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Archive for the ‘Disability’ Category

Steve is out of town and John Ramos will be the group facilitator  

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 WHAT ARE YOUR HEALTH CARE PREMIUMS? 

FINDING HEALTH CARE INSURANCE

(Especially with HIV)

 

Our topic this week is obtaining medical health care insurance. We have an expert guest speaker, Clifton W. Eserman, who will provide a wide range of options, plans and assistance programs available. This will be a comprehensive topic discussion.

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Cliff has 20 years of experience in medical health care consulting. He owns a company located in Wilton Manors. Cliff has been the health insurance expert speaker at the Department of Health’s Men’s Wellness Conference and has been a consumer’s guardian advocate for participants under the ADAP program which has resulted in significant reforms for the betterment of consumer’s choices.

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1757E540-450E-4BEB-A038-B6688A0904FF

  1. Clifton W. Eserman, PHIAS® HIA®

    Specializing in ACA (Affordable Care Act). ON/OFF Exchange & Medicare Supplements, MA (HMO / PPO / RPPO), & Specialty SNP MA Plans

 

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Print

 

Print

    www.incompasinsurance.com

 

 

 

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Steve is out of town and John Ramos will be the group facilitator  

.

 

HOW & WHERE TO FIND

HEALTH CARE INSURANCE

(Especially with HIV)

 

Our topic this week is obtaining medical health care insurance. We have an expert guest speaker, Clifton W. Eserman, who will provide a wide range of options, plans and assistance programs available. This will be a comprehensive topic discussion.

.

Cliff has 20 years of experience in medical health care consulting. He owns a company located in Wilton Manors. Cliff has been the health insurance expert speaker at the Department of Health’s Men’s Wellness Conference and has been a consumer’s guardian advocate for participants under the ADAP program which has resulted in significant reforms for the betterment of consumer’s choices.

.

,

1757E540-450E-4BEB-A038-B6688A0904FF

  1. Clifton W. Eserman, PHIAS® HIA®

    Specializing in ACA (Affordable Care Act). ON/OFF Exchange & Medicare Supplements, MA (HMO / PPO / RPPO), & Specialty SNP MA Plans

 

.

      

Print

 

Print

    www.incompasinsurance.com

 

 

 

.

 

 

Read Full Post »

Steve is out of town and John Ramos will be the group facilitator  

.

.

 $$ WHAT ARE YOUR HEALTH CARE PREMIUMS?

FINDING HEALTH CARE INSURANCE

(Especially with HIV)

 

Our topic this week is obtaining medical health care insurance. We have an expert guest speaker, Clifton W. Eserman, who will provide a wide range of options, plans and assistance programs available. This will be a comprehensive topic discussion.

.

Cliff has 20 years of experience in medical health care consulting. He owns a company located in Wilton Manors. Cliff has been the health insurance expert speaker at the Department of Health’s Men’s Wellness Conference and has been a consumer’s guardian advocate for participants under the ADAP program which has resulted in significant reforms for the betterment of consumer’s choices.

.

,

1757E540-450E-4BEB-A038-B6688A0904FF

  1. Clifton W. Eserman, PHIAS® HIA®

    Specializing in ACA (Affordable Care Act). ON/OFF Exchange & Medicare Supplements, MA (HMO / PPO / RPPO), & Specialty SNP MA Plans

 

.

      

Print

 

Print

    www.incompasinsurance.com

 

 

 

.

 

 

Read Full Post »

Steve is out of town and John Ramos will be the group facilitator  

.

.

 WHAT ARE YOUR HEALTH CARE PREMIUMS?

FINDING HEALTH CARE INSURANCE

(Especially with HIV)

 

Our topic this week is obtaining medical health care insurance. We have an expert guest speaker, Clifton W. Eserman, who will provide a wide range of options, plans and assistance programs available. This will be a comprehensive topic discussion.

.

Cliff has 20 years of experience in medical health care consulting. He owns a company located in Wilton Manors. Cliff has been the health insurance expert speaker at the Department of Health’s Men’s Wellness Conference and has been a consumer’s guardian advocate for participants under the ADAP program which has resulted in significant reforms for the betterment of consumer’s choices.

.

,

1757E540-450E-4BEB-A038-B6688A0904FF

  1. Clifton W. Eserman, PHIAS® HIA®

    Specializing in ACA (Affordable Care Act). ON/OFF Exchange & Medicare Supplements, MA (HMO / PPO / RPPO), & Specialty SNP MA Plans

 

.

      

Print

 

Print

    www.incompasinsurance.com

 

 

 

.

