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Old 02-08-2011, 04:57 AM   #1
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medicare and supplemental insurance

i am on ssdi now, under 65, when i become eligible for medicare what is the time limit for purchasing supplemental insurance? i have been told it is 90 days, if i miss that window is that it until i am 65? if not when can i purchase.

Last edited by lemonfl; 02-12-2011 at 07:34 AM.

 
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Old 02-08-2011, 07:19 AM   #2
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Re: medicare and supplemental insurance

I was wondering myself . Did you get something in the mail that you were eliable for it ? thats a vedry good question hope someone can answer it because a lot of people are probly wondering the same thing. Good Luck to you.

 
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Old 02-08-2011, 04:43 PM   #3
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Re: medicare and supplemental insurance

You can sign up for supplemental plans in the 90 before and the 90 days after you get Medicare. If you miss that deadline, they you have to wait until the annual dates where anyone on Medicare can change their insurance. For supplemental insurance(often called a Medigap plan), I believe it's Nov 15th to Dec. 31(also the change time for Part D drug plans) but if you have an Advantage plan(Medicare part C), you also have Jan 1 to March 31st.

They used to penalize you as well if you didn't do it right up front but that may have changed with the new reforms. I know they did for Medicare at 65 but not sure about Medicare with SSDI.

Jenny

 
Old 02-08-2011, 06:29 PM   #4
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Re: medicare and supplemental insurance

lemonfl: You will be eligible for Medicare after you have received 24 months of SSDI regardless of your age. What was your benefit begin date?

Benefit begin date is not the date you get approval or first check, but it's the date you would have been eligible for SSDI. For example, if you were just approved for SSDI and got your first check in January 2011, but SS says benefits were due as of September 2009, then you will be eligible for Medicare in September 2011.
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Old 02-08-2011, 06:46 PM   #5
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Re: medicare and supplemental insurance

if you are simply looking for a medicare supplement(to cover the 20% that medicare allows but doesnt pay)there is no time limit. the time limit applies to those seeking a meicare replacement like a medicare advantage plan-like i have; i opted for humana medicare ppo because it covers alot of things regular medicare doesnt; it also covers medicare d(prescriptions)but humana has a better rx plan than just medicare D. that is wher the time limits apply i believe you had from(i think) oct thru

- dec 31,2010 to opt for a meicare avantage plan iiand there were alot to choose from-i believe i made a good choice in picking humana ppo medicare; its called "humana CHOICE (regional ppo)a medicare health plan with prscrition drug coverage)my benefit or loss date was 1/272007 so i had well surpassed the 2 year wait for meicare to kick in.i also rec'd backpay from 7/272007 thru oct 2010-got 1st reg ssdi ck sept 2010
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Last edited by BB07; 02-08-2011 at 07:03 PM.

 
Old 02-08-2011, 07:29 PM   #6
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Re: medicare and supplemental insurance

BB07: good information. I never realized Medicare advantage and Medicare supplement were different. I know I'll want an advantage plan, sounds like that works more like a traditional PPO or HMO plan. Am I right? I'm worried about expenses and surgeries under Medicare such as having a harder time getting surgeries or treatments approved. If SSDI is approved I'd be eligible for Medicare in Nov 2011 (my employer insurance requires Medicare be chosen and be primary when I am eligible.)
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Old 02-08-2011, 09:04 PM   #7
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Re: medicare and supplemental insurance

If one receives a government disability (not SSDI) would one be eligible for medicare after the 24 month period?

 
Old 02-08-2011, 09:26 PM   #8
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Re: medicare and supplemental insurance

Quote:
Originally Posted by Stella052 View Post
If one receives a government disability (not SSDI) would one be eligible for medicare after the 24 month period?
I know in CA, A person on SSDI and has medicare, they can also have the government disability at the same time. In CA it is called Med-Cal . I believe it has to do with how much money you recieve a month to be eligible for both.

 
Old 02-08-2011, 09:28 PM   #9
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Re: medicare and supplemental insurance

Medicare eligibility is tied to SSDI approval or SS retirement as all SS benefits are based on paying into SS via FICA and OASDI taxes. Some government jobs don't pay into the SS system and thus aren't eligible for SSDI, SSR, Medicare. Some people straddle the two by having eligibility for minimal SSDI and a government disability pension. Every year about 2-3 months before your birthday SS sends every eligible employee a multi-page document that outlines estimated. SSDI and SSRetirement.
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Last edited by SpineAZ; 02-08-2011 at 09:30 PM.

