When you are on SSDI, do you Have to get Medicare?
 

After reading the Gap thread, I worry about this stupid Medicare thing...so if you are okayed for disability income, do you go onto Medicare?
I don't want to...the government is reducing Medicare payments to doctors, and there are more and more who are refusing to take on Medicare patients.:(

I don't want to lose the good docs I've got under my DH's insurance...this situation is so stupid in our country...just let us go to whatever doc we want, please...

There is a 29 month wait before you even qualify for Medicare: The 5 month eligibility for SSDI, plus 24 months.

Medicare is supposed to be a low cost health insurance for SSA recipients on a fixed income. If you choose to enroll in Medicare the premium will be deducted from your monthly benefits check.

But, you are not required to enroll in Medicare. If you are one of the lucky ones that has a good plan you can afford. Keep it.

But, also keep in mind that if you don't enroll when you are eligible, you can't just enroll at any time later. You have to wait for the open enrollment. I'm not sure, but think that is only once each year.

I'm confused. I was under the impression that once on SSDI and Medicare eligible...Medicare would be considered your first coverage, then whatever private insurance you have would be considered your second. I could be wrong. I think Dej is pretty knowledgeable in this subject...maybe she'll chime in here soon and give us the facts! :)

What 29 month wait?? I applied for SSDI back in June of 09. I was denied on the claim that they never received paperwork they requested (which was sent in). I then filed an appeal, which I was supposed to have a decision on in Jan, but then I got a call that they cannot process my appeal because when they denied me, they kicked my application out completely and I had to re-apply. Which I did in Jan. In the mean time, I went to Social Services to ask for help as I have NO income and another 3 month waiting period. Still waiting though we seem to be making progress, they keep requesting more paperwork.

I was approved for medicaid within a week. It was the only thing i was approved for. Apparently, if you have MS you are automatically approved if you apply. They cover my meds, and my doctors. The only real fight has been the back brace that i was supposed to have to help the broken bones... and it has been 3 weeks and I still have no response.

At this point, the brace is pointless as it has been 3 weeks and the bone have already set. For that I am angry. I cannot get the $500 brace that would have saved them from paying over $20,000+ in surgery on my spine. Yet I had no problems getting the $5800/ month Ty infusions approved. The doctors have had to fight for the MRIs. That is what scares me about the idea of our government taking over everyone's health care.

It's my understanding (and my personal experience) that once approved for SSDI there is a 5 month wait for your first check. Then there is a 24 month wait until Medicare becomes available. I will be Medicare eligible in August of 2010. I was told that I was not eligible for Medicaid.

Another 5 months? That is insane! If it wasn't for my mom and DH2B I would be homeless right now thanks to this stupid system.

I know, Legzz....it's a ridiculous system. They agree I'm disabled....even approve me for SSDI....but make me wait 2 years for any type of medical insurance. Makes no sense.

Thank goodness I was immediately approved for SSDI. Don't know what I'd do without access to my benefits.

Let me tell you what I learned.


When I accepted a SSDI retirement. I was FORCED to take medicare. It was part of the settlement REQUIRED by the insurance company. Which I thought was really stupid. I thought I would never ever need medicare in the mix. I had 2 golden policies. why do I need medicare?! The SSDI folks said it was required by the terms of my retirement.

#1 as long as the husband remained working HIS insurance now went to the head of the line as primary. My Medicare remained 2ndary. no biggie right? As long as he or I were working. Medicare stayed in the back ground.

#2 the minute the DH retired Medicare went to the head of the line, and became my primary. Now if medicare wont pay even a penny my Golden policy wont either. I have 2 golden or cadillac programs, but Medicare goes first, then mine, then my DHs policy.

PLEASE ask the SSDI folks. If you are UNDER 62 you CAN turn it down, BUT it WONT be offered to you again till you are at least 62 years old. So, if you decide to walk away, no matter the reason, it could leave you without any insurance. As long as your DH works, HIS insurance will stay at the head of the line. So, if you are already using him, then medicare would stay behind you as the 2ndary till he retires.

Does that make sense? Clear as mud?

