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Old 08-20-2010, 05:02 PM   #1
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Post Approved! Questions about Medicare and backpay......

Hi all! I know I'm a newbie but I'm definitely not a stranger to these types of boards. Some of you know me on Neurotalk as cherry33778. For those of you who don't here's my story from Neurotalk:

I was diagnosed in June 2008 with Myasthenia Gravis and I have been on oxygen since September 2007, a rare constant symptom of MG.

I applied on August 4, 2008. I believe my first denial was around October/November that same year. I then hired an attorney Novenber 2008. My second denial was around Spring of 2009. We then filed for a hearing on May 1, 2009. I was really surprised when I got a notice in April 2010 that my hearing was going to be May 26, 2010.

On the day of my hearing I was met by an attorney that I had never met, my guess is that something happened to my attorney and he could not be there that day. This attorney seemed somewhat familiar with my case and he "prep'd" me before going into the hearing.

When I entered the room there was a long table that covered most of the room. The judge was seated at the head of the table that was closest to the door with the reporter on his right and the vocational expert was to her right. My attorney was seated across from the VE and to the left of the judge. I had to sit at the end of the table all by myself which I must say was kinda scary.

After my lawyer asked me questions such as my symptoms and limitations, the judge then asked me questions like what I go through on a day to day basis. After those type of questions he then started asking me about my previous employment, my wages, did I quit my job, etc.

A little background...I worked as a part-time supervisor at UPS and was terminated. Since my termination was unfounded I was award unemployment. According to Florida's unemployment it is not neccessary to look for full-time work and since I was not employed full-time prior it wasn't even expected. Even though I did look for part-time work I was always passed over, assumability because of medical reasons.

The judge then stated that since I received unemployment he would award me right then if I changed my onset date to January 1, 2010 giving up 28 months of backpay and medicare eligibility. He excused me and my lawyer so we could talk about it. My lawyer pretty much told me it was up to me, but I needed to know that if I changed (amended) the onset date I could not reverse it, and the judge may still amend it himself. I told him absolutely not, according to the law I did not do anything wrong.

We went back into the room and my lawyer told the judge No, I did not want to change my onset date. My lawyer then stated that he would argue that I was not trying to get substantial gainful employment. The judge then asked me why was my onset date in September 2007 when it showed that I had worked until June 2008. I told him that it actually was not the case. My job, as part of their benefits package, gave me my full salary while on short-term disability. I had returned to work at the end of February of 2008, but had to stop the first week of May 2008 and UPS then paid me short-term disability until June 2008. My lawyer then stated that he would argue that it was an unsuccessful work attempt.

After that I believe he asked me one more question then we moved on to the vocational expert. He asked her three question by which she answered No to all and stated that there were no jobs in the national economy that I could work. The hearing was then concluded and the judge said that I would receive a decision by mail.

On the way out my lawyer said that he was happy that I refused to amend the onset date and that he was optimistic.

So, over 2 months later I finally get the FULLY FAVORABLE decision. The total wait time was 1 year, 51 weeks and 1 day. August 4, 2008 to July 29, 2010.

I have seen that many ALJ's are now trying to "deal or no deal" these decisions if claimants agree to amend the onset date, but I feel that my life is not a game show. I understand many people are in dire straits, but giving up the entire backpay is outrageous.

In conclusion, do not let the wait defer you from filing and don't just settle even if the decision is "in the bag." Also, do not believe other people when they tell you that you cannot receive unemployment while waiting for SSDI. As long as you are looking for part-time work, and as long as that is the minimum requirement in your state, you CAN receive it. Just keep your ground with the judge and have your lawyer argue that you were not, nor required, to look for substantial gainful employment.

I have heard countless times that my age, being only 26, it was going to be almost impossible, but as you can see it wasn't.



Now my questions......

1. My monthly benefit is $926 and to qualify for medicare QMB it has to be under $923. I would like to know if ANY of you have had a similar problem and the state made an exception or if they are strict with those income limits?

2. After receiving SSI backpay how soon will I receive SSDI backpay?

3. When you received your first check did they automatically take the retro medicare premiums? See, I was fortunate enough to get my oxygen supplies, medication, and doctor visits for free so I do not have any bills since January 2009. My medicare eligibility date is March 2010. If I knew that I was going to have to pay for insurance then I guess I would have used it but since I didn't should I still have to pay 5 months of part B premiums?

Thanks in advance!

Last edited by Administrator; 11-03-2012 at 02:23 AM.

 
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Old 08-20-2010, 10:08 PM   #2
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Re: Approved! Questions about Medicare and backpay......

