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Thread: Questions for those who are currently working full time

  1. #1

    Questions for those who are currently working full time

    I‘ve accepted an offer at my previous employer and will start next month. I know about the ticket to work program but have some concerns regarding my monthly medical supplies costs.

    I am a t2 complete para and I get 200 catheters a month and Medicare is paying for that.
    When I go back to work, my employer offer 2 health plans.
    1) 500 deductible then 90/10 (they pay 90%, I pay 10%); monthly premium is $274
    2) 1500 deductible then 80/20 (they pay 80%, I pay 20%); monthly premium is $176

    I know that I can still keep my Medicare up to 93 months after the trial period.
    Right now, I don’t pay for the Medicare premium because I also have Medicaid and the state pay for my Medicare premium.

    when I go back to work, will I have to pay for the Medicare premium?

    When I go back to work Will Medicare continue to pay for my medical supplies or will they force me to purchase one of the health plans above through my employer?

    For those who are currently working full time and have health insurance through your employers, what kind of plan do you have (90/10, 80/20)? How much do you pay out of pocket for your medical supplies each month?

    Also, SSDI have a 5 years expedite reinstatement that I am aware of. Will I have to re-apply for ssdi after the 5 years period?

    Thank you,
    Tin
    Last edited by tinng321; 12-22-2017 at 01:59 AM.
    T3 Complete
    to my alarm: "quiet b*tch! I know what I have to do every two hr. Argggggg!!!!"


  2. #2
    Senior Member
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    This is the trap of the US system. The costs of private insurance plus out of pocket makes employment too expensive. Once you earn more than the SSDI limit (~$1200/month) you no longer qualify for Medicare so, yes, you have to buy the employer insurance. As an SCI is recommend adding up the premiums plus the maximum out-of-pocket expense plus an estimate of what the private insurance will reject (>20 PT visits, certain drugs, most DME, etc).

    This is the price of employment. Now subtract that amount from your after-tax income. In many instances the resulting figure makes employment expensive.
    T3-T7 complete since Sept 2015

  3. #3
    I know you didn't ask this but I will add that if and when you retire your Social Security payment is based on your recent highest income.
    An advantage of returning to work is to keep an eye on retirement planning - if your employer has deferred compensation take it; if long term disability insurance is offered, take it. Save as much as possible. These arrangements can make retiring early a possibility, if and when needed.

  4. #4
    Quote Originally Posted by Mize View Post
    This is the trap of the US system. The costs of private insurance plus out of pocket makes employment too expensive. Once you earn more than the SSDI limit (~$1200/month) you no longer qualify for Medicare so, yes, you have to buy the employer insurance. As an SCI is recommend adding up the premiums plus the maximum out-of-pocket expense plus an estimate of what the private insurance will reject (>20 PT visits, certain drugs, most DME, etc).

    This is the price of employment. Now subtract that amount from your after-tax income. In many instances the resulting figure makes employment expensive.
    are you saying that if I make over the limit I will no longer get Medicare? I thought they still give it to you for 93 months after your 9 months twp ends.
    T3 Complete
    to my alarm: "quiet b*tch! I know what I have to do every two hr. Argggggg!!!!"


  5. #5
    Senior Member
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    Your right. You get 8.5 years of Medicare after returning to work. I hadn't realized that before.
    T3-T7 complete since Sept 2015

  6. #6
    Senior Member ChesBay's Avatar
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    Quote Originally Posted by triumph View Post
    I know you didn't ask this but I will add that if and when you retire your Social Security payment is based on your recent highest income.
    An advantage of returning to work is to keep an eye on retirement planning - if your employer has deferred compensation take it; if long term disability insurance is offered, take it. Save as much as possible. These arrangements can make retiring early a possibility, if and when needed.
    All excellent advice Triumph, imho. Higher SSDI, Long Term Disability and an employee retirement plan have made some health issues that arose for me much more manageable @ 40 years post SCI. I didn’t do meticulous planning but very grateful it has worked out that way.

  7. #7
    I just called Medicare and spoke to them. I explained to them about my situation and asked them about the 93 months that SS mentioned on their website. They informed me that I will not lose my medicare and there is no limit or expiration period. Has anyone here worked more than 93 months can confirm this?
    T3 Complete
    to my alarm: "quiet b*tch! I know what I have to do every two hr. Argggggg!!!!"


