How does disability affect medicare enrollment

[Truce]

At some point the employer will remove him from active employee coverage and send him a COBRA offer for him and his wife. It depends on how he uses up sick days and medical leave and it's no use speculating when this will happen just based on his last day of actual work, so go through HR like you said.

If the active employee phase of coverage doesn't extend through wife turning 65, she'll need to COBRA to fill the gap. It almost never makes sends to buy an individual plan, regardless of cost, for that short amount of time with a new deductible/new network etc.

For him, 24 months after SSDI is approved (yes, it will be backdated so this might be only 18 months after he starts getting payments), he'll be enrolled in Parts A and B. They'll mail the card a few months before start date and take the premium from his SS (unless he proactively opts out due to other coverage). This assumes the 24 months of SSDI arrives before he is 65.

Here's where your creditable coverage question comes in and you can help him. COBRA lasts for 18 months (except for death divorce disability and turning 26). SSDI Medicare might not kick in until 24 months. Before the 18 months of COBRA are up, if he is not 65 he'll need to prove to COBRA he is SSDI disabled so they extend the COBRA using the special disability extension. You might think the employer would know he is disabled because of the LTD and extend automatically. In my experience, it's just not gonna happen that way even if they did have an SSDI offest in the LTD. See page 7 here:

https://www.dol.gov/sites/dolgov/fi...bra-continuation-health-coverage-consumer.pdf

If the COBRA is expensive, AND their income qualifies him for very low cost ACA coverage, AND they luck out by living in a zip code with adequate ACA plans, ACA is an option for him. Try to time it so he is not exposed to two separate deductible calender year deductibles. So maybe take COBRA to ride out the year, then review ACA when he has a full 12 months for the same plan and a year with lower income since no wages. Be careful a big SSDI lump sum doesn't blow up your low income ACA instead of COBRA concept. Many times COBRA is the best way to go, sometimes ACA, sometimes COBRA then ACA.

Being able to advise the younger spouse about COBRA/ACA sure helps to win the business of the "easy sale" T65 spouse.

 

[ValeRosso]

He's not going through SSDI YET.

His LTD carrier will force him to apply eventually. At age 60, he's more often to be approved than denied.

29 months after he is approved for SSDI, he'll be eligible for Medicare.

With LTD, he should still have his employer plan. However, they'll term him after a year and he'll lose insurance.

It could screw up the 63 day bit, but it won't be a huge deal. He will likely need to go through wife's eghp OR ACA if he can.

Thanks for the information! Im not too familiar with this disability plan stuff. Wife said he will have his employer plan until 65 (several years away) even while on disability, but it sounds like thats not true from what you said.

 

[ValeRosso]

At some point the employer will remove him from active employee coverage and send him a COBRA offer for him and his wife. It depends on how he uses up sick days and medical leave and it's no use speculating when this will happen just based on his last day of actual work, so go through HR like you said.

This is what I needed to know, if active coverage will continue throughout the disability years, wasn't sure about this part.

If the active employee phase of coverage doesn't extend through wife turning 65, she'll need to COBRA to fill the gap. It almost never makes sends to buy an individual plan, regardless of cost, for that short amount of time with a new deductible/new network etc.

For him, 24 months after SSDI is approved (yes, it will be backdated so this might be only 18 months after he starts getting payments), he'll be enrolled in Parts A and B. They'll mail the card a few months before start date and take the premium from his SS (unless he proactively opts out due to other coverage). This assumes the 24 months of SSDI arrives before he is 65.

Here's where your creditable coverage question comes in and you can help him. COBRA lasts for 18 months (except for death divorce disability and turning 26). SSDI Medicare might not kick in until 24 months. Before the 18 months of COBRA are up, if he is not 65 he'll need to prove to COBRA he is SSDI disabled so they extend the COBRA using the special disability extension. You might think the employer would know he is disabled because of the LTD and extend automatically. In my experience, it's just not gonna happen that way even if they did have an SSDI offest in the LTD. See page 7 here:

https://www.dol.gov/sites/dolgov/fi...bra-continuation-health-coverage-consumer.pdf

If the COBRA is expensive, AND their income qualifies him for very low cost ACA coverage, AND they luck out by living in a zip code with adequate ACA plans, ACA is an option for him. Try to time it so he is not exposed to two separate deductible calender year deductibles. So maybe take COBRA to ride out the year, then review ACA when he has a full 12 months for the same plan and a year with lower income since no wages. Be careful a big SSDI lump sum doesn't blow up your low income ACA instead of COBRA concept. Many times COBRA is the best way to go, sometimes ACA, sometimes COBRA then ACA.

Being able to advise the younger spouse about COBRA/ACA sure helps to win the business of the "easy sale" T65 spouse.

Thank you for this information! Very informative

 

[rousemark]

I was taught, if you could sit on a street corner selling pencils, you were not disabled according to SSDI rules.

That is exacty what they told my sister-in-law.