 

 

Read Full Post »

On Thursday, the Milton Hershey School agreed to pay a 14-year-old Philadelphia boy and his mother $700,000 to settle their federal lawsuit against the Derry Twp.-based boarding school, which had initially refused him enrollment because he’s HIV-positive.

“I thought we had moved beyond this with the amount of education people have received regarding HIV and AIDS and how it’s contracted and transmitted to others,”

 

To read full article CLICK HERE

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Social Security Disability

How Much Can I Earn and Still Collect SSDI?

If you work while you are collecting disability benefits, special rules apply:

Trial work period – you can work up to 9 months in any five year period and continue to collect disability benefits.  There is no cap on your earnings during the 9 month trial work period.  However earnings over a specific amount in a particular month will cause that month to count at a trial work period month.   If you earn more than $720 in a month in 2012, 2011 or 2010, that month counts as a trial work period month.  If you earned less than $720, that month would not count towards your 9 month limit.   In 2009, the trial work period trigger was $700, and in 2008 it was $670. In 2007, the trial work period trigger was $640, and in 2006, the trial work period trigger was $620.

Extended Period of Eligibility. After you have used up your nine months of trial work , Social Security looks at your earnings on a month by month basis for a 36 month “extended period of eligibility.”  During the extended period of eligibility, you receive your regular SSDI check if your earnings are not “substantial.”   If your earnings are “substantial” you are not eligible for a check in that month.  How much is “substantial?”

2012- $1010 per month

2011- $1,000 per month

2010 – $1,000 per month

2009- $980 per month

2008-  $940 per month

2007 – $900 per month

2006 – $860 per month

If you earn more than the above limits for a particular month, you will be asked to repay Social Security for any disability benefits received during that month.  SSA will literally review your earnings month by month – if you exceed the limit for a particular month, you will have to pay it back.

In addition, if your earnings record shows a pattern of work, SSA will likely review your case to determine whether benefits should be stopped.  This is called a “continuing disability review” and is an eligibility issue rather than a money issue, although the two often go hand in hand.

Note that special rules apply for blind disability claimants – a blind person can earn more money before his earnings are deemed “substantial.”

To read full article CLICK HERE

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March 23, 2011

HIV Classified as Disability by EEOC
New EEOC Americans with Disabilities Act (ADA) regulations classify HIV as a disability:

“The U.S. Equal Employment Opportunity Commission (EEOC), the federal agency responsible for enforcing laws against workplace discrimination, has released the final revised version of its Americans with Disabilities Act (ADA) regulations, according to an EEOC statement. The EEOC’s new regulations clarify that impairments of major bodily functions-such as being HIV positive-qualify as disabilities under the law. The revisions were triggered by the ADA Amendments Act of 2008, which overturned a number of Supreme Court rulings that defined ‘disability’ narrowly, reinforcing the inclusive intentions of the original legislation.”

Read more: http://www.towleroad.com/2011/03/hiv-classified-as-disability-by-eeoc.html#ixzz1IqpgM1vj

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September 28, 2010 From AIDSmeds

Updated: Revise Social Security HIV Disability Requirements Says Institute of Medicine

The following article, originally published September 21, has been revised to reflect clarifications from the lead author of the IOM report.

A new report issued by the Institute of Medicine (IOM) on September 13 says the criteria used by the U.S. Social Security Administration (SSA) to gauge HIV-related disability is outdated and should be overhauled to include new qualifications based on CD4 cell counts and specific sets of medical conditions. The IOM recommendations—requested by SSA—will only apply to new Social Security disability applicants once the existing criteria are amended; current disability claimants will not be effected by the proposed changes.

The IOM recommendations, which have yet to be officially reviewed by SSA, reflect the fact that modern-day antiretroviral (ARV) therapy can often improve the health of HIV-positive people with low CD4 counts or a history of AIDS-related opportunistic infections and, in turn, effectively reduce the need for disability benefits. The report also stresses the need for disability benefits for people living with HIV experiencing certain non-AIDS-related complications and ARV treatment-related side effects that can lead to disability.

The HIV Infection Listings, established in 1993, are the criteria currently used to determine whether people living with HIV are disabled by their infection and eligible for benefits. For example, a person living with HIV and a history of employment may be eligible for Social Security Disability Insurance (SSDI)—and, with it, access to Medicare—once a serious AIDS-defining illness has been diangosed, such as Mycobacterium avium complex or cytomegalovirus. Other benefits, including Social Security Income (SSI) and Medicaid for people living with HIV who have limited employment histories, are also dependent on disability status as determined by SSA.

