A 73% Error Rate?

    From Follow-up on the Accuracy of the Social Security Administration’s Manual Billing Process to Collect Medicare Premiums, a report by Social Security's Office of Inspector General:

...  When a Medicare Part B recipient receives a monthly Social Security benefit, SSA deducts the monthly Medicare premium from the benefit. Some individuals’ monthly Social Security benefit is lower than the monthly Medicare premium. SSA bills these individuals for the balance of the premium. Each year, SSA uses its Benefit Rate Increase (BRI) program to generate an alert for individuals whose Social Security benefit is lower than their monthly Medicare premium. SSA considers this alert to be a high priority because SSA must bill beneficiaries the remaining Medicare premium as soon as possible and timely issue benefit statements.

In a 2016 report on the Accuracy of the Social Security Administration’s Manual Billing Process to Collect Medicare Premiums, we concluded SSA incorrectly calculated the Medicare premium owed for 48 percent of the sampled beneficiaries we reviewed. For this audit, we reviewed a random sample of 100 beneficiaries from a population of 111,976 beneficiaries SSA’s BRI program identified in November 2022.

SSA timely processed the cases in our sample; however, it incorrectly processed or calculated the Medicare premium owed for 73 of the 100 beneficiaries we reviewed where their Medicare premium was higher than their SSA benefit payments. This included approximately $147,000 in processing errors where employees did not correctly credit monthly benefits to Medicare billing information and $102,000 in payment errors where beneficiaries were not correctly billed for Medicare premiums, which led to overages and arrearages.

Based on the results for our sample, we project SSA did not correctly update records or calculate Medicare premiums owed for approximately 82,000 beneficiaries, which resulted in approximately $76 million in billing errors and $91 million in processing errors. ...

Field Offices Workloads

     Below is an illustration from the testimony of Katherine Zuleger of Wausau , WI. President, Chicago Social Security Management Association, Executive Committee Member, National Council of Social Security Management Associations to the Senate Finance Committee on June 18, 2024 on Work and Social Security Disability Benefits (I can't help thinking that some of this looks like an illustration from a sex education textbook!):

Click on image to view full size

Here are what those acronyms mean, as best I know them:

• AUX -- Auxiliary claims, such as child claims
  
• CDR -- Continuing Disability Review
• CO -- Central Office 
• CSNO -- Centralized Special Notice Option (I don't know what that is.)
• ERPA -- Electronic Representative Payee Annual report
  
• GI -- I think General Information in this context
  
• MDW -- Modernized Development Worksheet
  
• MNUP -- Medicare Non-Utilization Project (to determine why an elderly person isn't using Medicare -- like maybe the person is dead.)  
  
• PSC -- Program Service Center -- where Title II benefits are computed, among other things
• RO -- Regional Office    
• RPMT --  ?
  
• TSC -- Teleservice Center -- where they answer most telephone calls to the 800 number    
  

This Won't Get Enacted But It Shows You Where The GOP's Heart Is

     From The New Republic:

Republicans have claimed over and over again that they are not trying to cut Social Security and Medicare. Heck, Joe Biden got them to agree they would not make cuts to the programs in a memorable verbal maneuver during his State of the Union speech earlier this year.

And yet, the Republican Study Committee (of which some three quarters of House Republicans are members of) just released its desired 2024 budget in which the party seeks to, you guessed it, cut Social Security and Medicare. ...

The proposed budget would effectively make cuts to Social Security by increasing the retirement age for future retirees.  The document seeks to assure people that there would only be “modest adjustments,” but does not list what Republicans think the new retirement age should be.

On Medicare, Republicans propose requiring disabled Americans to wait longer before getting benefits and turning Medicare into a “premium support” system, a long-floated Republican idea that essentially turns the government program into a voucher scheme. ...

This Should Come As No Surprise

     From the Associated Press:

Most U.S. adults are opposed to proposals that would cut into Medicare or Social Security benefits, and a majority support raising taxes on the nation’s highest earners to keep Medicare running as is.

