I was following one of the threads here that I wanted to reply to, but I wasn’t allowed to post at the time and now I can’t seem to find the post again. I wanted to see if you could clarify the following suggestion that you made to another user.
Beth: //If he wants/needs Medicare on the earliest date possible, he should begin a home training program before the first day of his 3rd month of dialysis. Doing this would give him the option to have Medicare start the first day of the month dialysis started.//
I’m not exactly sure what you mean by ‘if he needs medicare on the earliest date possible’. I do need medicare on the earliest date possible, but from what I understand you have to be approved for Disability before medicare will even look at your application. And also if I’m not mistaken you have to be on Dialysis before you can be approved for Disability. So, I am curious where might you suggest I begin getting started? Today, I applied on-line for Disability. I also went to a local nephrologist’s office to check up on my referral and they couldn’t even find my referral. I feel so alone and in the dark here. Please, can you point me in the right direction?
People can qualify for Medicare for a number of reasons including age, receipt of Social Security Disability Insurance, and ESRD (kidney failure). A form (CMS 2728) the dialysis clinic completes and the doctor signs alerts Social Security (where Medicare applications are filed) that the individual has ESRD, which is the medical reason to get Medicare. If you haven’t yet started dialysis or had a transplant but you have worked long enough, you may qualify for Social Security Disability Insurance. However, Medicare won’t start for that reason until you’ve received Social Security Disability Income checks for 24 months. If you have started dialysis, Medicare starts after 3 months if you’re doing in-center dialysis, but if you choose to train for home dialysis before the end of 3 months, Medicare can backdate to the first day of the month dialysis started.
It’s unfortunate that some people may believe they have to take disability when they need dialysis. Patients can work and get Medicare. In fact, in my experience as a nephrology social worker working with hundreds of patients over my career, those who worked were often less stressed because they had more money from work, they enjoyed spending time with their work friends, and they had other things that kept their mind occupied so they coped better with being on dialysis.
And I’m assuming the only way a dialysis clinic would sign off on a CMS 2728 form is if you are already on dialysis?
As for qualifying for SSDI, I have been unemployed since December of 2011. So, I’m assuming I wouldn’t qualify.
I don’t have an aversion to working, and as far as I know I am currently physically able to work. I just haven’t been able to find work what with this recession and everything. I was forced to mark that I am unable to work on my on-line Disability application, because otherwise I would have to be over the age of 65 in order to continue with the application. I did write a disclaimer saying that to the best of my knowledge I am able to work at this time. So, they may deny me on that discrepancy alone.
To be clear, the woman at the local medicare office told me that I would either need to possess custody of my child or first be approved for disability before they would be able to offer me any services. My main concern is getting on dialysis, and I am not sure how that is at all possible without first being approved for medicare.
[QUOTE=Beth Witten MSW ACSW;22811]People can qualify for Medicare for a number of reasons including age, receipt of Social Security Disability Insurance, and ESRD (kidney failure). A form (CMS 2728) the dialysis clinic completes and the doctor signs alerts Social Security (where Medicare applications are filed) that the individual has ESRD, which is the medical reason to get Medicare. If you haven’t yet started dialysis or had a transplant but you have worked long enough, you may qualify for Social Security Disability Insurance. However, Medicare won’t start for that reason until you’ve received Social Security Disability Income checks for 24 months. If you have started dialysis, Medicare starts after 3 months if you’re doing in-center dialysis, but if you choose to train for home dialysis before the end of 3 months, Medicare can backdate to the first day of the month dialysis started.
It’s unfortunate that some people may believe they have to take disability when they need dialysis. Patients can work and get Medicare. In fact, in my experience as a nephrology social worker working with hundreds of patients over my career, those who worked were often less stressed because they had more money from work, they enjoyed spending time with their work friends, and they had other things that kept their mind occupied so they coped better with being on dialysis.[/QUOTE]
Yes, you have to start on dialysis for the dialysis clinic to fill out that form. You could qualify for Medicare under your own work record or a spouse’s work record if you’re married or widowed. You may qualify under a former spouse if you were married at least 10 years. Even if you haven’t worked since 2011, you may be eligible for Social Security Disability if you have earned enough work credits. To find out if you have enough work credits, you can sign up and choose and ID and password to view and print your Social Security report on the SSA website (www.ssa.gov). It will tell if you have enough work credits to qualify for disability and Medicare (ignore that it says that you’d qualify when you’re 65). SSA has a book that lists conditions that are potentially disabling. http://www.ssa.gov/disability/professionals/bluebook/AdultListings.htm
I suspect you meant Medicaid office (vs. Medicare office) when you said that you’d have to have a custody of your child or be disabled to get their help. Families with children, elderly and disabled people who have limited income and assets may qualify for state medical assistance (Medicaid).
