SSDI/Medicare...When?

[dp1969]

I apologize, I know this has been discussed frequently, but I could not find an answer.

Facts:
1. I was diagnosed in June [arm onset], progressing rapidly
2. Currently working full time, estimate thru March 2011
3. 3 month STD plan thru work [70%]; LTD plan thereafter [70%]; catastrophic supplamental plan to provide remaining 30% when eligible.
4. Will continue to be an employee for 52 weeks following start of STD; therefore maintain health ins. benefits thru work at employee premium level for that 52 week period.
5. STD/LTD plan insurer will require application for SSDI benefits when STD is applied for, benefits will be reduced for SSDI amount.

Questions: when should I apply for SSDI/Medicare? What is the waiting period for SSDI...does the first payment include a catch-up payment for the waiting period? Given I have private insurance...should I apply for Medicare at the same time? When can I apply for Medicare if I defer at the time I apply for SSDI? What is the out of pocket cost for medicare [premiums?]?

Any help is appreciated.

Dan

 

[Lavender Lady]

Hi Dan,

I quit work after my diagnosis and immediately applied for SSDI/Medicare and was approved 1 1/2 months later. There is a five month waiting period from my last day of work. I do not know if it will be retroactive or not. The new law with SSDI and our diagnosis is it is an automatic approval as of DEC. 12th 2010. You can find this on their web site. I would suggest you talk to your Social worker with the ALS specialist you are seeing and ask them when you should apply.

Best of luck to you, and hopefully I was of some help.

 

[sadiemae]

You can not get SSDI until you are no longer employed. You can work and get SSDI, as long as you make no more than around $800 a month. They do not pay anything retroactive unless you made less than $800 a month. The out of pocket for just basic Medicare (Part A and B) is around $100 a month, which is deducted from your SSDI payment. After you apply, you will be approved immediately, however, you wait 5 months before Medicare kicks in, and 6 months before you receive a payment.

 

[Katie C]

We applied for SSDI at the time that Glen transitioned from STD to LTD. There is a five month waiting period. They considered his last day of work to be the start of the 5 months, even though he was collecting company disability and state disability during that period. Medicare came automatically with the SSDI. Starting the application sooner rather than later is a good thing as there is a LOT of paperwork... the online application works well because you can work on it then come back to it at another time. ALS is on the "compassionate diagnosis" list so if the paperwork is filled out and submitted there shouldn't be a problem with approval.

 

[AKjo]

My husband was diagnosed 9/1/2010. He was retired, but working part time for a couple of years, and sort of "cycled" between COBRA and regular insurance depending on how many hours he had worked (135 hours would give him another month of insurance coverage.) Due to his increasing weakness in his leg and lack of balance (climbing ladders was necessary for his work), he had not worked since May, so his SSDI kicked in 11/1/2010. That process actually went very smoothly after applying, but YES, there was a lot of paperwork. At the time that SSDI was approved, you are automatically put on Medicare by the system. As I understand it, there is no opting out. What we did not realize is that since he was on COBRA insurance at the time that the application was made, COBRA was immediately discontinued when he became eligible for Medicare. We didn't even think about that possibility, and assumed that we had another year of COBRA insurance left. We thought Medicare would be primary for him and COBRA secondary; and COBRA would still be available for myself and our college age son, who was still covered on our policy. In the middle of November, we learned from our insurance company that we were no longer covered, so have been scrambling to figure out an insurance plan for me as well as Medicare Part D for Gary. We had just had 3 month supply of medication refilled before we learned of this, so are kind of wondering when the bill for the Rilutek (and a few others) will come back to haunt us. I'm sure COBRA is not going to just pay for it out of the kindness of their heart.

This got pretty long winded! I hope it makes sense. My point is this: make sure your current insurance doesn't automatically disappear when you are granted SSDI, and therefore Medicare. (I'm thinking that what you call LTD might work the same as as COBRA.) If we had known, we could have had a better plan of action. Since Gary had the same employer and the same insurance company for 28 years, we were really spoiled and clueless about any other types of insurance. We really took for granted that it would always be there until age 65. If you are on Medicare under the age of 65, it is also hard to find Medicare supplements who will accept you. I'm curious about what others have done about that. Is it worth it/necessary to pay for a supplement? How about Part D?