The new findings, revealed in a March poll by The Associated Press-NORC Center for Public Affairs Research, come as both safety net programs are poised to run out of enough cash to pay out full benefits within the next decade.

Few Americans would be OK with some ways politicians have suggested to shore up the programs: 79% say they oppose reducing the size of Social Security benefits and 67% are against raising monthly premiums for Medicare. ...

Instead, a majority — 58% — support the idea of increasing taxes on households making over $400,000 yearly to pay for Medicare, a plan proposed by President Joe Biden last month. ...

Three-quarters of Americans say they oppose raising the eligibility age for Social Security benefits from 67 to 70, and 7 in 10 oppose raising the eligibility age for Medicare benefits from 65 to 67. ...

While most support increasing taxes on households earning more than $400,000 a year to pay for Medicare, the poll shows a political divide on doing so: 75% of Democrats support the tax but Republicans are closely divided, with 42% in favor, 37% opposed and 20% supporting neither. ...

    So why do Republicans in Congress keep talking about raising full retirement age and keep refusing to consider any changes to FICA? That's what their big money donors want; their rank and file members not so much.

AARP Concerned About Idea Of SSA Administering Paid Leave Plan

     From the AARP:

...  Lawmakers are considering a paid leave benefit that is funded by taxpayers.  Such paid leave benefits would be administered through an existing federal agency.  Currently, the Social Security Administration is being considered to manage the paid leave benefit.

AARP sought to understand the views of voters 50-plus on the topic.  While there is broad support for such a program, older voters are concerned that administering this benefit through the SSA would negatively impact the administration of Social Security benefits to retirees. ...

     This is the first I've heard that Social Security might be involved in administering a paid leave plan. If that's to happen, the agency certainly needs a lot more resources. It would be a throwback to the 1960s when Social Security was running Medicare and to the 1930s and early 1940s when Social Security was running a number of other programs. Social Security's administrative funding was vastly better in those days.

Are TV Stations Social Security's Ombudsmen?

      From a TV station in the San Francisco area:

It's a common mistake, but one that proved costly for a Danville man. You might say, this is a case in point -- a decimal point. ...

He sent in an online payment to Social Security for his Medicare B coverage for what he thought was for $1,695.60.

When he received verification of his payment, he discovered he put the decimal point in the wrong place.

The payment ended up being for $16,956.

"So I about freaked out. And obviously the numbers were right, but the decimal was put in the wrong place," he told us.

Russ called Wells Fargo, requesting a stop payment. The bank told him it couldn't do that.

"It was an electronic transfer, and not a check. That I'd have to contact Social Security. So that's when all my woes began," Bernard said.

Social Security told him it could only give him a credit and not a refund for the overpayment. That was the policy. ...

 He learned on Christmas Eve that Social Security denied his appeal.

That same day, his wife Carla came down with COVID-19.

"All of a sudden the room went sideways, and I was sick," she recalls.

Still, Carla had enough strength to suggest Russ call 7 On Your Side.

"I said if anybody can get this fixed, it's 7 On Your Side, call them," she said.

He did, and we contacted Social Security.

A spokesperson told us it couldn't comment due to privacy reason.

But it refunded $15,000 back into Bernard's bank account.

"7 On Your Side can't be beat," said Bernard. ...

Some Covid-19 Tidbits From SSA

     I found these recently added items on Social Security's Covid-19 website:

... I received financial assistance under the CARES Act Higher Education Emergency Relief Fund. Will this affect my Supplemental Security Income payment?

Date: June 1, 2020

We do not consider Higher Education Emergency Relief Fund financial assistance as income or a resource for SSI purposes. Receipt of this assistance will not affect your SSI payment. ...

Can I enroll in Medicare?

