THE TICKET TO HIRE E-NEWSLETTER

Vol. 2, No. 5            May 2003


A monthly update from the TICKET TO HIRE PROGRAM, a service sponsored by the Social Security Administration's Office of Employment Support Programs, with additional support provided by the Department of Labor's Office of Disability Employment Policy.

This month's edition covers:

· Questions from Our Subscribers with responses

· Questions that Social Security Disability (SSDI) Beneficiaries may ask about their Medicare coverage when they are considering employment

· Federal Employers Are Posting Jobs with TICKET TO HIRE to Hire People with Disabilities under the Selective Placement Program

· Tip of the Month

Questions from Our Subscribers

Q. How come when I get a job announcement from TICKET TO HIRE the employer's name isn't given?

A. As a condition of participating in the TICKET TO HIRE Program (TTH), employers are guaranteed confidentiality and control over the process. When an Employment Network (EN) or State Vocational Rehabilitation Agency (SVRA) informs TTH that the provider has a qualified candidate for a specific position, we immediately notify the employer about the match. The employer then decides how to proceed. Usually, an employer will contact the EN or SVRA directly. We have learned through experience that guaranteeing employers this kind of confidentiality and control is how they prefer to participate in TTH.

Q. Sometimes I get job postings that are too far away or in a neighboring state. Why is that and how can I prevent this from happening?

A. Some ENs and SVRAs have job seekers who are willing to relocate for the right job. However, if you wish to receive job openings only within a certain geographic location or radius (i.e., jobs located within 50 miles, 25 miles, etc. from your physical location), please contact TICKET TO HIRE at 866-TTW HIRE (866-889-4473) (Voice/TTY) or tickettohire@acs-inc.com. On the other hand, we can also do state- or nationwide searches for ENs that serve larger constituencies.

Q. What do I do if TTH sends me an announcement for a type of job that is not a good match for my clientele's skills and qualifications?

A. Call or e-mail TICKET TO HIRE and explain what types of jobs are suitable for your clients or customers.

If you have a question or comment about the TICKET TO HIRE Program, please give us a call at at 866-TTW HIRE (866-889-4473) (Voice/TTY) or e-mail us at tickettohire@acs-inc.com.

Medicare Questions that SSDI Beneficiaries May Ask You When They Are Considering Work

Extended Medicare Coverage for Working Social Security Disability Insurance (SSDI) Beneficiaries

How long will I get to keep Medicare if I go to work?

As long as your disabling condition still meets Social Security Administration (SSA) rules, you can keep your Medicare coverage for at least 8½ years after you return to work. (The 8½ years includes your nine-month trial work period.)

I have Medicare hospital Insurance (Part A) and medical insurance (Part B) coverage. Will I get to keep both parts?

Yes, as long as your disabling condition still meets SSA's rules. Your Medicare hospital insurance (Part A) coverage is premium-free. Your Medicare medical insurance (Part B) coverage will also continue. You or a third party (if applicable) will continue to pay for Part B. If your Social Security Disability Insurance cash benefits stop due to your work, you or a third party (if applicable) will be billed every 3 months for your medical insurance premiums. If you are receiving cash benefits, your medical insurance premiums will be deducted monthly from your check.

I have Medicare (Part A) but I did not take Part B coverage when it was first offered to me. Can I get Part B now?

Yes, this law did not change the enrollment periods. If you did not sign up for Part B when you first could, you can only sign up for it during a general enrollment period (January 1st through March 31st of each year) or a special enrollment period.

The special enrollment period is a period of time, during which you may enroll. If you did not enroll during your initial enrollment period because you are covered under a group health plan based on your own current employment or the current employment of any family member.

The special enrollment period may occur during any month you are covered under a group health plan based on current employment, or during the 8-month period that begins the first full month after employment or group health plan coverage ends, whichever comes first.

When I return to work and get medical coverage through my employer, will this change my Medicare? Do I need to notify anyone?

·Medicare may be the "secondary payer" when you have health care coverage through your work. See the information below under the heading "Medicare and Other Types of Insurance or Coverage" about when Medicare is a "secondary payer or primary payer".

·Notify your Medicare contractor right away.

·Prompt reporting may prevent an error in payment for your health care services.

After my Trial Work Period, how long will I have Medicare coverage?

You will get at least 7 years and 9 months of continued Medicare coverage, as long as your disabling condition still meets our rules.