I may be wrong since it's been a few yrs since I started receiving my disability but yes, they take out the retro pay out of your first check. I remember them taking out for 4 or 5 months for Medicare Part B.
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Old 08-20-2010, 11:20 PM   #3
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Re: Approved! Questions about Medicare and backpay......

If you are awarded SSDI, then it doesn't matter how much your SSDI beneit is, you are still eligible for Medicare. Medicare is offered as soon as you have reached two years of SSDI benefits. So if your date of onset was June of 2008 then Medicare would begin June 2010. I wasn't quite clear as to what the date of disability onset was as determined by SSDI.

If you are now eligible for Medicare you are given the option to enroll. Only once you enroll can premiums be deducted.

As for SSI, if you received SSI during a period when SSDI would have been payable than that is calculated when your back pay is processed.

For example, if SSDI should have begun May of 2008 and each month you should have received $1000 in SSDI, but you were getting $200 in SSI from May 2008 through present, they'll deduct $200 and pay you $800 for every month in which you would have received SSDI.

You may find more at

www.ssa.gov
www.medicare.gov
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Old 08-21-2010, 12:48 AM   #4
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Re: Approved! Questions about Medicare and backpay......

As stated earlier, I was eligible for Medicare March 2010. I just don't understand why they take retro premiums when I did not use them. For goodness sakes, I'm not a mind reader! If I had a crystal ball I would use it to figure out what the next Powerball numbers will be, lol.

I would understand if it was an option for people who did have medical bills, but a requirement that's just nuts! It's not my fault that the state of Florida is inadequate and slooow.

If I had known that I would be approved then I would have seen my pulmonologist which I haven't seen for 2 years!

For some of you $553 is not a lot of money but's MY $553 that I could DEFINITELY use. I guess I could call social security on Monday to see if this money can be given back to me.

 
Old 08-21-2010, 06:40 AM   #5
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Re: Approved! Questions about Medicare and backpay......

Quote:
Originally Posted by princess9483 View Post
I have seen that many ALJ's are now trying to "deal or no deal" these decisions if claimants agree to amend the onset date, but I feel that my life is not a game show. I understand many people are in dire straits, but giving up the entire backpay is outrageous.
I agree that many ALJ's are trying to get amended onset dates in exchange for a fully favorable decision. In my case I was only giving up 7 months back benefits in order to be ensured a fully favorable decision on the spot. To both myself any attorney it was a 'no-brainer' to accept that outcome, especially since the judge in question usually did not like to offer more than a year in back benefits, and in my case it he was giving me 2 years.

So yes, I did lose 7 months of back benefits, but I had to factor in the cost of possibly being denied and then waiting up to 2 more years to get to an appeal council, and also the amount of money per month that I would have been getting during that time and going forward, with the possibility of ending up with nothing after all that additional waiting in order to recover 7 months of benefits. Obviously in my case I wasn't giving up the entire back pay, but even if somebody was going to have to do that, there might be circumstances in which accepting such an arrangement would be the prudent thing to do. A good attorney who specializes in SSDI will be able to help their client in making that difficult decision, based on their knowledge of the judge in question and the state and ODAR in particular.

It offered me immediate emotional relief to know that I was going to be receiving my benefits sooner rather than later or possibly not at all, and I don't think I can put a price tag on that. In the end each individual person is different and must weigh their present circumstances and the guarantee of benefits going forward versus the possibility of getting nothing. Good for you for sticking with your guns and not giving up your back benefits. I'm glad I didn't have it come down to that much money being left on the table in my case. I don't know if I could have played that game of 'chicken' against the system without losing my mind!

 
Old 08-21-2010, 07:06 PM   #6
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Re: Approved! Questions about Medicare and backpay......

I agree with you Princess, I also wanted the money they took out for Medicare. Nobody ever asked or gave me a option to accept or not accept the Medicare.
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Old 08-21-2010, 10:09 PM   #7
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Re: Approved! Questions about Medicare and backpay......

My experience seems to be different. I received a letter asking me if I wanted to "buy" Medicare for the prior months. Since I already had good insurance and didn't want to fool with re-filing everything from the past couple of years with Medicare and getting all the payments swapped, I declined. Also, I would have still been out my very expensive Blue Cross insurance payments, so it wasn't worth it to me. This was in 2008, so perhaps the rules have changed, but I definitely got a choice in the matter.

Going forward, now, that's a different story. Back then, once you qualified for Medicare, most insurance plans made you take it. I think the rules changed this year, and vaguely remember reading that some people got to keep their regular insurance with no penalty.

Last edited by roses4lace; 08-21-2010 at 10:12 PM.

 
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