Medicare and Disability?

Discussions for Patients, Family, and Friends PD For Patients
1

My husband has been unable to work since September 2007 due to ESRD. He applied for Disability and Medicare. He had PD Catheter inserted and started his training October 2007. He has not heard anything about Disability yet, but he received a letter stating that Medicare starts February 2008.

Can anyone tell me how the Medicare premium is paid? Will we have to pay the premiums monthly?

I assume we are going to appeal this decision, since from what I have been reading he is entitled to Medicare from the 1st day of training. I am very concerned about making the payments until he gets his Disability. We are paying the insurance premium from his previous employer. I am grateful for the insurance, but neither one of us are employed right now. I am planning to go out in search of employment.

He has been unable to work at previous place of employment due to lifting restrictions. His job required him to lift over 100 lbs on a regular basis. His restrictions are no lifting over 10 lbs. He does dialysis 4 times a day,

Will you please give me any information you can about Medicare premiums and how often Medicare is paid? I was hoping we could pay it monthly. It would be more affordable that way.

Also, any information about Disability would be greatly appreciated too. We were told there is a 5 month waiting period for everyone, even people with ESRD.

Thanks for your time and any help you can give us.

2

His Medicare should be backdated to the first day of the month that training started, which should be October 2007. It’s possible that the dialysis clinic did not fill out the CMS 2728 form correctly. Call Social Security to ask if they have record of his having started training in October. The dialysis clinic can amend the form if the home training section wasn’t completed or wasn’t completed correctly or if the MD didn’t sign it certifying that he expected your husband to complete the training.

BTW, in case you didn’t realize this, if your husband has worked enough to qualify (or if he can qualify on your work record), your husband can get Medicare just because he has kidney failure and needs dialysis or a transplant to survive. In fact, he can keep Medicare as long as he’s on dialysis and even 36 months after a transplant. He doesn’t need to get disability to get Medicare.

When someone has a Social Security benefit (retirement or disability) check, the Medicare premium is typically deducted from that check every month. When someone doesn’t have a Social Security benefit check, bills are mailed quarterly. Your husband will likely get a bill for several months at once. An envelope comes with the bill. The payment should go to:
Medicare Premium Collection Center
P.O. Box 371384
Pittsburgh, PA 15250-7384

Unless you and your husband make over $160,000 a year, his Medicare Part B premium for months in 2007 should be $93.50/month. For 2008, the Part B premium is $96.40/month.

If your family income is low and you don’t have much in savings, he may qualify for a Medicare savings program that could get state help to pay Medicare premiums. With one of the programs (QMB), the state will pay the Medicare deductible and coinsurance on Medicare covered claims.
http://www.medicareadvocacy.org/FAQ_MedicareSavingsProgs.htm

So far as disability benefits, if he applied for Social Security Disability Insurance, as you said, there is a 5-month waiting period for anyone who applies for SSDI and it could take time to get the award letter. People usually get their first check after 6 months. There will never be any payment for the 5 month waiting period. I suspect the waiting period is 5 months to see if the applicant will regain his/her health and be able to return to work.

There is a program called Supplemental Security Income that can help very low income people by providing a very limited monthly payment to help them survive while waiting for SSDI to start. You can look on the Social Security website at http://www.ssa.gov for information on Social Security benefit programs. Since he applied for SSDI, here’s the booklet on that program:
http://www.ssa.gov/pubs/10153.pdf

Sometimes people on dialysis feel worse and worse as their kidneys are failing, especially if they’re very anemic. This can make them feel like it would be impossible to work. Getting the extra fluid and toxins off with dialysis can allow them to feel good enough to return to work. If it’s possible for your husband to return to work, he will probably do better physically and emotionally. In my experience working with patients, many men feel uncomforable depending on someone else to be the primary breadwinner. As you’ve probably figured out, SSDI does not come close to replacing a wage earner’s income and even when it pays for dependents, there is a maximum family benefit.

If your husband wants a transplant and he gets SSDI based on ESRD, he should start thinking about his work options, decide if he wants to return to the same or a different job, and seek help from Vocational Rehabilitation (a state agency) for any training he would need for a new job. If possible, he should do this while he’s on dialysis. SSDI based on ESRD can end as soon as 12 months post-transplant and it would be best if he has a job before losing his disability check. If he is approved for disability based on something other than ESRD, he may be able to keep disability, but Social Security will ask him to complete forms and get a medical evaluation periodically to make sure he is still disabled.

