Social Security Disability - enrollment procedure?

[radmoo]

I am still f/t employed with United Healthcare provided my employer. I have kept hubby who has reached full retirment age and then some on the coverage and it is this private coverage that is our primary insurance. Medicare picks up where this leaves off and as he is also a vet, he is eligible for those benefits as well. We've been doing this for many years and private insurance has always been his primary coverage.

 

[timeos2]

Please help me better understand your post. Once your SS Disability application was approved, you were required to enroll in Medicare and discontinue participation in the "free" primary plan offered by your employer? Correct?

Correct. y previously 100% employer paid plan HAS to become secondary to Medicare.

In addition, your post appears to suggest that once accepted for SS Disability, a recipient may not enroll in "any" supplemental medical or drug program (i.e, AARP). Is that correct? If not, why didn't you enroll in AARP or another secondary medical & drug plan once accepted for SS Disability?

That part is also true but it is a requirement of my employers insurance company plan NOT Federal law/rule. Just taking advantage of an already big savings they get IMHO.

 

[timeos2]

Here's the rule on the govt official website. It looks like there's a possibility your small employer might be able to accommodate you if they care to.
http://www.ssa.gov/disabilityresearch/wi/medicare.htm#coordination

That applies to insurance paid by a currently EMPLOYED persons insurance payment as radmoo says. As a retiree the rules are Medicare first - private/retirement second. If my wife had coverage from her work then it would be primary over Medicare but we are both covered by my (formerly) excellent retirement insurance benefit. Actually she & my daughter still get the great coverage I had until July. When she goes to SS then she too will have to pay & have Medicare as primary. Yuuch. Of course my daughter needs her own very soon as her school time is ending.

 

[NWL]

Has anyone ever enrolled a dependent for Social Security Disability? This is for my 23 year old son who has autism.

I'm just wondering what the process is - I don't imagine it's easy...

Before spending money on an attorney, it might be worth your time to contact the local (not D.C. Office) office of your Congressional representatives ('Senators and Representative) for advice. This is the type of service they provide and your tax dollars are funding the offices. Give them a try. You may be pleasantly surprised with the help you receive. Unlike an attorney, it won't cost you any money to ask.

Cheers!

 

[pgnewarkboy]

I think timeos problem on secondary insurance is unusual and the fault of the employer -not social security as timeos seems to say.

 

[Plucky]

Believe me I tried every way to Sunday to get that - absolutely no! Once you are on SS you MUST go to Medicare and any type of plan they had offered, which covered literally hundreds of thousands of dollars of treatment, surgery & virtually all prescriptions at my cost of less than $300 over 3 years reverts to secondary to Medicare which for prescriptions alone has cost me over $2500 in less than two full months since the switch. Heaven help me I need any more surgery, etc - it will probably take any savings and more! It is terrible & they warned me if I try to get third party coverage of any type then even what they cover now as secondary will be terminated! It is a no option set up - you take what they offer or be on your own. It has to have cut their costs by thousands but they claim they don't even know - it's just the way the program works.

It really is a nightmare that to get the benefits you worked all your life for you must give up other benefits that were supposed to be for life. All too typical of the way government "helps" when involved with things they have no clue about and shouldn't be involved with. Take your SS contributions, kill your other benefits - whats the problem? It just isn't right but there is no option. None. And no one to appeal to as that is the law.

That just does not sound right.
I'm not sure why this was different for me.
After two years on SSDI, you are enrolled in Medicare part A which is free.
If you want part B, you pay monthly for it. You do not have to take it.

When I went out on disability 14 years ago, I did not take part B, because my husband's employer was covering me. When my husband went on SSDI, we lost his work health insurance and both needed to sign up for part B.

All I had to do was sign a waiver saying the reason I didn't take part B all those years ago, was because I had coverage through my husband's employer. His employer had to send proof. That was it. No muss, no fuss.
I don't believe they "force" you into taking part B Medicare if you don't want it.
It's up to you if you want to use part A for anything and I never did.

We now both have a supplemental policy through my old company since I went out on Long Term disability. Between the two, (Medicare and MVP from the former employer) we have had to pay next to nothing out of pocket for anything- specialists, surgeries, prescriptions. What one doesn't cover, the other does.

 

[timeos2]

I think timeos problem on secondary insurance is unusual and the fault of the employer -not social security as timeos seems to say.