I completed my Trial Work Period. I am now in my 36 month of Extended Period of Eligibility. Will this law apply to me?

Yes, this will apply to you.

Note:
Promptly report any changes in your work activity. This way you can be paid correctly, and SSA can tell you how long your Medicare coverage will continue after you return to work.

Even after my Medicare ends I plan to continue working. When my Medicare does end will I still be able to purchase Medicare after my premium -free Medicare (hospital insurance) ends?

Yes,

·As long as you still have a disabling condition, you can purchase Medicare (hospital insurance, Part A).
·If you purchase Part A, you may purchase medical insurance (Part B).
·You cannot purchase Part B in this situation, unless you purchase Part A.

Do I need to apply for premium Medicare (hospital insurance, Part A)? If so, when?

Once your premium free Medicare ends, you will get a notice that will tell you when you can file an application to purchase Medicare coverage.

How much are the premiums if I decide to purchase Medicare Hospital Insurance?

·$174.00 per month if you or a family member has at least 30 quarters of Medicare covered employment. (Note: Many individuals qualify for the reduced premium rate. If an individual works in covered employment during the premium-free Medicare 8 and ½ year period, a maximum of 38 quarters of coverage would be earned.

· $316.00 per month (Note: This premium is paid only by individuals who are not otherwise eligible for premium-free hospital insurance and have less than 30 quarters of Medicare covered employment).

Part B: (Medical Insurance) Premium

·$58.70 per month.

Note:
There is a program that may help you with your Medicare Part A premiums if you decide to purchase Part A after your extended coverage terminates. To be eligible for this help, you must be:

· Under age 65.
· Continue to have a disabling impairment.
· Sign up for Premium Hospital Insurance (Part A).
· Have limited income.
· Have resources worth less than $4,000 for an individual and $6,000 for a couple, not counting the home where you live, usually one car, and certain insurance.
· Not already be eligible for Medicaid.

To find out more about this program, contact your county, local or State Social Services or medical assistance office. Ask about the Medicare buy-in program for Qualified Disabled and Working Individuals.

Medicare and Other Types of Insurance or Coverage

I am under age 65, disabled and have Medicare and group health coverage. Who pays first?

It depends. If your employer has less than 100 employees, Medicare is the primary payer if:
· you are under age 65, and
· have Medicare because of a disability.

If the employer has 100 employees or more, the health plan is called a large group health plan. If you are covered by a large group health plan because of your current employment or the current employment of a family member, Medicare is the secondary payer (see example below).

Sometimes employers with fewer than 100 employees join other employers in a multi-employer plan. If at least one employer in the multi-employer plan has 100 employees or more, then Medicare is the secondary payer for disabled Medicare beneficiaries enrolled in the plan, including those covered by small employers. Some large group health plans let others join the plan, such as a self-employed person, a business associate of an employer, or a family member of one of these people. A large group health plan cannot treat any of its plan members differently because they are disabled and have Medicare.

Example: Mary works full-time for GHI Company, which has 120 employees. She has large group health plan coverage for herself and her husband. Her husband has Medicare because of a disability. Therefore, Mary's group health plan coverage pays first for Mary's husband, and Medicare is his secondary payer.

Medicare and group health coverage for people with End-Stage Renal Disease (ESRD) Permanent Kidney Failure

I have ESRD and group health coverage. Who pays first?

If you are eligible to enroll in Medicare because of End-Stage Renal Disease (permanent kidney failure), your group health plan will pay first on your hospital and medical bills for 30 months, whether or not you are enrolled in Medicare and have a Medicare card. During this time, Medicare is the secondary payer. The group health plan pays first during this period no matter how many employees work for your employer, or whether you or a family member are currently employed. At the end of the 30 months, Medicare becomes the primary payer. This rule applies to all people with ESRD, whether you have your own group health coverage or you are covered as a family member.

Example: Bill has Medicare coverage because of permanent kidney failure. He also has group health plan coverage through the company he works for. His group health coverage will be his primary payer for the first 30 months after Bill becomes eligible for Medicare. After 30 months, Medicare becomes the primary payer.

Can a group health plan deny me coverage if I have permanent kidney failure?

No. Group health plans cannot deny you coverage, reduce your coverage, or charge you a higher premium because you have ESRD and Medicare. Group health plans cannot treat any of their plan members who have ESRD differently because they have Medicare.