3

My husband applied for disablility in December of 2006. He was approved for full disability and early retirement in Feb. 0f 2007. His checks also started at this time. All less than three months.

When we started his PD training on Monday the papers were filled out for Medicare. We were told DO NOT drop your Blue Cross/ Blue Shield. No C-Plus. Full major medical coverage has to be kept. A big shock for sure.

4

Thank you for all your help!

If he applied for Disability in December 2006 and had it approved and had Disability by February 2007 - did he get paid for the entire time? Didn’t you have a waiting period? We live in Pennsylvania. Does it make a difference what state you live in?

We were first told by Social Security Administration that it would only take 1 to 3 months to get Disability, but then it changed. We are now being told it takes at least 5 months. We were told there was a 5 month waiting period.

I will check out the different links that were provided.

5

Yes it did. No waiting period. I live in Alabama. We were totally surprised because we had been told it would take a couple of years and we would have to get an attorney involved. I would imagine the doctors reports were the cause of the fast approval. He had had a mild stroke a couple of years before and then in 2006 had a shunt implanted in his arm for dialysis when he applied.

He had only applied for disablitlity after his doctors kept telling him to do so.

6

When disability payments start depends on when the person stopped working and whether the reason the person stopped working was one that Social Security believes is disabling. If the person stopped working more than 5 full months before applying for Medicare, it’s possible to get payments for any months after the waiting period. The first payment received should be for the 6th full month after the last month worked. The only exception to the 5 month waiting period is for disabled children of workers. If back payments are owed, they’re paid in a lump sum and can be for up to 12 months. This is a federal policy – where you live should make no difference.

Look at the Social Security “blue book” to see the listing of conditions that Social Security considers as potentially disabling. The kidney-related conditions are in section 6.00, but there are many other conditions of body systems that can be disabling as well. Some listings are for adults and others for children. This book also has general information, what evidence is needed to prove disability and some FAQs.
http://www.ssa.gov/disability/professionals/bluebook/

One question in the FAQs states:
[I]Q. When do disability benefits start?
A. The law provides that, under the Social Security disability program, disability benefits for workers and widows usually cannot begin for 5 months after the established onset of the disability. Therefore, Social Security disability benefits will be paid for the sixth full month after the date the disability began. The 5-month waiting period does not apply to individuals filing as children of workers. Under SSI, disability payments may begin as early as the first full month after the individual applied or became eligible for SSI.

In addition, under the SSI disability program, an applicant may be found “presumptively disabled or blind,” and receive cash payments for up to 6 months while the formal disability determination is made. The presumptive payment is designed to allow a needy individual to meet his or her basic living expenses during the time it takes to process the application. If it is finally determined that the individual is not disabled, he or she is not required to refund the payments. There is no provision for a finding of presumptive disability or blindness under the Title II program. [/I]

Some people apply for Supplemental Security Income (SSI) if their family income and assets are low and they receive that income while waiting for the first SSDI check. Some people who did not earn much from working and who have low assets can receive SSDI and SSI. In most states (not all) having SSI means your income is low enough to qualify for Medicaid too.

Someone who is applying for Medicare due to disability must get SSDI checks for 24 months before he/she gets Medicare (29 full months after stopping working). Having ESRD means you don’t have to wait 29 months to get Medicare. In fact, at most you only have to wait 3 months after starting dialysis and you don’t have to be disabled to get Medicare. Starting a home dialysis training program or getting a transplant right away before the end of that 3 months, waives the waiting period for Medicare.

7

You say your husband had a stroke and had a dialysis access placed in his arm a year before he started dialysis. When did your husband last work? Those months that he didn’t work before he applied for SSDI could be counted toward the waiting period.

If his BCBS insurance is from his former employer, it pays first for dialysis and Medicare could pay second, depending on how much the employer plan pays. The dialysis clinic gets more money from an employer plan than from Medicare. That’s why they told you not to drop that insurance. BTW, having Medicare limits what the dialysis provider (or any Medicare participating provider) can make you pay. With the high cost of healthcare, paying the Medicare premium is worth every penny.

If your husband’s BCBS coverage ongoing coverage because he is considered a retiree (i.e., if he’s on COBRA), I’d suggest you talk with a health insurance advisor at your state insurance department to find out if your husband an get a Medigap plan (Medicare supplement) when his COBRA coverage ends. These plans help to pay the deductibles and Medicare coinsurance for Medicare covered services. They don’t typically pay for services that aren’t Medicare covered, like dental, vision, etc., but they’re good options for those services that are Medicare covered.