I had hoped that was the case but two contacts with the SS office (one call one letter) they confirmed that as a RETIREE my insurance MUST be secondary to Medicare. Period.No other options except refuse SS benefits. It may only be $500 net but its $500 more than I had before and more hassles and costs than I ever anticipated. It just doesn't make sense for them or me but thats government I guess.

 

[Plucky]

I also don't understand how you could be paying so much for coverage. It looks like we live in the same city.
You could pay your part B and buy a supplemental through Medicare for about another $90 a month and get a ton of coverage including prescriptions.
My husband and I are looking to switch to one of those as it is cheaper than what we're paying through Kodak.
I don't think $200 a month is that outrageous for health insurance that includes decent co pays for everything including prescriptions and free annual gym membership at your choice of gyms. We feel like we're getting a deal. We were paying higher premiums when he was working.

The "Medicare and you" book prices are no different for retirees and disabled people not retirement age.

I think you need to go in person to the SSDI office. Calling doesn't usually work for me. You'll get a lot of misinformation.

 

[timeos2]

I also don't understand how you could be paying so much for coverage. It looks like we live in the same city.
You could pay your part B and buy a supplemental through Medicare for about another $90 a month and get a ton of coverage including prescriptions.
My husband and I are looking to switch to one of those as it is cheaper than what we're paying through Kodak.
I don't think $200 a month is that outrageous for health insurance that includes decent co pays for everything including prescriptions and free annual gym membership at your choice of gyms. We feel like we're getting a deal. We were paying higher premiums when he was working.

The "Medicare and you" book prices are no different for retirees and disabled people not retirement age.

I think you need to go in person to the SSDI office. Calling doesn't usually work for me. You'll get a lot of misinformation.

The fixed cost is only $105 but I had better coverage for zero! The big cost is my ongoing drug prescriptions - one cost me $496 every three weeks since the deductible now is 40% (the true cost is over $3500/every 3 weeks) vs ZERO under my private plan. So you can see where the money (cost) is but wouldn't be there for most people (until you NEED it!).

Once I pay $4500 within any 12 months of 1/1 each year the deductible drops to $0 so then it is equal to my previous plan. But at a cost of $5700 I didn't have to pay before (the deductible plus monthly $105) for less coverage. Plus they go by year not count so my $4500 for 2011 will run out 12/31 & I have to pay another $4500 before my old benefit level returns in 2012! Makes me sicker than I am just to deal with it.

I will continue to try to find options but so far it doesn't appear there are any. If that changes I'll let you know.

 

[Plucky]

So basically, your previous private plan ended when you retired? That I can understand, but that's the employers policy, not SS's. SS would most certainly like you to stay on another insurance plan, rather than theirs. Or use both.

Have you spoken to Medicare about this? They may be able to give you some other options for the scripts. That out of pocket sounds so high to me and I'm so sorry you have to pay it. When you're not feeling well to begin with, all of this is just terrible.

Prices on drugs are outrageous. Did you sign up for a supplemental plan in addition to part B? I think that would lower your out of pocket for those huge drug costs and save you money, even after paying the premium.

My husband was on very expensive prescriptions when being treated for cancer. Thousands of dollars a month that ended up costing us a maybe $100. (His annual premium was covered in just one month of the insurance company paying his scripts.) Some of it was picked up by the Lymphoma society. All it took was filling out an application. Google- help for prescription drugs for cancer patients. I hope you find something.

So sorry to hear you're dealing with this. It all sucks. Cancer, treatments, insurance companies.

 

[timeos2]

So basically, your previous private plan ended when you retired? That I can understand, but that's the employers policy, not SS's. SS would most certainly like you to stay on another insurance plan, rather than theirs. Or use both.

Have you spoken to Medicare about this? They may be able to give you some other options for the scripts. That out of pocket sounds so high to me and I'm so sorry you have to pay it. When you're not feeling well to begin with, all of this is just terrible.

Prices on drugs are outrageous. Did you sign up for a supplemental plan in addition to part B? I think that would lower your out of pocket for those huge drug costs and save you money, even after paying the premium.

My husband was on very expensive prescriptions when being treated for cancer. Thousands of dollars a month that ended up costing us a maybe $100. (His annual premium was covered in just one month of the insurance company paying his scripts.) Some of it was picked up by the Lymphoma society. All it took was filling out an application. Google- help for prescription drugs for cancer patients. I hope you find something.