I have Medicare and Veteran's benefits. Who pays first?

If you have or can get both Medicare and Veterans benefits, you can get treatment under either program. When you get health care, you must choose which benefits you are going to use. You must make this choice each time you see a doctor or get health care, like in a hospital. Medicare cannot pay for the same service that was covered by Veterans benefits, and your Veterans benefits cannot pay for the same service that was covered by Medicare. You do not always have to go to a Department of Veterans Affairs (VA) hospital or to a doctor who works with the VA for the VA to pay for the service. To get services under VA, you must go to a VA facility or have the VA authorize services in a non-VA facility.

Are there any situations when both Medicare and VA can pay?

Yes. If the VA authorizes services in a non-VA hospital, but doesn't pay for all of the services you get during your hospital stay, then Medicare may pay for the Medicare-covered part of the services that the VA does not pay for. John, a veteran, goes to a non-VA hospital for a service that is authorized by the VA. While at the non-VA hospital, John gets other non-VA authorized services that the VA refuses to pay for. Some of these services are Medicare-covered services. Medicare may pay for some of the non-VA authorized services that John received. John will have to pay for services that are not covered by Medicare or the VA.

Can Medicare help pay my VA co-payment?

Sometimes. The VA charges a co-payment to some veterans. The co-payment is your share of the cost of your treatment, and is based on income. Medicare may be able to pay all or part of your co-payment if you are billed for VA-authorized care by a doctor or hospital that is not part of the VA.

I have a VA fee basis ID card. Who pays first?

The VA gives fee basis ID cards to certain veterans. You may be given a fee basis card if:
· You have a service-connected disability;
· You will need medical services for an extended period of time; or
· There are no VA hospitals in your area.

If you have a fee basis ID card, you may choose any doctor that is listed on your card to treat you for the condition. If the doctor accepts you as a patient and bills the VA for services, the doctor must accept the VA's payment as payment in full. The doctor may not bill either you or Medicare for any charges.

If your doctor doesn't accept the fee basis ID card, you will need to file a claim with the VA yourself. The VA will pay the approved amount to either you or your doctor.

Where can I get more information?

You can get more information on Veterans' benefits by calling your local VA office, or the national VA information number 1-800-827-1000. Or, you can use a computer to look on the Internet at www.va.gov. If you do not have a computer, your local library or senior center may be able to help you get this information using their computer.

Medicare and COBRA

What is COBRA (The Consolidated Omnibus Budget Reconciliation Act of 1985)?

COBRA is a law that requires employers with 20 or more employees to let employees and their dependents keep their group health coverage for a time after they leave their group health plan under certain conditions. This is called continuation coverage. You may have this right if you lose your job or have your working hours reduced, or if you are covered under your spouse's plan and your spouse dies or you get divorced. COBRA generally lets you and your dependents stay in your group health plan for 18 months (or up to 29 or 36 months in some cases), but you may have to pay both your share and the employer's share of the premium. Some state's laws require employers with less than 20 employees to let you keep your group health coverage for a time, but you should check with your State Department of Insurance to make sure. In most situations that give you COBRA rights, other than a divorce, you should get a notice from your benefits administrator. If you don't get a notice, or if you get divorced, you should call your benefits administrator as soon as possible.

What happens if I have COBRA and enroll in Medicare?

If you already have group health coverage under COBRA when you enroll in Medicare, your COBRA may end. The length of time your spouse may get coverage under COBRA may change when you enroll in Medicare. For more information about group health coverage under COBRA, call your State Department of Insurance.

What happens if I am in Medicare and choose to get COBRA coverage?

If you elect COBRA coverage after you enroll in Medicare, you can keep your COBRA continuation coverage. If you have only Medicare Part A when your group health plan coverage based on current employment ends; you can enroll in Medicare Part B during a Special Enrollment Period without having to pay a Part B premium penalty. You need to enroll in Part B either at the same time you enroll in Part A or during a Special Enrollment Period after your group health plan coverage based on current employment ends. However, if you have Medicare Part A only, sign-up for COBRA coverage, and wait until the COBRA coverage ends to enroll in Medicare Part B, you will have to pay a Part B premium penalty. You do not get a Part B special enrollment period when COBRA coverage ends. State law may give you the right to continue your coverage under COBRA beyond the point COBRA coverage would ordinarily end. Your rights will depend on what is allowed under the state law.

