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Thread: Does being on SSDI automatically put you into Medicare?

  1. #21
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    Quote Originally Posted by cass View Post
    calling bullshit on the medicare info. i am well under 65 and disabled. they refused to be my primary for almost a yr now. have yet to see them pay. keep watching, i'm paying medicare, work ins secondary. i'm fed up.\\

    they admitted to be primary. medicare i mean. waiting to see payment.
    Like I said, the info at ssa.gov was poorly worded, But it isn;t addressing your situation, where you have insurance from work but are NOT working. It skips around it.

    It is clear for my situation ... insured by spouse who is working, large company, medicare is secondary. (And that is how it is working in practice too). And I think offroaderswife fits too.

    Hopefully it also applies to Chad, as it sounds like he is still working a small amount (obviously small enough to stay on medicare).

    Ami, as far as YOUR coverage, I think you need to talk to HR where Chad works and confirm that his coverage continues after medicare starts. If so, you should be good. My worry is that his LTD plan is written to include insurance only until Medicare kicks in.

    But the passage I linked it titled, in part, "for working beneficiaries". I actually can't find any specific info to fit your situation, but maybe I haven;t looked hard enough.

    (I also know my situation is unusual, as EVERYONE bills it wrong the first time, no matter what I say! )
    T7-8 since Feb 2005

  2. #22
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    For CaSS

    Cass

    Look here (from my second post) and scroll down to the chart.

    http://www.medicare.gov/publications/pubs/pdf/02179.pdf

    It appears to spell it out for your case as well. At least it should get you something to work from when you call:
    T7-8 since Feb 2005

  3. #23
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    I am confused as to why you think you are not insurable. Private policies are available though they may be expensive if you have health issues. The expensive ones ask only the three biggies: Heart issues, cancer, hiv /aids. Most will want to know about your doctors visits in the last period of time. Do not play down preventative visits or those for normal issues. For instance, they want to know that you have had your recommended female care and that you saw a doctor when you had strep throat two years ago. They are really afraid of people who have not had appropriate medical care in recent history.

    Again, I do not want to scare you, only inform you.

    Remember that if you cannot get medical insurance, coverage may be available through your state. This is probably not what you would choose but is better than nothing. You will probably be enrolled in an HMO option. This is not always a bad thing. As long as you go by the rules and are willing to scream when needed, it can be a good thing.

    Tom (husband) had an HMO choice in his group medical plan open enrollment this hear for the first time in years and after researching the doctors that we wanted (including Ryan), I pushed him to go that route. This does mean that Ryan cannot go back to Shepherd until medicare kicks in (they are not in the network for VA) but our out of pocket for the rest of the family is limited as long as we go through our primary care doc. Naturally, we have a relationship with our primary care doc and referrals are no problem when we need them. I have an older (21 years old) son on the plan who had a brain tumor removed 10 years ago but still follows up with specialists and has MRI's and EEG's done every six months. The 20% of these tests after a deductible were real money. Now, as long as he has his referrals, it is 40 bucks a pop. Much less. The key to an HMO option is the relationship with your primary care doctor. For us, it is a phone call to get the referrals we need when we need them. Our doctor sees us on a regular basis and is not so egotistical as to think that he is all we need. I know that some insurers make referrals difficult for both the patient and the doctor. The key there is an honest conversation with your doctor. I have personally successfully navigated both BCBS and CIGNA (current) HMO options without compromising my families care. I think they key is that the doctors are not employed by the insurance carrier nor is our hospital. There is a carrier in our area that I will not get involved with. They own 80% of the hospitals (and therefore the doctors). This is where incentives become a real problem. Choice is key. I am very thankful that our doctor is a partner in our health care and listens to our concerns. I know that is not always the case and I feel for those caught up that problem.

    Finally, read you plan documents. They are they key to your rights.--eak

  4. #24
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    Quote Originally Posted by sjean423 View Post
    Cass

    Look here (from my second post) and scroll down to the chart.

    http://www.medicare.gov/publications/pubs/pdf/02179.pdf

    It appears to spell it out for your case as well. At least it should get you something to work from when you call:
    But this still only addresses people who are currently working Sjean... It doesn't address someone who is disabled and still covered under an employers insurance and no longer working. Perhaps Cass is considered retired?


