So you would rather not be able to provide the folks with the answer to the question?
Medicare and Disability
- Thread starter kstein
- Start date
So you would rather not be able to provide the folks with the answer to the question?
- 1,745
To answer the Medicare question specifically, he has not worked long enough to qualify for Social Security/Medicare. For these cases there is a parallel program called Supplemental Security Income that many younger disabled persons qualify for, and in this case family income won't be considered generally, since he is over 18, his assets/income only are considered.
My other post mentions how to be sure the child qualifies as low/no assets for Medicaid by putting any assets for the child's care/future into a "special needs trust", assuming the family is able to do that.
- 507
If the 26 year old can't qualify for SSDI they could qualify for SSI if Social Security agrees they are in fact disabled and not able to work. Awarding SSI benefits is not tied to work quarters and it comes with Medicaid not Medicare.
- Thread starter
- #14
So depending on the exact age of disability, a person has to have a specific number of credits (1 credit =$1300 of earnings). In this case he had 3 credits and needs 10 to get ssd and medicare.
So the solution we determined is for him to take cobra and find a way to get 7 more credits.
So the solution we determined is for him to take cobra and find a way to get 7 more credits.
Since neither parent is disabled or retired, the benefits cannot be coming from a parent's record.
1. You need to determine if the benefit he is receiving is Social Security Disability Insurance (SSDI) based on his own work record, or is it Supplemental Security Income Disability Income (SSIDI) which is a needs based program. Note that clients DO NOT understand the difference and call all of it "Social Security".
2. You state he may have been drawing since before age 18. Unless he had substantial work for at least 1 1/2 years, the drawing before age 18 is an indicator that this may be an SSIDI payment, which does NOT carry Medicare with it. However, SSIDI DOES provide automatic Medicaid in many states.
If he has a Medicare card with Part A Hospital benefits only, and if he is losing the employer group coverage of the parent, he should have a special enrollment period to obtain Part B without delay and without penalty.
Enrollment periods are different for Parts B, C, and D.
I also suggest reviewing an online document regarding Medicare enrollment periods. I use this to be sure the client can qualify: Publication 11219, Understanding Medicare Part C & D Enrollment Periods.
Q1Medicare and also the Medicare Rights Center have helpful info on their websites as well.
1. You need to determine if the benefit he is receiving is Social Security Disability Insurance (SSDI) based on his own work record, or is it Supplemental Security Income Disability Income (SSIDI) which is a needs based program. Note that clients DO NOT understand the difference and call all of it "Social Security".
2. You state he may have been drawing since before age 18. Unless he had substantial work for at least 1 1/2 years, the drawing before age 18 is an indicator that this may be an SSIDI payment, which does NOT carry Medicare with it. However, SSIDI DOES provide automatic Medicaid in many states.
If he has a Medicare card with Part A Hospital benefits only, and if he is losing the employer group coverage of the parent, he should have a special enrollment period to obtain Part B without delay and without penalty.
Enrollment periods are different for Parts B, C, and D.
I also suggest reviewing an online document regarding Medicare enrollment periods. I use this to be sure the client can qualify: Publication 11219, Understanding Medicare Part C & D Enrollment Periods.
Q1Medicare and also the Medicare Rights Center have helpful info on their websites as well.
- Thread starter
- #16
Most situations I see with early disability seem to be Medicaid qualified.
If the child was disabled before 18, and registered as such with the group carrier before age 18, they can, under current law, generally stay on the group insurance indefinitely while the parent is employed.
Yorkriver, do you have any additional information on the above situation? The parent owns the business so this might be another area to investigate if the info below turns out to be inaccurate from SSA. I'll have to go back and ask if he was considered disabled prior to 18 but I don't think that was the case.
Here are some of the notes from the SSA conversation. I made sure to have it on speakerphone with the client's dad too.
This person is on SSI (confusing for the average person and it was referred to as disability during our conversations). SSI has income/asset requirements tied to it so the client is going to bring up the part time work option (to get the required credits to qualify for SSDI or disability as most people refer to it) at a SSI meeting he has in the next few weeks.