Remember, enrolling in Medicare Part B will also trigger your Medigap open enrollment period. To make sure you understand about this, you should call 1-800-MEDICARE (1-800-633-4227, TTY/TDD: 1-877-486-2048 for the hearing and speech impaired) and ask for your free copy of the Guide to Health Insurance for People with Medicare.

Who pays first, Medicare or my COBRA continuation coverage?

If you or a family member has Medicare based on a disability and COBRA continuation coverage, Medicare is the primary payer. However, if you or a family member has Medicare based on ESRD, COBRA continuation coverage is the primary payer for a 30-month period and Medicare is the secondary payer.

Medigap Policies for People Under Age 65 With a Disability or End-Stage Renal Disease

A Medigap policy is a health insurance policy sold by private insurance companies to help you pay the medical costs the Original Medicare Plan does not cover.

If I have Medicare and I want to enroll in mine or my spouse's employer group health plan, can I stop my Medigap policy?

The Ticket to Work and Work Incentive Improvement Act of 1999 gives you a right to suspend a Medigap policy. If you are under 65, have Medicare, and have a Medigap policy, you have a right to suspend your Medigap policy. This lets you suspend your Medigap policy benefits and premiums, without penalty, while you are enrolled in your or your spouse's employer group health plan. You can get your Medigap policy back at any time.

If, for any reason, you lose your employer group health plan coverage, you can get your Medigap policy back. You must notify your Medigap insurance company that you want your Medigap policy back within 90 days of losing your employer group health plan coverage.

Your Medigap benefits and premiums will start again on the day your employer group health plan coverage stopped. The Medigap policy must have the same benefits and premiums it would have had if you had never suspended your coverage. Your Medigap insurance company can't refuse to cover care for any pre-existing conditions you have. So, if you are disabled and working, you can enjoy the benefits of your employer's insurance without giving up your Medigap policy.

Where can I find publications on Medicare?

You can view, print, or order publications online or by calling 1-800-MEDICARE (1-800-633-4227). The fastest way to get a publication is to use our search tool and then view and print it. If you order online or through 1-800-MEDICARE, you will receive your order within 3 weeks. The link to search publications is at: http://www.medicare.gov/Publications/home.asp

If I had additional question on my Medicare coverage, who do I call?

1-800-MEDICARE (1-800-633-4227, TTY/TDD: 1-877-486-2048 for individuals with hearing and/or speech impairments)

Federal Employers Are Posting Jobs with TICKET TO HIRE for People with Disabilities under the Selective Placement Program

The Federal Government's Selective Placement Program

Many applicants with disabilities for Federal employment are hired competitively after taking a civil service examination. However, those unable to participate in an open competitive examination may be hired noncompetitively. There are several ways to do this under the Selective Placement Program (SPP). They include temporary appointments under the Schedule A hiring authority.

Certification of Disability for Schedule A

In order to be considered for an appointment for a Federal job under the Schedule A excepted service hiring authority, a job applicant must provide certification of disability to the Federal agency where his or her application is being considered. The certification is issued by a counselor at the State Vocational Rehabilitation Agency of the Vocational Rehabilitation and Employment Service of the Department of Veterans Affairs. The certification must certify that the individual is disabled and eligible for appointment under a particular Schedule A appointment authority. This type of certification is sufficient for an application to be considered for any job.

The second step takes place after an individual with a disability has been tentatively selected for the position. The second letter must state that the counselor has evaluated the job tasks and determined the applicant is able to perform the essential duties of the position. The letter also must state what reasonable accommodation, if any, are sought.

Any certificate of disability must be maintained in a separate, confidential folder, rather than in the person's official personnel folder (OPF). This material is not to be included or placed into the individual's OPF or Employee Medical Folder.

For more information of Federal Employment of People with Disabilities, see: http://www/opm.gov/disability/hrpro_3-07-B.asp

Tip of the Month

1. Title I of the Americans with Disabilities Act is an affirmative action law.

_____ True _____ False

False. At its most basic level, an employment affirmative action law requires employers to make an extra effort to hire certain groups of individuals. The ADA requires only that an entity not discriminate on the basis of disability when an individual makes the effort to apply for a job with that employer.

We'll talk to you again next month. In the meantime, if you have any questions, please contact us at: 866-TTW HIRE (866-889-4473) (Voice/TTY) or tickettohire@acs-inc.com.