So sorry to hear you're dealing with this. It all sucks. Cancer, treatments, insurance companies.

No, I retired 10 years ago & my private plan was guaranteed for life. Only the application & acceptance for SS benefits triggered the change. My insurance (NOT SS) says if I get another coverage of any type (such as AARP) they will immediately terminate my plan with them & I'm on my own.

Some of the problem is with my plan but the key & start of it all is the SS rules. Yes, it sucks. I'd rather not need the stuff & it would all be moot until I needed something else. The costs are incredible for the medicines & the other treatments have dwarfed those. Thankfully I had the non-medicare coverage for the first 3 1/2 years I've been ill so literally I got hundreds of thousands paid at a total cost to me of less than $500. I just bemoan the loss of that great coverage all because I claimed my lifetime of contributions to SS - like most I had no choice but to be in that system. Now it's biting me AGAIN for more money & I truly resent it. But the option isn't a good one so I'll carry on. But it isn't right.

 

[Passepartout]

Denise, my DW is an attorney specializing in SS Disability filing. Or refiling as denials are almost universal. She- and other reputable practitioners charge no upfront fee. They will need your (his) denial letter and a signed letter to access his entire SS and medical files. Other posters are correct- this can take years. The attorney's fees are much lower than those stated by others and are largely paid by SS, not the claimant. It should cost him nothing to consult with an attorney about this.

I'll ask her to perhaps drop you a PM, but we have been away for 2 weeks and she has a lot of catching- up to do with current clients, and of course only works for local clients, so couldn't personally help your son.

Jim Ricks

 

[ondeadlin]

It used to be that retirees could keep their private insurance when they went on Medicare. Private insurance companies have ended that practice - they now force you to take medicare as the primary payer as soon as you are eligible. This is not something medicare or social security or the federal government mandates, it's something that private insurers have forced employers to build into their coverage.

 

[Wonka]

No, I retired 10 years ago & my private plan was guaranteed for life. Only the application & acceptance for SS benefits triggered the change. My insurance (NOT SS) says if I get another coverage of any type (such as AARP) they will immediately terminate my plan with them & I'm on my own.

Some of the problem is with my plan but the key & start of it all is the SS rules. Yes, it sucks. I'd rather not need the stuff & it would all be moot until I needed something else. The costs are incredible for the medicines & the other treatments have dwarfed those. Thankfully I had the non-medicare coverage for the first 3 1/2 years I've been ill so literally I got hundreds of thousands paid at a total cost to me of less than $500. I just bemoan the loss of that great coverage all because I claimed my lifetime of contributions to SS - like most I had no choice but to be in that system. Now it's biting me AGAIN for more money & I truly resent it. But the option isn't a good one so I'll carry on. But it isn't right.

I'm still a bit confused. It appears an AARP Supplemental Medical and Drug Plan would greatly reduce your out of pocket risks and the cost of purchasing both plans. So, why not simply drop your "free" private insurance and sign-up for something else? Or, would the cost of the medicine be the same with other drug plans?

 

[timeos2]

I'm still a bit confused. It appears an AARP Supplemental Medical and Drug Plan would greatly reduce your out of pocket risks and the cost of purchasing both plans. So, why not simply drop your "free" private insurance and sign-up for something else? Or, would the cost of the medicine be the same with other drug plans?

The other coverage beyond the prescription coverage is still a very big benefit. I would need to get the AARP plan plus a major medical plan to completely replace my ex-employers plan if I gave that up. And in a quick test of the AARP plan as an example the deductible would be less than I have now but still more than I had in June & prior. Plus the cost of the AARP plan isn't that low so taken as a whole I remain ahead with the ex-employer provided plan vs getting my own.

 

[Wonka]

The other coverage beyond the prescription coverage is still a very big benefit. I would need to get the AARP plan plus a major medical plan to completely replace my ex-employers plan if I gave that up. And in a quick test of the AARP plan as an example the deductible would be less than I have now but still more than I had in June & prior. Plus the cost of the AARP plan isn't that low so taken as a whole I remain ahead with the ex-employer provided plan vs getting my own.

I have Medicare and AARP Supplements. I'm work for the government, and the cost of the government plans don't seem to offer any additional real savings over Medicare and AARP (there's an annual enrollment period). As such, I've never bothered to look into them further. I've had several medical procedures the last two years and most things have been fully covered under Medicare. But, I have not had to take an super expensive medications.

