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Disabilty / Medicare


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#1 CraigR

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Posted 04 November 2008 - 11:04 AM

Recently I heard that after two years of complete disability, one can be eligible for medicare.

I am working part time and still retain my company benefits. This is very good, but I would like to know the medical insurance options should I become completely disabled. I spoke with a lawyer who seemed to think that 100% disability would be easy in my case, but for now I prefer to work. But if I were completly disabled, I think COBRA would be possible for 18 (possibly 36) months, followed by Medicare after 24 months disabled. Does this sound correct? Does anyone know how to get COBRA benefits for the entire 24 months while waiting for Medicare, if 100% disabled?

Thanks for any advice that you may have!

Craig

#2 tsaddict

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Posted 04 November 2008 - 01:33 PM

Maybe I'm wrong, but I'm thinking that Medicaid will kick in and cover you if you become completely disabled.

#3 Gidget

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Posted 04 November 2008 - 02:34 PM

Craig,
Under cobra, you can get health insurance up to 18 months. If during this 18 month period, you are determined to be disabled by Social Security, your cobra can be extended for an additional 11 months. So, this would allow you access to cobra coverage for 29 months (18+11). Now here is the catch.

1 - You need to be found disabled while on cobra in order to be granted the 11 extension. So, if you are on Cobra, you want to start the Social Security disability application immediately in order to get a decision within the 18 month initial Cobra period. If you get the SSDI approval in month 20, Cobra will not be re-instated.

Also, it is true, that Medicare starts 24 months after being determined however Social Security adds a 6 month waiting period to this date. So, if Social Security determines you are disabled on Jan 1, 2008, you would think you would be eligible for Medicare on Jan 1, 2010 -- but instead, you have to add 6 months to your disabled date of Jan 1, 2008 and then start the 24 month clock from this point. So, in reality you do not become eligible for Medicare until July1, 2010 or 30 months after your disabled date.

And yes, you guessed it -- Cobra with the extension is 29 months but Medicare does not start until 30 months -- so you are 1 month without coverage. Now, it works out ok if with your company, you are disabled under short term disabilty for 6 months before your long term disability kicks in. In which case, your Cobra does not start until you are on LTD but meanwhile Social Security disables you from the date you went out on short term disability--which means that with this timing -- you have Cobra coverage until eligible for Medicare and you do not have the 1 month lapse of 29 vs. 30 months.

Good Luck in your decisions. It took me almost 2 years to get SSDI but that was because I was in the New England and they opened a new office and then closed the office and in the meantime, my file floated around while they were opening/closing the same office and nobody would address it. Other people say they get their approval 123. I would say you want to try for SSDI sooner than later as even though I have sclero with lung involvement, etc.. I was initially denied and was approved on appeal. Again good luck, Gidget

#4 Wohali

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Posted 04 November 2008 - 03:25 PM

As far as COBRA coverage goes its governed under Federal law and you can only have it for 18 months. COBRA is offered only after you leave your present employer and you have the option of continuing your present medical plan under COBRA with that employer. But its not cheap. I've been under 3 different COBRA plans and one was $430 a month and another was $1,100 a month.

From what a lawyer just told me today you cannot get soc sec disability until you have been not working at all for at least 6 consecutive months.

#5 Gidget

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Posted 05 November 2008 - 04:18 AM

According to the Social Security site, you should apply "as soon as you are disabled' -- so I don't think the 6 month wait applies for filing the application. However, even if you are found disabled by social security to be your disabled date, they will not pay benefits retroactive to this date. Instead benefits are paid retroactive to 6 months after your disabled date. Basically, social security takes the 6 months as application review time and gives you a determination date which is your disabled date plus 6 months as the date that you are entitled to disability payments. Gidget

#6 Lyn

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Posted 05 November 2008 - 04:51 AM

I applied the end of Oct '04, that was when I finally gave up my part time job. When I got my approval, they said I was considered disabled in August, even though I was working part time, because it was so little. It would be good to find out what they consider few enough hours to be that way, I do not remember at all. I had been working more part time hours for 3 months before August, but had to leave that second job due the my disability. Lyn

#7 MaryFanPhilly

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Posted 05 November 2008 - 07:37 AM

Hi Craig,
I left work in December 2005 and filed for disability right away. I could not and did not work after that date. I was approved six months later (June 2006)for SSD and got my first check right away.
The difficulty is those six months when you are not allowed to work. They told me NO working at ALL. I basically lived on Aflac and credit cards for those six months.
Medicare kicked in after two years of the APPROVAL date ie, June 2008; NOT the date of disability.
My employer kept me on the payroll so he could cover my insurance without going into COBRA. He was very kind to me in that regard.
However now I also have a Medigap plan (paid for separately) to cover what Medicare does not, so please make sure you look into what is and is not covered by simple Medicare. They also take a portion of your SSD every month to pay for the Medicare. In my case it is nearly $100.
I hope this is a help, and good luck.
Love, Mary in Philly
Diffuse sclero; diabetes; hypertension; GERD with Barrett's

#8 CraigR

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Posted 05 November 2008 - 08:50 AM

Thanks everyone for all your help.

I have LTD insurance through my company for 66.6% of salary, and that is what I am applying for at this time (for the partial - working half-time). But the S/S, Cobra and Medicare will need to be strategized in the event of complete disability.

Craig

#9 Wohali

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Posted 05 November 2008 - 11:00 AM

Craig,

I actually had a conference call today between Soc Sec and my Voc Rehab counselor. I was told a person can make no more than $940 a month during those months that you are claiming you are disabled. If that makes sense. An example is I had a good job up until 3 wks ago so even though I was sick for years with CREST and struggling to overcome injuries most of the the past 5 years I can only use 3 weeks ago as the date that I first became disabled because of the amount of my salary.

Likewise should you get SSD you can work parttime for extra income and make up to $940 a month though friends have told me it should be kept under $500 or else SS starts threatening to take someone off SSD claiming they are healthy and able to work again.

#10 Sweet

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Posted 09 November 2008 - 04:06 AM

Hey Craig,

Not sure I can answer your question, but while I was on holiday I received 2 packets from Medicare. My desk is knee deep after being gone for a month, but at the quick glance I gave it, it made it sound like I needed to pick the plans I wanted. I'm a bit confused as I thought you needed to wait 2 years after being disabled to receive medicare. I was approved this past May, but it was retroactive to a year I believe. Anyway, I would be thrilled if I was eligible now. The government doesn't always communicate well, so I need to read the fine print and will probably give SS a call as well to clarify. The stuff I did look at was clear at mud. :)
Warm and gentle hugs,

Pamela
ISN Support Specialist
International Scleroderma Network (ISN)

#11 CraigR

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Posted 10 November 2008 - 07:18 AM

Thanks to all for the excellent information. The issue of extending COBRA by 11 months for 29 total months being 1 month short of the required 30 months for Medicare eligibility is sort of a problem.

My employer is having great difficulty trying to put together a 2009 budget (a major part of what I do) and would probably love to eliminate my position. Maybe they would like to work out a deal to keep me on the payroll a short time, as Mary from Philly was able to do.

I am currently putting together the paperwork for partial disability through my employer's long term disability (LTD) policy, but it may be wiser just to move to complete disability, if it can be worked out. Should not be difficult at all, considering my medical history (I just got the extensive documentation from my rheumatologist - and it sounds like I should have been dead years ago!).

Craig