Date: June 2, 2020

If you already have Medicare Part A and wish to sign up for Medicare Part B under the Special Enrollment Period (SEP) due to a loss of employment or group health coverage, please complete form CMS 40-B, Application for Enrollment in Medicare - Part B (Medical Insurance) along with the CMS L564-Request for Employment Information and gather proof of employment, Group Health Plan (GHP), or Large Group Health Plan (LGHP).

You have three options to submit your enrollment request under the Special Enrollment Period. You can do one of the following:

• Go to Apply Online for Medicare Part B During a Special Enrollment Period and complete CMS-40B and CMS-L564. Then upload your evidence of Group Health Plan or Large Group Health Plan.
• Fax your forms to 1-833-914-2016.
• Mail your CMS-40B, CMS-L564, and evidence to your local Social Security field office.

Note When completing the CMS-L564

• State on the form “I want Part B coverage to begin (MM/YY)”
• If possible, your employer should complete Section B.
• If your employer is unable to complete Section B, please complete that portion on behalf of your employer without your employers signature and submit one of the following forms of secondary evidence:
• income tax form that shows health insurance premiums paid;
• W-2s reflecting pre-tax medical contributions;
• pay stubs that reflect health insurance premium deductions;
• health insurance cards with a policy effective date;
• explanations of benefits paid by the GHP or LGHP; or

• statements or receipts that reflect payment of health insurance premiums. ...

This Isn’t Making Sense To Me

     From Federal News Network:

... While the Social Security Administration has been under pressure for not yet rolling out electronic signatures, the agency, which handles Medicare Part B enrollment applications on behalf of the Centers for Medicare and Medicaid Services, is launching an online form to digitize what has been a completely paper-based process. 

“You either walk it into a field office, you fax it in or you mail it in, but ultimately there’s going to be paper involved, David Ellison, SSA’s lead for digital transformation, said last Friday in an ACT-IAC webinar. “Right now, that isn’t happening, with the exception of some fax traffic that we’re picking up.” 

With the pandemic disrupting paper processes, Ellison said SSA is quickly putting together an online form that with have anti-spam CAPTCHA features built-in. 

“It’s not like the old ones, where you look at a grid and you have to pick out the bicycles, and if you get it all wrong, and you have to do it again. With the modern versions, that’s all done in the background,” he said. 

By pushing its anti-fraud measures to the background, Ellison said SSA strikes a balance between providing a straightforward, easy-to-navigate experience for the public, but still keeping fraud measures in place. 

“If someone is misrepresenting themselves, we have a lot of data, like the phone number they’re calling in with. If that’s mismatching with something that we have stored in our back-end systems, because we have a relationship with this citizen, we can steer that caller to someone who maybe is going to handle a fraud scenario, but we want to do it more in the background. We don’t want to expose all the citizens to an uncomfortable experience,” Ellison said. “We’re very lucky right now that these platforms are evolving to collect all this data and to be able to pass it along to our back-end fraud systems. ...

     I don’t understand. Are they designing something to help claimants or to stop fraud? How much fraud could there be in signing up for Medicare Part B? Will they really be treating every case where someone is calling from their child’s phone as if it were possible fraud? 

     Maybe the agency ought to get over its electronic signature paranoia especially for instances that involve a low potential for fraud. It’s not like requiring “wet” signatures gives any real protection against fraud.

Fax Number For Medicare Part B Enrollment Released

     From the Social Security Administration:

Although our offices are closed to the public for in-person services, we are taking steps to serve you and your clients during the Coronavirus Disease (COVID-19) pandemic. Your clients who already have Medicare Part A (hospital insurance) but need to sign up for Medicare Part B (medical insurance) can now submit their completed Form CMS-40B, Application for Enrollment in Medicare Part B (Medical Insurance) to us by:

• Fax at 1-833-914-2016; or
• Mail to their local Social Security office. You can find the local office’s mailing address by using the Locate An Office by Zip button at www.ssa.gov/locator.