Since the Listings were created, the IOM report argues, HIV care has advanced and the disease has dramatically changed from a uniformly fatal condition to a potentially chronic manageable infection, in which CD4 cell recovery and a return to physical health—and ability to work—is an expected positive consequence of contemporary ARV treatment. Conversely, a number of non-AIDS-related health complications are becoming increasingly prevalent among people living with HIV receiving ARV therapy—such as neurocognitive impairment, chronic kidney disease, osteoporosis and a number of treatment-associated side effects—many of which can cause disability and were not included in the original 1993 HIV Infection Listings.

To account for the more recent reality that opportunistic infections can be cured or prevented by ARV treatment and prophylaxis, the potential health consequences of ARV therapy and the increasing prevalence of conditions that can occur jointly with HIV infection, IOM is now recommending to SSA that people living with HIV meet one of the following criteria to qualify for disability benefits:

A CD4 cell count at or below 50 cells per cubic millimeter of blood serum, a laboratory benchmark that indicates an advanced stage of illness.
One of a few rare but fatal or severely disabling HIV-associated conditions, such as pulmonary Kaposi’s sarcoma, certain lymphomas, dementia or progressive multifocal leukoencephalopathy (PML).
An HIV-associated condition that appears in another section of SSA’s full Listing of Impairment, such as cardiovascular disease, chronic kidney disease and hepatitis.
An HIV-associated condition that is not already included in any other section, such as neuropathy, neurocognitive disorders and wasting syndrome.
In short, the IOM committee recommends that SSA move away from a list of less common AIDS-defining opportunistic infections and focus on manifestations and disease states that are more likely to be associated with disability today.

In addition to IOM’s disability-defining criteria recommendations, it also stresses the importance of mandated, regular reassessments of a person’s disability status by the SSA. “Since antiretroviral treatment often allows clinical improvement over a period of one or two years,” the IOM report suggests, “the committee believes claimants allowed under such a listing should be reevaluated periodically for disability status. The committee believes three years would allow for a sustained response and is the maximum practical period for Social Security Administration (SSA) reassessment.”

For example, in a person living with HIV deemed disabled because of a CD4 count below 50 cells, “if the claimant’s CD4 count exceeds the minimum threshold and the claimant is not disabled according to other sublistings [after three years], he should no longer receive disability benefits. However, in the event that the CD4 count drops below 50 cells, his disability benefits should be reinstated.”

Only those diagnosed with fatal or severe HIV-associated conditions (see the second bullet point above) will be granted permanent, “compassionate” disability status and will not be required to undergo medical reassessments.

IOM notes that the proposed revisions to the Listings affect new HIV-positive SSDI and SSI applicants only and are not to be applied retroactively. “The protection of those with existing disability is a solid part of SSA,” says Paul Volberding, professor of medicine at the University of California, San Francisco, and a lead author of the IOM report. “SSA was clear that revisions are not allowed to withdraw existing benefits.”

Aware that some community activists are concerned about the possiblity of medical reassessments for those currently receiving SSA benefits, along with the suggestion that revisions for new claimants will create a two-tier system for disability beneficiaries, Volberding urges participation in the SSA review, which will likely involving a public comment period. “Community advocates should be engaged in this process, as the IOM recommendations are only the start of a discussion, not the end by any means,” he says.

Another concern among some community activists is that the the IOM report only addresses changes to SSDI and SSI qualification requirements—the committee sidesteps the important issue of access to care that, for thousands of people living with HIV, is tied to SSA disability status. At present, people living with HIV who are uninsured can access Medicare or Medicaid, once they have been deemed disabled by SSA. While the new recommendations may make it easier for some people living with HIV to qualify for these public health insurance programs, it is possible that the absence of list of serious opportunistic infections—some of which can occur at CD4 counts above 50—will hinder the ability of others to access health care when they need it.

“Although the issues of … access to care [is] critical in the discussion of Social Security disability benefits,” the IOM report authors write, “in-depth discussion of the means by which people receive treatment and medications was deemed outside the Committee’s scope.” SSA, in turn, will be left to grapple with the issue of how to retain people in care and on ARV treatment if the criteria for disability benefits are changed, a task that will likely be made much more difficult in light of existing AIDS Drug Assistance Program (ADAP) waiting lists for uninsured or under-insured people living with HIV and other changes stemming from the recent passage of health care reform legislation.

“We completely appreciate the linkage of disability to care access,” says Volberding. “Now, one has to get an OI for easy access. The revisions we suggest would allow the many who are diagnosed with advanced stage disease but without an OI to gain access. The suggested changes would allow compassionate disability for those with still terrible complications and would clarify the relationship between HIV Listings and the existing ones for problems now appreciated as HIV related like cardiovascular disease.

“The whole combination of disability benefits with Ryan White and ADAP is a completely appropriate area for a community dialog,” he adds, “but trying to ignore the difference between AIDS in 1993 and the situation today seems hard to hold too seriously.”

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