  8. #8
    Quote Originally Posted by tinng321 View Post
    I just called Medicare and spoke to them. I explained to them about my situation and asked them about the 93 months that SS mentioned on their website. They informed me that I will not lose my medicare and there is no limit or expiration period. Has anyone here worked more than 93 months can confirm this?
    Whether this is the case or not, I wouldn't count on things being the same eight years from now. That's two presidencies and four congresses and plenty of opportunity for a change in policy with healthcare apparently pretty high on the agenda (judging by bills introduced).

    Keep in mind that once you are working Medicare becomes secondary (if you have insurance through your employer). This basically means Medicare ain't gonna pay much/at all and is really just going to function to slow things down with DMEs and whatnot (BCBS approved my new chair in 48 hours, Medicare is still pending and going back and forth with the DME 8 months later, but Medicare won't pay a penny toward the chair... but I digress).

    Somehow I don't pay for my supplies? I have a company shipping them to me that was shipping them to me back when I had Medicare and Medicaid, they keep sending me the supplies, but not a bill, so idk if they are just eating the copay or if I'm going to get a whopping bill one day, but it's nice for the time being. 200 caths, 35 condom catheters and two leg bags are about $400 before insurance for me, so I'd assume when it catches up to me I'll be out of pocket about $80 a month in supplies with my 20% copay.

    For an extra hundred bucks, I don't think you can go wrong with the lower deductible lower out of pocket plan. I mean by my calculations, assuming you have $1500 in expenses per year, you are only spending an extra $200 PER YEAR for the better plan, so assuming you have a total of $3500 a year in expenses (which as I said above I meet and exceed with just my supplies, not counting any meds or Dr visits) it will be worthwhile.

  9. #9
    Quote Originally Posted by funklab View Post
    Whether this is the case or not, I wouldn't count on things being the same eight years from now. That's two presidencies and four congresses and plenty of opportunity for a change in policy with healthcare apparently pretty high on the agenda (judging by bills introduced).

    Keep in mind that once you are working Medicare becomes secondary (if you have insurance through your employer). This basically means Medicare ain't gonna pay much/at all and is really just going to function to slow things down with DMEs and whatnot (BCBS approved my new chair in 48 hours, Medicare is still pending and going back and forth with the DME 8 months later, but Medicare won't pay a penny toward the chair... but I digress).

    Somehow I don't pay for my supplies? I have a company shipping them to me that was shipping them to me back when I had Medicare and Medicaid, they keep sending me the supplies, but not a bill, so idk if they are just eating the copay or if I'm going to get a whopping bill one day, but it's nice for the time being. 200 caths, 35 condom catheters and two leg bags are about $400 before insurance for me, so I'd assume when it catches up to me I'll be out of pocket about $80 a month in supplies with my 20% copay.

    For an extra hundred bucks, I don't think you can go wrong with the lower deductible lower out of pocket plan. I mean by my calculations, assuming you have $1500 in expenses per year, you are only spending an extra $200 PER YEAR for the better plan, so assuming you have a total of $3500 a year in expenses (which as I said above I meet and exceed with just my supplies, not counting any meds or Dr visits) it will be worthwhile.
    If I buy health insurance through work then my medicare becomes secondary right? What if I don't buy any thing from work? Will I still get to keep my medicare as my primary? The vender I get my supplies from doesn't accept the two insurance companies offer by my employer.
    Just like you, I don't get any bills from the local supplier that I get my catheter from. I spoke to him the other day and asked who pay for my 200 catheters every month and he said medicare pays 80%. I asked who pay the other 20% and he said I do. I said how come I never get a bill from you and his reply was because we never bill you. I went onto medicare website and looked at the claims. Every month medicare pay the vendor $1465 for 200 Bard touchless catheter kits and 6 jelly tubes. I am assuming that they still make a good profit from the $1465 they get every month from medicare and that's why they don't bill me.
    Do you mind me asking what kind of catheter you use because $400 is very cheap and who is the vendor that you get your supplies from? I may need to switch if my current vendor start to bill me 20% of 1500 each month.
    T3 Complete
    to my alarm: "quiet b*tch! I know what I have to do every two hr. Argggggg!!!!"


  10. #10
    I use coloplast 14 Fr straight tip catheters. I just looked them up to compare to the ones you use and if you buy out of pocket in bulk the coloplasts are about 90 cents each and the touchless catheters you use (best I can figure) are about $2.75. That probably accounts for the bulk of the difference in our costs

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