Hopefully the economy will turn around and more jobs will be available soon. Although funding is limited, states have vocational rehabilitation programs to help those who qualify be evaluated and receive services, which may include training or job placement. http://wdcrobcolp01.ed.gov/Programs/EROD/org_list.cfm?category_cd=SVR
I signed up for a ID and password and checked my ‘estimated benefits’.
It said: You have worked enough to qualify for Medicare at age 65. Even if you do not retire at age 65 be sure to contact Social Security three months before your 65th birthday to enroll in Medicare
I didn’t see anything about renal failure in the list of potentially disabling conditions, but I understand there is a clause in there somewhere for renal failure. I’m just not sure if that would apply to a person with stage 4 kidney disease, or what the stipulation may be.
Yes, I’m sorry. I always get Medicaid and Medicare mixed up. Do you suppose I went to the wrong office? I assume the same office would handle both medicaid and medicare insurance.
Thanks for the link to the vocational rehabilitation programs. I wonder if I would qualify for assistance prior to beginning dialysis.
So, I wonder if I’ve done all that I can do or if I should perhaps go to the medicaid/medicare office and further explain my situation.
Because your statement says you have enough credits for Medicare at age 65, you have enough credits now. With Medicare you only have to have earned enough credits during your lifetime. For Social Security Disability, you need to have earned enough credits in the not too distant past. The number of credits you need depends on your age. See the chart in the SSA booklet How You Earn Credits:
The Social Security “blue book” lists dialysis and transplant under “genito-urinary” (Section 6.00). At Stage 4, whether SSA would find you disabled would depend on your labs, symptoms, etc. It’s likely that SSA would ask for medical records from your doctors and it’s possible that they may want you to see one of their doctors. When you have kidney failure and are on dialysis, SSA accepts that form (CMS 2728) as proof of kidney failure.
Social Security accepts and processes Medicare applications. Medicaid applications are processed by the state agency which is called different things in different states. You could look up your state’s Medicaid agency here: www.medicaid.gov.
You could contact your state VR agency and see if they’ll help you. The worst they can say is that you don’t meet one of their eligibility criteria now, which means you may meet their eligibility criteria later.
BTW, when you start dialysis, there will be a social worker and a dietitian in addition to the nurses, technicians, and physician(s) that will work with you to help you stay as healthy and active as possible.
Okay, so apparently there is also an on-line application for Medicare on the SSA site. I will apply for that now and hopefully it won’t take forever to find out whether or not I am approved. Thanks for all of your help.
Okay, so I went to the social security office yesterday to apply for Medicare. They asked me to reapply for Disability, because apparently they didn’t receive my on-line application. So, I went back today to turn in my application for Disability and they informed me that there are two different Disabilities that you can apply for. I’m not sure of the names, but the one takes 5 months to be approved and the other I can be approved for now (which is called SSI, I think). She said the SSI wouldn’t be as much money, but that it comes with Medicaid. And for now that is my top priority as I need to get on dialysis as soon as possible. Of course she referenced the same form (CMS 2728). So, I called the local dialysis center to inquire about that particular form and I was told that I wouldn’t be able to receive that form until I have become a patient there. And I cannot become a patient there until my Nephrologist refers me to that clinic. And the Nephrologist my doctor has referred me to is booked out until the end of April/First of May. So, I don’t know if I should call around and see if I can’t find a Nephrologist who isn’t booked out so far or if it is quite common for Nephrologists to be booked out so far, but perhaps this will allow time for me to be approved for some type of Medicaid or Medicare so that I’m not racking up a ridiculously high hospital bill.
So, I guess all I can do now is wait around for the people from the social security office to call me after they’ve run my background check (to verify that I am unemployed).
There are two disability programs from Social Security. They both have the same medical criteria.
