SSDI => Medicare

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Jerilynn
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SSDI => Medicare

Post by Jerilynn » Fri Mar 08, 2013 1:16 am

I have a friend that has been disabled for about 7 yrs. She just recently got approved for SSDI. She's 51. Normally, after one is on SSDI for 24 months, they are automatically enrolled in medicare regardless of age.

My question:
since she's been disabled for 7 yrs, can she qualify for medicare immediately and not have to wait the 24 months?
Cordially, Jeri . . . 100% all natural asset allocation. (no supernatural methods used)

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ObliviousInvestor
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Re: SSDI => Medicare

Post by ObliviousInvestor » Fri Mar 08, 2013 8:26 am

It looks like this is the POMS section that provides for health insurance for people entitled to disability benefits:
https://secure.ssa.gov/apps10/poms.nsf/lnx/0600801146
ssa.gov wrote:In most cases, D-HI entitlement begins after an individual has been entitled (or deemed entitled) to disability benefits (DIB, DWB, or CDB) for 24 months, i.e., D-HI begins with the first day of the person's 25th month of disability benefit entitlement.
So the key is finding out the date on which your friend was first "entitled" to a disability benefit.

This looks to be the relevant POMS section for that:
https://secure.ssa.gov/apps10/poms.nsf/lnx/0410105060

Edited to add: Just to be clear, I don't know anything about this really. I'm looking it up for the first time.
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Penguin
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Re: SSDI => Medicare

Post by Penguin » Fri Mar 08, 2013 9:12 am

I just looked it up myself.
It appears that disability entitlement can be retroactive for 12 months: https://secure.ssa.gov/poms.nsf/lnx/0410105015
An application for DIB may establish entitlement for any month in which the NH meets all of the eligibility requirements in DI 10105.005 up to 12 months before the month the application is filed.
I would guess that one is eligible for Medicare 24 months after that retroactive date.
Jon

mur44
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Re: SSDI => Medicare

Post by mur44 » Fri Mar 08, 2013 12:28 pm

The date that she is disabled (Disabled date) as per SSDI approval letter determines
Medicare eligibility date.

The actual disability duration does not have any effect on Medicare eligibility.


Disclosure: I am a Certified Volunteer Medicare Counselor from NJ

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Jerilynn
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Re: SSDI => Medicare

Post by Jerilynn » Fri Mar 08, 2013 2:57 pm

Ok, let me see if I understand this....


Here are the facts:
She was disabled in actuality on Sep 2009. The SS folks determined that her disability date was Sept 1, 2011, but they did not determine that until about a month ago, (she got back benefits)


Based on this, she should be automatically enrolled in Medicare on Sept 1, 2013. Is that correct?


2nd question,

What does she have to do in order to get the SS folks to move her disability date back to at least March 2011? If she can accomplish that, she would be eligible for medicare right now, yes?

Thanks. (I'm currently on hold with the SS folks, but I'll betcha a pizza I get an answer from the bogleheads before I get an answer from the SSA. ;)
Cordially, Jeri . . . 100% all natural asset allocation. (no supernatural methods used)

Penguin
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Re: SSDI => Medicare

Post by Penguin » Sat Mar 09, 2013 10:10 am

Jerilynn wrote:Ok, let me see if I understand this....


Here are the facts:
She was disabled in actuality on Sep 2009. The SS folks determined that her disability date was Sept 1, 2011, but they did not determine that until about a month ago, (she got back benefits)


Based on this, she should be automatically enrolled in Medicare on Sept 1, 2013. Is that correct?


2nd question,

What does she have to do in order to get the SS folks to move her disability date back to at least March 2011? If she can accomplish that, she would be eligible for medicare right now, yes?

Thanks. (I'm currently on hold with the SS folks, but I'll betcha a pizza I get an answer from the bogleheads before I get an answer from the SSA. ;)
Did you win a pizza?
First question. I think you are correct.
Second question was answered by Oblivious Investor:
DI 10105.060 Requirements for Entitlement to a Disability Insurance Benefit (DIB)

A number holder (NH) is entitled to DIB as of the first month in which all of the following requirements are met:
DIB insured status (RS 00301.120); and
A valid application has been filed (GN 00204.001); and
The NH has not attained full retirement age (FRA) or age 55 for certain blind cases (See DI 10105.080); and
Is disabled (DI 10105.065); and
Has served a waiting period or is exempt from a waiting period (DI 10105.070). Also see DI 10105.015 for additional requirements for benefits payable prior to 9/65.
I am guessing that a valid application was not filed before Sept 1, 2012. If it was then perhaps you can move the disability date back to one year before the application date.
Is that what the social security office told you?
Jon

apk
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Re: SSDI => Medicare

Post by apk » Sat Mar 09, 2013 10:39 am

Another issue for your friend to consider is health insurance for what Medicare does not pay. Typically, Medicare pays 80 percent of the bill. Your friend would pay the other 20 percent. Your friend could choose a Medicare supplement, but she won't have much choice until she is 65. For some reason there are not many supplement options until she is 65. Then, she can choose any supplement she wants.

Normally, I don't like Medicare Advantage plans, but in this instance a MA plan might be your friend's best option. Most MA plans include prescription drugs. If she doesn't want a MA plan, or if the one she wants does not cover prescriptions, she would be eligible for a Part D (prescripton drug) plan.

She could, of course, self-insure paying the cost not paid by Medicare. And she could pay for her drugs out-of-pocket.

I hope this helps. Lots of people who receive SSD and become eligible for Medicare think Medicare covers everything.

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Re: SSDI => Medicare

Post by LadyGeek » Sat Mar 09, 2013 4:03 pm

This thread is now in the Personal Finance (Not Investing) forum (insurance).
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stjoe56
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Re: SSDI => Medicare

Post by stjoe56 » Sun Mar 10, 2013 12:37 pm

I agree with APK. I will qualify for medicare on 5/1/2013 through SSDI. I recently went looking for a medicare supplement plan and only two would sell me to me. Both were Medicare advantage plans. One was an HMO and the other PPO. I went with the PPO even though it was the most expensive, $205 per month, because with my drugs it was middling expensive and all of my docs were on it.

If your friend is sick enough to qualify for SSDI, she needs an Advantage Plan.

SJ

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