Your clients can get Form CMS-40B at www.cms.gov/Medicare/CMS-Forms/CMS-Forms/CMS-Forms-Items/CMS017339. ...

     I'm almot certain that this fax number is solely for Medicare Part B enrollments. Let's hope it's monitored regularly and that, if it's a paper fax, that they keep it loaded with paper.  Social Security needs to switch to e-faxes. That's a change that the rest of the world has made or is making.

Medicare Part B Problems

     From the Associated Press:

At greater risk from COVID-19, some seniors now face added anxiety due to delays obtaining Medicare coverage.

Advocates for older people say the main problem involves certain applications for Medicare's "Part B" coverage for outpatient care. It stems from the closure of local Social Security offices in the coronavirus pandemic. ...

Social Security handles eligibility determinations for Medicare, and while many issues can still be resolved online, some require personal attention. That can now entail hold times of 90 minutes or more to reach Social Security on its national 800 number, according to the agency's website. ...

Fred Riccardi, president of the advocacy group Medicare Rights Center, said an already cumbersome process has been exacerbated by the pandemic shutdown, raising the risk that some seniors will fall into a coverage gap or end up owing penalties. ...

His organization is among groups asking Congress to hold seniors harmless from Medicare application problems during the coronavirus emergency. It's unclear how many are affected.

Social Security declined several interview requests and instead sent The Associated Press written responses to questions. The agency said it has seen an increase in requests for Part B enrollment because of older workers losing job-based coverage.

Social Security said it worked with the Centers for Medicare and Medicaid Services to waive certain signature requirements for Part B forms during the pandemic and has set up a dedicated fax number to receive applications.

Social Security gets credit for trying, said Leslie Fried of the National Council on Aging, but that "I don't know anyone who has a fax machine anymore." ...

Social Security said the pandemic did lead lead to much longer telephone holds, but its latest weekly average was down to 45 minutes, depending on when a person calls and whether others are trying at the same time. Agency employees have been able to continue to serve the public by teleworking. ...

     What's that "dedicated fax number to receive applications"? That certainly hasn't been publicized. Applications for what? Just Part B? Is that national or local? Don't they still need "wet signatures"?
     Second, Leslie Fried doesn't know anyone who has a fax machine anymore? I don't know what to say in response to that other than LOL!

Buttigieg Social Security Disability Proposals

     Pete Buttigieg is the first Presidential candidate to issue detailed proposals to help disabled Americans. Here’s the section of his plan dealing with Social Security:

• Eliminate the “benefit cliff” for Social Security Disability Insurance (SSDI) so benefits gradually phase out until recipients reach nearly $45,000 in annual earnings.
• Eliminate SSDI’s ineffective current work incentives.
• Reduce excessive wait times for SSDI and Supplemental Security Income (SSI) appeals cases.
• Enable SSDI participants to start receiving income benefits as soon as they are admitted to the program.
• Eliminate SSDI’s 24-month waiting period for Medicare coverage.
• Update critical SSI thresholds to allow people to receive greater assistance as costs of living rise.

Government Health Care Has Been Around For A While And It's Still Part Of The Social Security Act

Signed by Harry Truman, the first President to propose Medicare

Medicare Screwup At SSA Affects 250,000 People

     From National Public Radio:

A quarter of a million Medicare beneficiaries may be receiving bills for as many as five months of premiums they thought they had already paid.  ...

Because of what the Social Security Administration calls "a processing error" in January, it did not deduct premiums from some seniors' Social Security checks and it didn't pay the insurance plans, according to the agency's "frequently asked questions" page on its website.

The problem applies to private drug policies and Medicare Advantage plans that provide both medical and drug coverage and that substitute for traditional government-run Medicare.

Some people will discover they must find the money to pay the plans. Others may find their plans canceled. Medicare officials say approximately 250,000 people are affected. ...