For Supplemental Security Income (SSI), you have to have very limited income or assets. Many people don’t qualify because the amounts are so low. However, if you do, you can get Medicaid in some states without having to apply or in some states you must apply to get Medicaid. If you’re eligible for Medicaid, it can pay for covered medical costs with doctors and other providers that accept Medicaid until you’re eligible for Medicare.
The other disability program is called Social Security Disability Insurance (SSDI). It requires you to have enough work credits to qualify. There is a 5 month waiting period for it. Some people get SSI during that time if they’re eligible. You wouldn’t get your first check until the 7th month since Social Security would be paying for the 6th month then.
What is your GFR (glomerular filtration rate or percent of remaining kidney function)? Patients are not considered to be in the final stage of kidney disease when dialysis or transplant is required until their GFR is <15 and patients may not actually start dialysis until they have lower GFR with symptoms like nausea, fatigue, sleeping a lot, swelling due to fluid, etc.
The issue doesn’t just relate to unemployment but unemployment due to an impairment (mental or physical condition) that keeps you from working and is expected to keep you from working for at least a year.
The way I understand it, SSI can be used while I’m waiting to be approved for SSDI. Also, I got the impression that I may be approved for SSI regardless of my medical condition as long as I meet the criteria for low income. If that is the case then perhaps I will at least be able to afford to see a Nephrologist.
My GFR is now 30, which is the beginning of Stage 4. So, maybe I don’t yet qualify for SSDI. Personally, I think it’s a bit ridiculous to wait until someone is nearly dead to start them on dialysis. Admittedly, I did freak out a bit when my GFR dropped 6 points in the last 90 days (which means the disease has progressed from Stage 3 to Stage 4) because I had the impression that stage 4 patients are ‘immediately’ put on dialysis, but as you point out there are obviously some symptoms to consider. Of the symptoms you’ve mentioned, I’ve experienced some mild nausea, fatigue, and have been sleeping in later and later. I haven’t had a lot of swelling, but I’m also still currently taking a diuretic.
I’m actually not really so concerned with getting Disability as long as I can afford to see a nephrologist and work out what I need to do next. One thing is for certain, I cannot afford to be as passive as I have been in the past.
It was helpful for me today when the woman at the social security office informed me that I have done all that I can do for now.
Here’s an SSA page that describes the eligibility for SSI, which can help people with limited income and assets if they’re aged (65 or older), blind (legally), or disabled (according to SSA criteria): http://www.ssa.gov/ssi/text-eligibility-ussi.htm
For an individual, the maximum payment from SSI in 2013 is $710/month. Some states add a supplement to that payment.
For an individual, the average payment from SSDI in 2013 is $1,132/month for someone who gets SSI because of disability. http://www.ssa.gov/pressoffice/factsheets/colafacts2013.htm
Some people start to have symptoms when their kidney function declines below 50%. Other people don’t have symptoms until much, much later. Still others feel like they have a bad case of the flu that takes them to hospital where they’re diagnosed with kidney failure and start dialysis emergently. You might want to ask your kidney doctor how long it might be before you need dialysis.
When your kidney function drops below 20, you can be placed on a transplant list or get a living donor’s kidney. Transplant programs want to be sure that people have the resources or a workable plan for how they will be able to pay for the transplant drugs after Medicare ends 36 months after transplant. This is another reason to be thinking about and preparing to get a job so you either get health insurance or have the money to pay the premium for health insurance you get on your own.
I discovered that my creatinine levels should be closer to 8.0 before I would require dialysis. My last creatinine level was at 2.7, so apparently I am ‘on the up side’ of the disease.
I’m not sure that I would still qualify for SSI, but I really can’t afford $200 a pop to see the nephrologist without medicaid to fall back on. They just keep sending me more paperwork to fill out, so I’m not sure if that’s a positive sign or what.
It looks like it’s going to be some time before you need dialysis so unless you have some other health condition that is disabling, you probably should look elsewhere for health insurance if you don’t have it now.
You can contact your state insurance department to find out what options you may have. Here’s a link to the National Association of Insurance Commissioners’ website map where you can get the contact information: http://naic.org/state_web_map.htm
You might also want to check out the government website for information on health insurance now and what’s coming in 2014:
There may be one ore more free or low cost clinics near where you live. You may be able to get blood drawn there that your nephrologist needs to see with the results being sent to your nephrologist. This could reduce your costs at the nephrologist’s office. http://findahealthcenter.hrsa.gov/Search_HCC.aspx