Medicare A is automatic at 24 months after you start receiving your SSDI payments, 29 months total and it is free. You pay for Medicare B, about $96 per month now, but can deny it. You must have proof of creditable drug coverage if you pass on Medicare D, equivalent to Medicare D.

There are no age restrictions on SSDI for Medicare.

It can be very confusing, but once you understand things it is fairly easy.:rolleyes:

Sheesh...how are we who are cognitive deficient supposed to understand all of this?
My DH is hopind (and dreaming) of retiring in 2 years...I think he has to use his regular insurance until he hits 65, yes?
His company has really good insurance coverage. So I'm hopeful that he won't have to have Medicare until the traditional retirement age...

Thanks for all the info...I'll keep tuned in...

I applied for SSD in '99, finally got approved in '01 with retro payment to back when I applied. So since I got retro I was automatiaccly approved for Medicare because it had been the required months wait. My husbands insurance was always primary and Medicare secondary. I loved it because the Medicare always picked up almost all of any copayment for anything. Now of course I am on just Medicare but many of the insurance compaunies provide the Medicare advantage plans. Yes you have the Medicare D prescrption coverage on those plans but without it I would have no coverage except what prescrption coverage I can get with AAA. Yes, I said AAA. It can save a lot of money! These two months will be tough with paying 100% until I pay $4500. But you just have to prepare for it. Hopefully it won't be difficult to do this. Also I can fall back on my AAA. But I'm not going to do that because I want to get out the gap quickly and get in to the catostrophic part of Medicare D of which most of my meds will be dirt cheap.

Insane, Ridiculous - Absolutely
 

Dejibo & Wkikta. Thanks for clearing that up. I took my info from someone I talked to at Social Security, but am slowly learning it is better to find the answers myself. It’s most likely I was so angry to find out that I qualified as Disabled, but did not qualify for Medicare I may not have understood the person at the other end of the phone.

So angry, in fact, I did research the 24-month waiting period (when I probably should have researched the ‘choice’ of Medicare). I could not believe some of things I discovered.

For one thing, while SSDI recipients must wait 24 months for Medicare, SSI recipients qualify immediately for Medicaid. SSI recipients are one of the federal ‘Mandatory Eligibility Groups’ for Medicaid, but SSDI is not.

The "Ending the Medicare Disability Waiting Period Act of 2009", sponsored by Senator Jeff Bingaman (S700) and Rep. Gene Green (HR1708) would phase out the 24-month waiting period over a span of ten years, but both bills seem to be in limbo, until something is decided on health care reform.

Even the Act would span 10 years. Why not, just add SSDI as one of the ‘Mandatory Eligibility Groups’ now.

I found a great website and fact sheet about the Act, and wish I had enough posts to include links, but I assure you the quotes below are legit, and I will post links when I finally can.

I added the emphasis to ‘keep costs down’, because it ties in to the following from Social Security’s website. This can be found on a page titled “Full Retirement Age is Increasing”.

So, you would think that with the full retirement age increasing, so would the age for Medicare Eligibility. At least that is what I thought. I was wrong. This from Social Security’s Medicare FAQs.

What am I missing? Could they not afford Medicare for all of us with Disabilities if they raised the Medicare eligibility age to 67 as well? And, the 1972 legislation referenced 'still receiving benefits under a private group plan'. I don't know if it was true then, but it certainly isn't true now. Yet, people still employed past 65 are most likely still insured under a private group plan, but if you look at the Medicare FAQs, they actually encourage them to apply when they turn 65. I just don't get it.

I really have to wonder if our legislators might be in violation of their own ADA Act.

Please forgive the rant. This has been one of my hot buttons.

Great Question!
 

I just got Medicare via SSDI. I had the option of refusing Medicare but a salesman who sells supplements told me if I refused it I could not get it until I'm 65.