SS was able to look at this kids work history and contributions into the SSDI/Medicare fund and give us an idea of what he had to this point. He has a required amount of work he has to do which is based off of the age he was when he became disabled and if he hits those credits (10 in this case based off of a disabled age of 22) then he can get Medicare A/B without having to piggyback on his parents. 1 credit = $1300 of income and he has 3 on his record as of now. So he needs 7 credits (with a max of 4 in any given year) to get to the magic number of 10.
Upon getting SSDI, then SS would look at his actual "disability date" (aka the date he became eligible for SSI which here was 2013 when he was 22) and use that date as the date of eligibility. I imagine there might be some sort of credit (if there is a difference between SSI and SSDI payments from the time he was disabled until now) but not sure on that part.
In a perfect world, this person would find a way to get those remaining credits (about $7,000 of part time work) in the next 18/36 months while on COBRA and then transition onto Medicare + Supplemental coverage + Extra Help at that time.
Luckily I'm in Missouri, which is an extremely pro consumer state when it comes to insurance laws. He can voluntarily leave the COBRA coverage whenever he wants to GI onto a Plan F/G/N (dep on carrier) so even if the Medicare is retroactive to 2015 (24 mo after the original disability date) we should still be fine there.
There are many things that have to happen here for this to follow through but the guy was extremely thankful about the help and guidance. I can't imagine how many people might be on ACA plans or uninsured and only need 1 or 2 credits to be eligible for Medicare. And they don't even know that it is available.
Thanks for the insight everyone!
If the child was disabled before 18, and registered as such with the group carrier before age 18, they can, under current law, generally stay on the group insurance indefinitely while the parent is employed.
Yorkriver, do you have any additional information on the above situation? The parent owns the business so this might be another area to investigate if the info below turns out to be inaccurate from SSA. I'll have to go back and ask if he was considered disabled prior to 18 but I don't think that was the case.
Here are some of the notes from the SSA conversation. I made sure to have it on speakerphone with the client's dad too.
This person is on SSI (confusing for the average person and it was referred to as disability during our conversations). SSI has income/asset requirements tied to it so the client is going to bring up the part time work option (to get the required credits to qualify for SSDI or disability as most people refer to it) at a SSI meeting he has in the next few weeks.
SS was able to look at this kids work history and contributions into the SSDI/Medicare fund and give us an idea of what he had to this point. He has a required amount of work he has to do which is based off of the age he was when he became disabled and if he hits those credits (10 in this case based off of a disabled age of 22) then he can get Medicare A/B without having to piggyback on his parents. 1 credit = $1300 of income and he has 3 on his record as of now. So he needs 7 credits (with a max of 4 in any given year) to get to the magic number of 10.
Upon getting SSDI, then SS would look at his actual "disability date" (aka the date he became eligible for SSI which here was 2013 when he was 22) and use that date as the date of eligibility. I imagine there might be some sort of credit (if there is a difference between SSI and SSDI payments from the time he was disabled until now) but not sure on that part.
In a perfect world, this person would find a way to get those remaining credits (about $7,000 of part time work) in the next 18/36 months while on COBRA and then transition onto Medicare + Supplemental coverage + Extra Help at that time.
Luckily I'm in Missouri, which is an extremely pro consumer state when it comes to insurance laws. He can voluntarily leave the COBRA coverage whenever he wants to GI onto a Plan F/G/N (dep on carrier) so even if the Medicare is retroactive to 2015 (24 mo after the original disability date) we should still be fine there.
There are many things that have to happen here for this to follow through but the guy was extremely thankful about the help and guidance. I can't imagine how many people might be on ACA plans or uninsured and only need 1 or 2 credits to be eligible for Medicare. And they don't even know that it is available.
Thanks for the insight everyone!
- 1,745
The details are dependent on state law, in some cases, and on the size of the group. COBRA is for groups of 20+, for example. Disability before 18, check with the group carrier, agent, and the full insurance policy, called evidence of coverage.
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