    I’m retired and have Medicare. Ialso have group health plancoverage from my former employer. Who pays first?
    Generally, Medicare will pay first for your health care bills and your group health plan(retiree) coverage will pay second.
    This is page 18 from the reference above
    T12-L2; Burst fracture L1: Incomplete walking with AFO's and cane since 1989

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  5. #25
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    Quote Originally Posted by zillazangel View Post
    I am essentially uninsurable, .
    I understand Ami..With C's Crohn's disease, insurance became impossible at the ripe old age of 13...my premiums jumped to $1600 a month. Sure I could afford that. So I had to drop it.

    I will pass the glass...
    T12-L2; Burst fracture L1: Incomplete walking with AFO's and cane since 1989

    My goal in life is to be as good of a person my dog already thinks I am. ~Author Unknown

  6. #26
    Quote Originally Posted by darkeyed_daisy View Post
    Cass not really sure on what information you are calling bullshit on.

    Medicare rules are spelled out on their website.

    Now it gets screwed up because you have to call Coordination of Benefits and explain to them that you have stopped working. This is different than just going on Medicare and calling Medicare on the back of your card. 1-800-999-1118 is the Coordination of Benefits number.

    Mine was screwed up too and they weren't paying since 2007. Until I called in January 2011...they would not pay a claim.

    What Sjean posted is correct... I would call the coordination of benefits number and talk to them and your problems should be cleared up.
    not really sure what i was trying to say either. been a coupla really bad pain days for me. but was not directed at any member but at medicare. first i realized there was a prob was jan, this yr. i took dis ret last july. medicare had my primary as my employer ins from 15 yrs ago! next i called they accused me of lying as i had just called a month previous to update. this was the coord number. geesh!

    sorry.

    daisy, ty, but after almost a yr (and talking to medicare coor ppl) i believe things are straightened out. my point here was yes, medicare can consider themselves secondary.

    so, medicare is my primary now, my secondary is from my work carrier, which is very important as that covers meds and picks up where medicare leaves off. but i pay for both. medicare deducts from my SSDI and Boeing is literally taking almost all of my pension for my secondary and my son's ins. it is not pretty.
    Last edited by cass; 04-13-2011 at 11:47 PM.

  7. #27
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    Cass, if Medicare is primary for you, and considering how much Boeing is taking for you for insurance, that is only secondary, could you drop that once your son has his own insurance somewhere? (I know he is a teenager, so we are looking at a ways out here .....).
    T7-8 since Feb 2005

  8. #28
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    Quote Originally Posted by darkeyed_daisy View Post
    But this still only addresses people who are currently working Sjean... It doesn't address someone who is disabled and still covered under an employers insurance and no longer working. Perhaps Cass is considered retired?



    This is page 18 from the reference above
    What about the part I circled? It seems to address it?
    T7-8 since Feb 2005

  9. #29
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    Quote Originally Posted by sjean423 View Post
    What about the part I circled? It seems to address it?
    What confused me is when you read page 16-17, it said disabled who is working.

    It is such a paperwork nightmare.

    Cass...I didn't take your post the wrong way at all. I just wish Medicare was easy. You sign up for it and it paid like it was supposed to. I hate that you are in so much pain and still having to navigate the system.

    Ami...I hope there is something out there to help you too.

    Last I checked NC did not have a high Risk insurance pool but maybe things have changed...we seem to be the last to get things other states have.
    T12-L2; Burst fracture L1: Incomplete walking with AFO's and cane since 1989

    My goal in life is to be as good of a person my dog already thinks I am. ~Author Unknown

  10. #30
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    Sjean - Chad doesn't work at all, hasn't since April 2005, he's been on LTD since then. For the first three years on LTD, he was paid 60% of his salary by his employer.

    After 3 years, SSDI pays approx 60% and his job pays 40% to TOTAL 60% of his previous salary. Meaning if he made $10,000 a month while working, he was paid $6,000 a month LTD by his employer for the first three years. Then after 3 years, SSDI pays $3,600 and the employer pays $2,400. By the way, those numbers are not his actual salary, just using round numbers to make it easier to follow.

    I sent a question to his benefits dept, so we'll see what happens. ....

    Thanks for passing the glass back Daisy!

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