All Part Of The Plan

     From Paul Krugman’s column in the New York Times:

When the Trump tax cut was on the verge of being enacted, I called it “the biggest tax scam in history,” and made a prediction: deficits would soar, and when they did, Republicans would once again pretend to care about debt and demand cuts in Medicare, Medicaid and Social Security. 

Sure enough, the deficit is soaring. And this week Mitch McConnell, the Senate majority leader, after declaring the surge in red ink “very disturbing,” called for, you guessed it, cuts in “Medicare, Social Security and Medicaid.” He also suggested that Republicans might repeal the Affordable Care Act — taking away health care from tens of millions — if they do well in the midterm elections. 

Any political analyst who didn’t see this coming should find a different profession. After all, “starve the beast” — cut taxes on the rich, then use the resulting deficits as an excuse to hack away at the safety net — has been G.O.P. strategy for decades. ...

House Budget Chairman Wants To Raise Medicare Age And Make Social Security Change

     From the Times Record which may be in Fort Smith Arkansas, although that's hard to tell from the newspaper's website (emphasis added):

A new congressional budget proposal dubbed Brighter American Future would not privatize Social Security or Medicare, but it would raise the age of eligibility for Medicare up to two years and provide alternatives that could help drive Medicare costs down, U.S. Rep. Steve Womack, told a group of citizens Tuesday at a town hall meeting in Fort Smith.

Womack, the 3rd District congressman from Rogers and new chairman of the House Budget Committee, addressed the concerns over Social Security and Medicare presented by Mona Harper of Fort Smith and a group of five others at the University of Arkansas  ... 

The only recommended change to Social Security the budget proposal would make is “closing a loophole with disability insurance” that “allows someone to collect unemployment,” Claire Burghoff, communications director for the House Budget Committee, wrote in an email Wednesday. ...

I'm Not A Medicare Expert; I Just Play One On TV

     From Philip Moeller writing for PBS News Hour:

Sharilyn – Ind.: My daughter has cancer. She is on disability and Medicare. She is getting married in two months. Can she stay on Medicare or will she have to get on her new husband’s insurance?

Phil Moeller: If she is receiving Medicare through her Social Security disability, it will be her choice whether to continue it or, if available, choose to be covered by her husband’s health plan. She could even keep both, using one as primary and the other as supplemental, depending on which has the best benefits.

     How many ways can you mislead someone in two sentences? First, Moeller fails to mention the very real possibility that the daughter is on Disabled Adult Child benefits. If so (apart from a very unusual circumstance) marriage will end not just the Medicare but the cash benefits as well. That's more than a theoretical possibility since the question probably concerns a young woman. It is important to warn people who may be at risk about this trap. Second, no, you don't get to choose between Medicare and private healthcare insurance. If you're Medicare eligible, any private healthcare insurance is a secondary payer even if you decline Medicare Part B coverage. In other words, you better have Medicare Part B because your healthcare insurance won't pay for anything Medicare Part B would have paid for. You can't decline Medicare Part A. You don't have to pay a premium for Part A. The young woman needs to be told to ask her new husband's insurer about any options they would offer her but what they offer will only supplement Medicare, not substitute for it.

Something's Gotta Give

     From the Washington Post:

A new analysis by the Kaiser Family Foundation has found out-of-pocket health-care costs for Medicare beneficiaries are likely to take up half of their average Social Security income by 2030. ...\

[I]n 2013, among all Medicare beneficiaries, average out-of-pocket health-related expenses consumed 41 percent of the average Social Security income, according to a report made available exclusively to The Washington Post.

"This is substantially higher than the share reported by the Medicare actuaries for the same year (23 percent) because it takes into account the full array of out-of-pocket health expenses that people on Medicare face," according to the report. ...

Give 'Em Hell, Les!