 
Old 02-09-2011, 07:02 AM   #10
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Re: medicare and supplemental insurance

Quote:
Originally Posted by Stella052 View Post
If one receives a government disability (not SSDI) would one be eligible for medicare after the 24 month period?

I was employed with the governmental agency for 10 years, therefore I do not have sufficient quarters to apply for SSDI. Prior to that, I did contribute into the social security system for over 30 years. I can draw on SSA reduced retirement at age 62. I'll have COBRA for 18 months with the possibility of extending that to 24 months. I'm just hoping that I don't have to wait until age 65 to qualify for medicare.

 
Old 02-09-2011, 08:14 AM   #11
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Re: medicare and supplemental insurance

Quote:
Originally Posted by Stella052 View Post
I was employed with the governmental agency for 10 years, therefore I do not have sufficient quarters to apply for SSDI. Prior to that, I did contribute into the social security system for over 30 years. I can draw on SSA reduced retirement at age 62. I'll have COBRA for 18 months with the possibility of extending that to 24 months. I'm just hoping that I don't have to wait until age 65 to qualify for medicare.
Per SSA.gov

Before age 65, you are eligible for free Medicare hospital insurance if:

You worked long enough in a government job where Medicare taxes were paid and you meet the requirements of the Social Security disability program;


If I am reading this correctly, since I did pay Medicare taxes these last 10 years, I should qualify for Medicare coverage after 24 months. My disability should meet the requirements of the Social Security disability program.

 
Old 02-09-2011, 08:29 AM   #12
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Re: medicare and supplemental insurance

First you must have an SSDI approval. If that takes 3 years then you are awardes Medicare 24 obtuse from the SSDI benefit effective date.

So in theory my SSDI should be awarded 10-01-09 and I would be eligible for Medicare 10-01-2011. But if I don't get SSDI awarded until 2013 I don't have medicare until 2013.
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Old 02-09-2011, 09:07 AM   #13
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Re: medicare and supplemental insurance

If you apply for SSDisability Insurance(SSDI) and are approved, then you become eligible for Medicare 2 years from the date of approval. There are rules regarding the approval date. It is in the 6th month after your injury or illness made you disabled. Example, I was injured in Dec 2006 so my approval was the following June 2007 and then Medicare would kick in 24 months later or June 2009 years on. You must be fully disabled for 6 months before they will even pay you a cent. After all, you have to prove you will be disabled for a minimum of another 2 years to even get SSDI. It's goal is to help you out after you've exhausted you short term or long term disability insurance from work.

Let's say you got hurt right now, today, and applied for SSDI today. If approved tomorrow, you would start getting checks in August 2011(in the 6th month after your injury) and Medicare would become available in August of 2013.

BUT those dates will stand even if you aren't initially approved and decide to appeal it. Let's say they deny your claim(70% are initially denied) and you appeal it. That takes time and it may take another 2 years(we'll use that as a time frame and as it is not far off from the reality). So you apply today and you finally get your claim approved in Feb. of 2013. They would keep your start date of August 2011 and you'd get back pay all the way back to Aug. 2011. But you still would not be eligible for Medicare until August 2013 so you'd have another 6 months to wait before Medicare kicks in.

So the sooner you apply, the sooner those dates get set in stone.

As for Medicare supplements...you have Medicare "parts".

"Part A" is the hospital insurance that we all get for free if we have paid into the system and it kicks in at age 65. Even if you didn't pay into the system, you can buy Medicare Part A from the government if 65 or over. It has deductibles and sets limits on how long you can be in the hospital or nursing home. Even sets limits on how long you can stay after surgeries such as 3 days for a knee replacement.

"Part B" is the out-patient insurance for doctor's appointments, tests and procedures. Everyone pays for that whether you are 65+ or disabled. The cost is set by income so if you have a spouse making a lot of money, you'll pay more than a single low income person. Right now, it's about $100/month. It generally covers 80% of everything except mental health care and that just rose form 50% to 55%. And it sets limits on tests.