Now that I've learned about Doughnut Holes in Part D Rx plans, it appears that it would be more cost effective for me if I got a plan through the Affordable Care Act aka Obamacare. When I called Medicare about opting out, I was told that since I did not decline in when first eligible, I CAN'T GET OUT of Medicare. They take $200 out of my SSDI check for Medicare and now I'm in the maze of trying to pick a Part D plan with a formulary that includes all my meds AND a Medicare Supplement. Its really confusing and makes me angry that I cannot opt out of Medicare.

Any guidance appreciated. My brain doesn't work Luke it used to. I think its the Gabepentin.

Yes, it is a comedy of errors that people who frequently have cognitive dysfunction have to negotiate these complex rapids thought. When I applied for SSDI I was more cognitively impaired than I am now, simply from a long period of exhaustion, having tried to work and function normally long past the date when I couldn't do that. It saved me that my husband was working and still had an insurance plan that covered me, even after my Cobra expired. And it did take 3 years to get SSDI, so by then I was eligible for Medicare. Medicare plus my husband's Secondary was excellent coverage, I cannot complain in that respect. If only it had covered dental, which now absorbs about 20% of my gross income. But in general I did OK. I cannot imagine how people can maneuver who have no other income or insurance in the family.
And my application for SSDI was lost twice, then found by my congressman's office in Washington DC.
As I said, all this happening to a person with cognitive impairment makes one realize how hard it is for people who were disabled all their lives, how hard to learn and cope.

Two different things
 

Medicare and Medicaid are two different things. Income and asset levels are used to determine if one is eligible for Medicaid. Medicare is for those 65 and older OR approved for disability.

When you file for disability (SSDI), you are also given an opportunity to also file for supplemental income (SSI).

Hope this helps some.

Not offerred SSI
 

I believe I was told I could not get SSI. Why might that have been? Because I am not in my 60's maybe?

Income and Assets
 

SSI is based on income and assets owned, NOT age.

Medicare Website
 

You should check out the Medicare.gov website. I believe there is a PENALTY for failing to take Medicare when you are eligible if certain circumstances exist. Too many if's and's but's to write the info. As with all government things, it is never simple. Never simply a YES, NO.

It is not the meds........ it is the policy that is so confusing. :)

Folks, this thread is 2 years old. Laws may have changed.

Its easy to get confused on WHEN you get Medicare after being granted SSDI. Its 2 years from the day you FIRST APPLIED for ssdi. In my case, I applied for SSDI and was denied. I applied again and was approved. This was over the course of 2 years. So when my approval came through, my waiting period for Medicare had also been met. I got it pretty much along with my first check..............which I got within 10 days. Again, if you apply and are denied....you are still going through all waiting periods if you are later approved.

For those approved right away.....they wait for their first check and they have to wait to receive Medicare.

Medicare is always primary and I still have Hubby's insurance (BCBS) so it becomes secondary and pays for most things Medicare does not. I haven't had any issues with doctors so far. Sometimes they will say they take Medicare, but do not accept what it pays.......so I have more of a cost share.
However, with the new healthcare law in place and cuts to Medicare....I can not speculate what will happen in the future.

How often do you go to the doctor through out the year, I mean any doctor
 

My sister and I were discussing health insurance tonight. I have a completely different need for insurance than she does but like my husband, she is right and I am wrong. She has a policy that doesn't have a Medicare D added to it but she doesn't pay for any tests or doctor visits. No she buys a separate drug plan that costs a good size premium and then also pays a lot for premiums yet she is on a lot of tier 3 and 4 drugs. She thinks it's silly I pay a lesser premium for my plan and have to pay for doctors and labs/xrays. She says she has to see her doctor every 6 months because her liver enzymes are high. Hers are high die toexcessive Tylenol use. Well so are mine but I'm on Avonex and they are expected to be somewhat high but my neurologist has an 'acceptable high'. I don't need to see her every 6 months. I just get lab work. Her PCP sees her every 4 months because of hypertension. I have hypertension also, I see him during my annual physical. So what is the norm???

Frequency of doctor visits???

That depends on the doctor and on the patient. Even if you have the same conditions as another does not mean the frequency of care need be the same.

Example: I have the same condition as a friend. My doc wants to see me every 3 months to monitor it. My friend sees the doc once a year for the same condition.