     In an op ed in the Los Angeles Times Les Gapay (who has an interesting backstory) writes:

In 1935, President Franklin D. Roosevelt signed into law the great Social Security program. It was designed to give workers an income after retirement.Today, it’s not so great. The tiny Social Security increase that will be bestowed on retirees and the elderly in January is a cruel fraud perpetrated by the government. That's because increases in Medicare Part B and Part D insurance premiums will negate all of the Social Security 2% cost of living increase for many recipients. Instead of staying even, we’ll fall behind.

I just got my annual benefits letter from Social Security. It says I will get $24 a month more next year. However, after the Medicare premium increases, my new Social Security check will be $3.40 a month less than the one I currently get. (The government deducts Medicare premiums from Social Security checks.)

In my case, the Medicare Part B insurance premium, for doctor visits, will go from $109 a month to $133 a month, eating the entire $24 cost of living increase. And my Part D prescription drug Medicare premium will increase to $20.40 a month from $17. For retirees on a fixed, low income, every dollar counts. We can't afford to have less money — even $3.40 a month — coming in from a government program we paid into for 45 years or so. ...

I paid into the system for decades from my wages, and I don’t want these programs cut.

My dwindling Social Security income is only half the problem, of course. My rent will go up on Jan. 1 by $27 a month. Food prices are rising....

Beyond Medicare premiums, the costs in other parts of that safety net keep rising as well. The Medicare Part B annual deductible — what I have to pay before Medicare ponies up — isn’t going up in 2018, but it rose last January to $183, from $166 in 2016, and $147 in 2015. And pray to God I don’t get hospitalized. That’s Medicare Part A, and the deductible will be $1,340 next year, up from $1,316. Most regular folks can't afford either amount. ...

No one in Congress from either party seems to give a damn. ...

Life Expectancy And Retirement Benefits

     The National Bureau of Economic Research has done a study on increases in life expectancy and retirement benefits in the United States. A few years ago when this study was begun there was much talk of increasing the full retirement age for Social Security benefits. That talk has mostly died away. It's politically impossible now. It's hard to imagine it becoming politically possible in the foreseeable future. Perhaps the least unlikely change would go in the opposite direction -- lowering the age limit for Medicare from 65 to 50 or 55. There is a fair chance of that happening should Democrats control the White House and Congress after the 2020 elections or even if Democrats control Congress after the 2018 elections.

     The study points out what was already well known, that while there has been an increase in overall life expectancy, those with lifetime earnings in the lowest 40% are experiencing little or no increase in life expectancy. This is increasing the gap in lifetime benefits between those with the highest and lowest lifetime income by $130,000.     

     The study contains this interesting graph (click on it to see it full size):

     To explain this, the 1930 cohort is people born in 1930 and the 1960 cohort is people born in 1960. Quintile 1 is the 20% of people who have the lowest lifetime earnings while quintile 5 is the 20% of people who have the highest lifetime earnings.

     Note that there was essentially no change between the 1930 cohort and the 1960 cohort. People make silly arguments about how different generations of people are vastly different. I've never seen that. 

     Note that poor people are much more likely to draw disability benefits than wealthy people. It shouldn't be hard to understand why. The same factors that make people poor make them more likely to become disabled. Low cognitive abilities, low educational attainments and serious chronic mental illness all predispose to both poverty and disability. Also, poverty leads to poor health care access which also predisposes to disability. None of this has anything to do with rural versus urban poverty. There's just more poverty these days in rural areas than urban areas.

Why So Brutal?

     A patient dying of cancer is told her Social Security disability claim has been approved but she's also told that she must wait six months before she'll be paid a monthly check. The patient thinks that's crazy. Why would the Social Security Administration behave in such a brutal way? Because they have to. It's the way the law is written. Anybody want to justify this as reasonable? Anybody want to make an argument about discouraging dependency? What about "ENTITLEMENTS ARE DRIVING US BANKRUPT?" I put that last one all in caps since that's usually the tone of anyone making the "argument" even though the same people always favor humongous increases in defense spending.
     And if you think that six month waiting period is terrible, what do you think of the two and a half year waiting period for Medicare?