I'm 45 years old and need some basic information about how Medicare, not Medicaid works. I heard it consists of parts and that's about all I know. How much does each part cost? If I get approved for social security disability for a condition that began almost 4 years ago, and I made my application 4 years ago, when do I get to purchase this insurance? Does it work like regular insurance policies?
You have to be on disability for 2 yrs before you are eligible for it. There are 3 main parts, part A is the hospitalization part. Part B is things like homecare, and therapies. Part D is the one that pays for medications, not all tho. I don't know how A works with disabiity. We don't pay for that. We pay for B, which is around $100 a month. Part D is around $25. Then there is supplemental, which pays for the amount that part A won't. That can vary, depending on the company and plan you pick.
In addition to Kaismama's information, Part B also pays for doc visits, after you meet your yearly deductible.
Who knows why one must be on Medicaid for two years after you receive disability. The two years starts after you are awarded your disability application. And if you go to the socialsecurtity.gov site, like mentioned above, you may find more information there.
PS... why isn't your attorney answering any questions?
Your questions to kaismama are very good. They count from date of application accepted with the medical date by the physician of the disability diagnosis as the starting point. Considering the wait period of nine months, those first months are not covered.
I was told the day I got out of the ICU by some administrator that I was permanently disabled and she wanted my Medicare number! I had no idea I was in that class and of course at fifty five did not have Medicare. Anyway, they counted the day my doctor figured out the disease, which was two days after admitted. They refused to count the two weeks before as I had a different diagnosis. I was fortunate in that everything was processed straight away. Needed no lawyer.
Then comes the wait for the Medicare insurance. It was brutal. I asked the same questions as you did. Why do I wait and be unable to pay for things, go broke and not get benefits right away? The law they said. They try to catch false claims! So, yes it does not make sense. Rich bureaucrats with the best health care in the nation make these decisions.
What can you do? Nothing I know about. If you have any insurance at all keep it until the Medicare starts. We used up our retirement and savings. But we have a small business in a little building and therefore do not qualify for Medicaid. That is our only source of revenue, my husbands business and it would cost far more to rent if we sold the paid for building. Without that we would be on the streets.
So sorry you are going through this anguish. Check through your community for programs to help and also check the local senior center. Even if you are too young for them, they can refer you to plenty of resources. I did qualify for a support program after a two year wait list. At that point I had Medicare and no longer qualified! Karen
Yes, it looks like regular policies but if you can afford to go with the supplemental insurance; I would suggest you take it. They actually will let you know when you become eligible and send you a lot of information through the mail. You probably will get the Medicare information first and a representative for United Healthcare or whoever your supplemental is will contact you to discuss your options. They actually came to my house and explained everything to me. That was the rep from the supplemental insurance or "Healthnet" at the time. That is now United Healthcare but I don't know if that is across the country or if each state has a different supplemental carrier.
Any way to make a long story even longer (you did say "conversational" and I love to conversate!).
The date you are determined to be disabled plus 6 months where there are no benefits then add two years. So when were you determined to be disabled??? At least that is how it worked in 2001. Things could have changed by now but that is how it worked for me.
It seemed like a long process for me. My pay was retro active for like 4 months... I forget. But I was determined to be disabled in let's say "May" then waited 6 months (everybody did) as the date to be used for retro pay which was November or 6 months from when I was determined to be disabled. So the retro pay from November through February when it showed up in my account. So, I got 4 months retro. Then before Medicare would kick in, I had to wait 2 years from November of 2001. I became eligible for Medicare in November of 2003. That is when everything else went haywire for me. I had great insurance on my now "ex-husband's" plan but lost that when Medicare kicked in. I am 57-3/4 years young now and glad I have insurance but sure hate being told who I can see and what treatments are paid for. You might find, too, that you have to change doctors because not everybody takes Medicare but for me... more doctors and specialists took the supplemental insurance.
There is another supplemental insurance besides straight Medicare. That supplemental is what I chose. It is United Healthcare. I pay $99.00/month which is deducted from SSDI(that is for medicare) and then a monthly premium for United Healthcare which is currently $122.00/month. I opted for the supplemental insurance because I have way too much going on health wise and it covers more than straight Medicare.
Hope that helps rather than confuses you.
One other complication. Are you currently working? Medicare has alookback period that limits how much one can earn when receiving benefits. For example, if you earn $1000 per month, they will only let you earn $200 or less per month without penalizing your monthly benefit.since that is over the amount it counts as working and reduces benefits. If you were working during that time, each month is looked at individually, you have more paperwork to demonstrate monthly earnings, and that can recalculate any money coming to you. They allow a handful of months working for five years. The five years is counted from the last time you worked while entitled to benefits and keeps adjusting forward until you are under the threshold. You can look this up on the website. If not working, this does not matter. The gist of this is if working, it will not be four years back pay. It starts when work ends.
Hi bills. You asked about back prescriptions through Medicare. You are covered for the period they start you. This we know. If your prescriptions were paid in any part by other insurance it will get complicated.
You can send in bills to Medicare at least six months old, not sure any more, it might be nine months, for that covered back period. They will pay for that. Generally the pharmacy will file for you as they have everything, or you can fill out their forms and send (not so easy). If you refile where you had insurance paying any part, the first insurance wants their money back for that period. And then medicare will pay and you will be stuck with the copay without secondary, since that has to come from a Medicare provider insurance. Unless you have that coverage with your husbands policy.
With all your questions you need to do a few things.
1). Call your current insurance, tell them what's up as possible and ask them about coverage and how they handle all these scenarios.
2). See a Medicare counselor at your local agency. Talk with them about how this might work for you. They will give you choices for the medicare insurance provider.
3). After that, take a break thinking about this and have some fun. Waiting is all you can do. You will have lots of information.
4). Work on your budget to get you through this time. Disability is not fun, there can be major cash expenditures waiting as well as receiving. This is a help to receive benefits, but sadly not a fixall. and the actual money goes for your care for the most part.
Good luck with the investigations. If you are anxious or depressed, we understand. Been through this and it really is pretty crazy how hard they make this for people just working on getting through the day. It can be done. Your attorney, I hope, doesn't get a big cut. When it is done, life will become easier. Just a bit, yet I take whatever comes along. Wishing you the same chance soon. Karen
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