"Part C" is what they call the Advantage programs and it is Medicare A and B done by private insurance companies and the you still pay the $100/month and the government sends it along to the company along with the money you paid in for Part A. The companies set the rules and payments. Their minimum programs must match or exceed what Medicare does. For even more money, you can get even better coverage. BUT..and it's big BUT, it may not cover if you go out of your state. Or you may have to pay out of state and then you'll get re-imbersed. But(another big but) if you live in a state where the docs get paid a low amount and go to NYC where they get paid a lot more money, you will get re-imbersed at YOUR state's rate and not the rate they pay for NYC docs so you can end up owing a lot if you travel.

Example of the above: Let's say you go for a second opinion for spine surgery(this is what I did and how it was charged). Here, in state, I was charged $200 for the initial appointment. Since the doctor was part of the Medicare Advantage Program, he agreed to take what Medicare and the Advantage program allows so he got $100 and I had no balance. BUT, when I went for a consult with a doc in NYC, he charged $600 for the same initial appointment. Although he was part of Medicare he was not part of that particular Advantage program so he got the same $100 my first doc got and I had to pay the balance of $500. Having the Advantage program is not considered having Medicare if you go out of the geographic area where the Advantage program is.

BTW, the government has vowed to raise the rates of these Advantage plans as the government is actually paying more for them than traditional Medicare and it has to start making it more equal. I know 3 years ago when I was starting to look for plans, the government was paying on average, $14/month more to supplement Advantage plans over regular plans and that has gone up. Soon the increases will be passed along to the consumer. So the price for these plans will be rising.

"Part D" is the dug plans. A mess unto itself.

Medigap(Medicare Supplemental Insurance) plans are not part of Medicare at all. They are plans put out by private companies that cover all or part of the 20% of doctors office visits and tests that Part B does not cover(it also has deductibles). Many also offer coverage for the deductibles that are in Medicare Part A. Medigap may cover or extend those limits on how many days. There are many different policies you can get, all set by the government but the prices are set by the company. They are listed by "type" as in type A, type C type F, etc.on the government site. When I asked my insurance agent what the main difference was between the companies that offer these plans, his response was who would pay easily or and who you had to fight to get payment. So you may end up picking a company who gives a low price but you may have to fight for every single payment. Or you might pay a little more and have no problems getting everything paid for. I found a general insurance agent great for telling who was good and who was a pain in the backside.

Medigap goes through the country, no restrictions on where you go for care as long as the doc takes Medicare. If I go to NYC, it pays those docs at NYC rates and if I go to Florida, it pays at Florida rates. You can get Medigap plans that will pay for out of the country care too up to a certain limit should you be the type who likes to travel. I have a plan that pays 100% of my co-pays and deductibles for both hospital and doctors and tests.

Know this has been long and technical but I spent months looking into all of this. And changes are coming. But this a baseline definition of what the types of coverage are.

Jenny

 
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Old 02-09-2011, 09:34 AM   #14
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Re: medicare and supplemental insurance

[QUOTE=jennybyc;4680461]If you apply for SSDisability Insurance(SSDI) and are approved, then you become eligible for Medicare 2 years from the date of approval................................ ........................................ ...................

So, even though I know I do not qualify for SSDI benefits (not enough quarters), I should apply anyway?

 
Old 02-09-2011, 09:57 AM   #15
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Re: medicare and supplemental insurance

Have you asked Social Security if you qualify for SSDI? It has to do with quarters but they don't all have to be worked recently...only a certain amount of them.

If they said you don't qualify then you don't qualify for Medicare either, until you are 65.

Social Security is a retirement program with Medicare for those 65 and older. Social Security Disability Insurance is a separate program that you pay into through Social Security in case you become disabled. You don't pay in, you don't qualify. They are NOT the same programs. It would be as if they offered you long term disability through work and you declined the coverage. No pay, no get. You get your retirement and medical benefits when you reach a certain age regardless of health. For SSDI, you must be under 65 and prove you are going to be disabled for at least the next 2 years.

If you get SSDI, it becomes regular Social Security when you reach full retirement age.

So if you don't qualify for SSDI due to non-payment, you can't get Medicare either so no point in applying.

Jenny

 
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