expensive drug in the same category. That's something you'd have to discuss with your physician.

This year, there are also "star" ratings, up to five stars, based on a survey done for Medicare about the quality and performance of those plans over the last year.

Step 9. After comparing the plans by cost, click on the name of each plan provider to find full details, including a helpful graph of the average monthly cost, as well as information about participating pharmacies and mail order availability. You can print out the pages for each plan, and keep them handy.

Step 10. Before signing up, call the plan's toll-free number and reconfirm their prices and coverages for the drugs you take, as well as all co-payments. Then you're ready to ask them to send you the application so you can sign up!

A plea for help: Government should be required to make these decisions easier for seniors. But since it hasn't, I'm asking the more computer-literate among you to clip this column, find a senior, and offer to help. It's easy once you've done it. And that's The Savage Truth.

Terry Savage is a registered investment adviser. Distributed by Creators Syndicate. Copyright Terry Savage Productions Ltd. Visit www.terrysavage.com and suntimes.com.

Earnings that Trigger a Trial Work Period

During a trial work period, a beneficiary receiving Social Security disability benefits may test his or her ability to work and still be considered disabled. We do not consider services performed during the trial work period as showing that the disability has ended until services have been performed in at least 9 months (not necessarily consecutive) in a rolling 60-month period. In 2007, any month in which earnings exceed $640 is considered a month of services for an individual's trial work period. In 2008, this monthly amount increases to $670.

Monthly earnings that trigger a trial work period Year Monthly earnings:
1978 & prior $50
1979-1989 75
1990-2000 200
2001 530
2002 560
2003 570
2004 580
2005 590
2006 620
2007 640
2008 670

Medicare Parts A - D

Medicare is a health insurance plan for people who are age 65 or older. People who are disabled or have permanent kidney failure or amyotrophic lateral sclerosis (Lou Gehrig’s disease) can get Medicare at any age. Medicare has four parts:

1. Hospital insurance (Part A) helps pay for inpatient hospital care and certain follow-up services.
2. Medical insurance (Part B) helps pay for doctors’ services, outpatient hospital care and other medical services.
3. Medicare Advantage plans (Part C) are available in many areas. People with Medicare Parts A and B can choose to receive all of their health care services through a provider organization under Part C.
4. Prescription drug coverage (Part D) helps pay for medications doctors prescribe for medical treatment.

Who is eligible for hospital insurance (Part A)?
Most people get hospital insurance when they turn 65. You qualify for it automatically if you are eligible for Social Security or Railroad Retirement benefits. Or you may qualify based on a spouse’s (including divorced spouse’s) work. Others qualify because they are government employees not covered by Social Security who paid the Medicare tax.
If you get Social Security disability benefits for 24 months, you will qualify for hospital insurance.
If you get disability benefits because you have amyotrophic lateral sclerosis (Lou Gehrig’s disease), you do not have to wait 24 months to qualify. Also, people who have permanent kidney failure that requires maintenance dialysis or a kidney replacement qualify for hospital insurance if they have worked long enough or if they are the spouse or child of a person who has worked long enough.

Who can get medical insurance (Part B)?
Almost anyone who is eligible for hospital insurance can sign up for medical insurance. Part B is an optional program. It is not free. In 2008, the standard monthly premium is $96.40. Some people with higher incomes will pay higher premiums.

Who can get Medicare Advantage plans (Part C)?
Anyone who has Medicare hospital insurance (Part A) and medical insurance (Part B) can join a Medicare Advantage plan. Medicare Advantage plans include: Medicare managed care plans;
Medicare preferred provider organization (PPO) plans; Medicare private fee-for-service plans; and Medicare specialty plans. You might have to pay a monthly premium because of the extra benefits the Medicare Advantage plan offers.

Who can get Medicare prescription drug coverage (Part D)?
Anyone who has Medicare hospital insurance (Part A) or medical insurance (Part B) or a Medicare Advantage plan (Part C) is eligible for prescription drug coverage (Part D). Prescription insurance is optional, and you pay an additional monthly premium for the coverage.

For more information, contact SSA and ask for Medicare (Publication No. 05-10043). Help with Medicare expenses for people with low income. If you have a low income and few resources, your state may pay your Medicare premiums and, in some cases, other “out-of-pocket” medical expenses, such as deductibles and coinsurance. Only your state can decide whether you qualify for help under this program. If you think you qualify, contact your state or local medical assistance (Medicaid) agency, social services or welfare office. You can get more information about this program from the publication, If you need help paying Medicare costs, there are programs that can help you save money (Publication CMS-10126). To get a copy, call the Medicare toll-free number, 1-800-MEDICARE (1-800-633-4227). If you are deaf or hard of hearing, you may call TTY 1-877-486-2048.

“Extra help” with Medicare prescription costs : If you have limited income and resources, you may qualify for extra help to pay for your prescription drugs under Medicare Part D. Social Security’s role is to help you understand how you may qualify and to process your application for extra help. To see if you qualify or to apply, call Social Security’s toll-free number or visit our website.