March 28, 2016
by:
Margie Johnson Ware, Aging and Health Specialist and Bonnie Burns, Medicare
Specialist
1. How does having a disability affect my Medicare options?
This is
one of the most common questions future beneficiaries ask. Although many
boomers are familiar with the eligibility age for Medicare,
many others do not realize that you can be enrolled automatically (earlier than
age 65) if you’re approved by the Social Security Administration
(SSA)to receive Social Security Disability Insurance (SSDI) benefit
payments.
After
drawing SSDI for 24 months (2 years), you will be automatically enrolled into
both Medicare Part A and Medicare Part B (also
known as “Original Medicare”) starting the 25th month, and you will receive a
Medicare card in the mail. In some cases, you can receive Medicare in less than
two years if Social Security determines that your disability started before
your disability application date, or if you have Amyotrophic Lateral Sclerosis (ALS) or End Stage Renal Disease (ESRD).
2. What if I don’t want to be automatically enrolled in Original
Medicare? Can I disenroll?
Part A is free for
most people, but Part B involves
paying a monthly premium. You cannot decline Part A unless
you’re willing to pay back all the SSDI benefits you received, so you’ll likely
need to keep it even if you are covered by your spouse’s employer insurance.
However,
if you have employer coverage, you have the freedom to disenroll from Part
B. It is important to check with the employer’s human resources office to find
out how their plan works with Medicare Part B. Make
sure the company has 100 employees or more—that means the employer insurance
will be primary (i.e. that insurance is billed first, and most likely covers
more of your care than Medicare Part B). If the employer has less than 100
employees, then your Medicare insurance will be primary—and you’ll therefore
need to join Part B.
If you
do decide you don’t need Part B, look on the back of your Medicare card for a
box you can check to be removed from Part B. Then send the updated card back to
the Social Security Administration (SSA). Or call SSA for help
with disenrolling in Part B.
3. Will there be any copays and deductibles (out-of-pocket
costs) if I am disabled?
Yes,
although if you have employer insurance that is primary to Medicare, you may
have fewer out-of-pocket expenses. If you don’t have employer insurance and you
are enrolled in Original Medicare (Parts A and B),
you may want additional coverage.
For
most beneficiaries (regardless of their disability status), the choice comes
down to deciding between two main options:
- Original Medicare (Parts A and
B) combined with an optional Part D plan (prescription
drug coverage) and/or an optional supplemental coverage plan to cover the
cost gaps in Original Medicare known as Medigap (enrollment
is limited for persons under age 65 in many states).
- A Medicare Advantage plan
(a private managed health plan that usually covers all of these services).
If you
are low-income you may also be eligible for Medicaid as a supplement
to pay out-of-pocket costs, depending on what the rules are in your state.
Have
more questions about choosing the best coverage for your needs? We recommend
you try taking the free Medicare Questionnaire tool (created
by nonprofit National Council on Aging) for access to free professional
Medicare advice from a licensed benefits advisor. You can also check out your
local SHIP (State Health Insurance Assistance Program) for
further assistance, or reach out to your local Aging and Disability Resource
Center.
4. How will I pay for my prescription medications on Medicare?
If you
are not covered by employer insurance, and haven’t signed up for a Medicare
Advantage plan that includes prescription drug coverage, you will need to
sign up for a Part D (prescription drug coverage)
plan to cover your medications.
In some
cases you may have been automatically assigned to a Part D plan if
you get Extra Help or Medicare Savings
Programs. A call to 1-800-MEDICARE will allow you to find out if you
have been automatically enrolled. If so, you will want to speak with the
representative and make sure that all of your medications are covered in the
plan they put you in. If they are not covered, you can choose another plan. You
can also contact your local SHIP (State Health Insurance
Assistance Program) for help with this process.
5. What if my disability responds to treatment and I am able to
return to work?
First,
speak to a representative at the Social Security Office about
how many hours you are allowed to work and still retain your SSDI payments. If
you return to what the Social Security Office considers “substantial gainful activity” (i.e. a paying
job above a certain income level, depending on your disability), you are still
eligible for Medicare for seven years.
If new employment
provides health insurance, then the employer insurance will become the primary
payer if there are more than 100 employees, and your Medicare will become
secondary–but still available in case your circumstances change.
https://www.mymedicarematters.org/2016/03/social-security-disability-medicare-guide/
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