 

[Katie C]

For what it's worth.. .when Glen was on long-term disability, his company still made Kaiser available to us, though at a high out of pocket rate. I still have to call the death-benefits office to find out where I now stand. (At the moment my Kaiser is still active). Also, his company paid for an agency that actually did all the paperwork with Social Security for us, handled all the phone calls, etc. They were a godsend. You might check with your company's benefits office to see if they offer something like that.

 

[halfin]

I am in a similar situation, still working full time but probably only for a few more months. One thing I would add, with our LTD plan there are two options, pay tax now on the premiums vs pay tax later on the benefits. Apparently it only matters what you chose last time when you go on disability. So ideally you do the second choice until the year you will be disabled, then switch to paying taxes on premiums the year you will become disabled. Of course most people couldn't time it like that, but ALS sometimes makes it possible.

It can make a big difference in your LTD income.

 

[Miss]

The thing I found shocking was that our LTD subtracts not only SSDI payments for my husband, they subtract the amount my son receives. This leaves VERY little that the LTD insurance company has to pay.

 

[dp1969]

thank you all for the insight.

Hal I am a tax accountant and yes that's correct regarding taxes...my employer does not allow me to pay my own premiums, so I am on the hook for income tax. FICA is also applicable, but ony for a max of 6 mos while on disability [generally 7.65% and can add another large bite out of that income].

Hal - have you applied for SSDI/Medicare yet?

Thanks again.

Dan

 

[dp1969]

Hal -
one other item, not certain the rules are based on who pays the last premium...I believe there is some form of proration, but I could be wrong [not my area of expertise].
Dan

 

[Will]

Akjo said
"COBRA was immediately discontinued when he became eligible for Medicare. We didn't even think about that possibility, and assumed that we had another year of COBRA insurance left. We thought Medicare would be primary for him and COBRA secondary; and COBRA would still be available for myself and our college age son, who was still covered on our policy. In the middle of November, we learned from our insurance company that we were no longer covered....."

I am a dependent on my partners current health insurance and he is going on Medicare April 1. I was planning on going over to COBRA at that time. Surely my COBRA will still be available when he goes to Medicare, won't it? I am totally screwed if I can't get the COBRA, cause I am 63 with some meds. Am I reading this right?

 

[AKjo]

Right about now I am sorry I posted this yesterday. We have been stewing and pulling our hair out for weeks trying to figure out new insurance for me, as well as Medicare Part D and maybe a supplement for Gary. Guess what?! A representative from his insurance before Medicare called today and said they had come up with something that would keep us both insured under their plan. I couldn't believe the timing: just yesterday I got an email confirmation that my Premera application had been accepted; and we sent the enrollment form (along with a check) to the state for their Medicare Carveout plan for Gary. So, today was another day spent trying to decipher stuff that they emailed us to get back into the system, plus writing letters to cancel the applications we just completed yesterday. It is amazing how much time these things can eat up.

I am grateful to continue on the old plan, as it has a low deductible and was always user friendly, and I have always found the insurance employees to be very helpful. I just would have liked for them to figure it out sooner. So.... the answer to your question is that you will probably be OK with continuing with COBRA. I would start researching now though, and remember, COBRA coverage is limited to 18 months. You will need to do something else in the future. In Gary's case, I will be able to roll over to another retirement policy they have, but for now, COBRA is the less expensive option.

I apologize for posting incorrect information. Until today, I didn't know.

 

[halfin]

Dan, I haven't applied for SSDI yet. I imagine I will end up doing similar to what you said, applying when I go on STD. Although actually in my situation it might be better if I can wait. The SSDI won't help as the LTD is reduced by that amount. And i won't need Medicare because I have to keep COBRA so my wife has insurance. My COBRA coverage is better than Medicare, at least for equipment: it pays 90% vs 80% for Medicare. But I suspect the disability insurance will pressure me to apply for SSDI.

 

[Miss]

Hal, our STD/LTD company required us to file for SSDI. They would only pay the difference. We did not lose any medical insurance benefits when LTD started. We still only pay the company/employee rate -family of 4, full coverage including vision and dental, low deductible for $236 bi-weekly. I was amazed.

 

[dp1969]

Hal/Missy -
Thanks. maybe we should do this thru pm, but my concern is if I apply for SSDI at the time of STD, will STD reduce payments for the 5 month SSDI waiting period or better answer, they are reduced only when SSDI benefits begin to get paid...I don't want to end up with a 5 month period where benefits are reduced below 70% in total.
I will be forced to apply for SSDI by my STD ins company as well.
Hal - have you thought about having medicare as primary/private ins as secondary?
Thanks again,
Dan