I guess I'm in for a shock if I ever need any of the real expensive medications? I understand the donut hole, but that doesn't seem too bad. And, I'm also in the VA plan. I've always considered that another "back-up" for the high priced stuff if needed.

 

[timeos2]

It used to be that retirees could keep their private insurance when they went on Medicare. Private insurance companies have ended that practice - they now force you to take medicare as the primary payer as soon as you are eligible. This is not something medicare or social security or the federal government mandates, it's something that private insurers have forced employers to build into their coverage.

This appears to be the ultimate source of the problem. Why the SS department would accept & require it when it clearly costs them more is a big question. Look no further then the campaign contributions to sitting representatives and I guess that answer is clear too. Wonder why we have trillions in debt? And no, the ones that voted to OK this aren't in the system! They are some of the tiny percentage that aren't required to pay & be in SS. Werth! They can't even eat their own dog food - they have prime rib or better to feast on at our expense.

 

[GeraldineT]

The reason that ss requires you to use Medicare as your Primary is so that they can monitor your health records to make sure they coincide with the disability they are being paid for. There were so many frauds out there that this is a control that actually saves money. You can have a private company as you supplement if the private insurer/employer allows it.

 

[GeraldineT]

As for the original post. Make sure you have all your backup documentation as to exactly why your son cannot work at all. Autism is a very broad area and many function fine and hold down full time jobs and have successful careers so there is a likelihood that your claim may be denied. The fact that your son does not work at all (even part time) may become an issue. Have you ever thought of enrolling him in a program through Easter Seals. Being in a program like that would almost guarantee a smoother process.

 

[timeos2]

The reason that ss requires you to use Medicare as your Primary is so that they can monitor your health records to make sure they coincide with the disability they are being paid for. There were so many frauds out there that this is a control that actually saves money. You can have a private company as you supplement if the private insurer/employer allows it.

Most (all I dare say) insurances cos are fully automated today & could easily and cheaply supply whatever information may be required. That is as big a bunch of bunk as I've heard recently. Any port in a storm for a ridiculous rule obviously done to save private insurers / employers costs at the expense of the public at large. It has not been exposed enough and more and more are going to find out about it as they are forced to join & hopefully a push back to correct it will occur. One can hope sanity returns to government at some point in time or we really are doomed as a nation & economy.

 

[Passepartout]

Has anyone ever enrolled a dependent for Social Security Disability? This is for my 23 year old son who has autism.

I'm just wondering what the process is - I don't imagine it's easy...

Please pardon the delayed response. My Beloved (passepartout) and I have been out of range for 10 days.

I will happily comment to cut through the mythology and misinformation already offered. I have practiced Social Security disability law since 1984 and am a proud member of National Organization of Social Security Claimants' Representatives (NOSSCR).

Social Security Disability (SSDI) and Supplemental Security Income (SSI) are both administered by the Social Security Administration. They are separate programs that serve similar populations and have identical medical severity criteria, but they have very different financial eligibility standards. Social Security is an insurance program for which wageearners and their employers pay a premium in the FICA tax. Social Security disability is payable to wageearners and survivors regardless of the financial means of the beneficiary. SSI is a welfare program for the low-income disabled and elderly. People who have not worked may qualify for SSI if they have virtually no income or assets. Children whose parents are still alive qualify for disability benefits, if at all, through the SSI program.

One starts with an application, which can be done online, and can be concurrently for both SSDI and SSI. Fairly shortly thereafter an interview will be scheduled during which a trained claims representative will gather a great deal more information about the beneficiary, their medical care, their education, training, and past work experience. Social Security will then obtain copies of all relevant medical records and may require the applicant to submit to additional medical evaluation and testing. The application will be reviewed by highly trained personnel at the state disability determinations agency.

In order to qualify medically, the applicant must show through the medical records that their combined impairments preclude reliably sustaining any kind of work in the national economy. This is a high standard to meet. To identify the clear cases, the regulations define hundreds of medical impairments that are readily measurable, such as in lab tests, MRIs, etc. Nationwide about 40% of applications are approved on the basis of the data in the medical records.

Impairments that affect patients from mildly to severely, such as diabetes, seizure disorder, mental disorders, and pain syndromes are typically denied at this stage, not because the evaluator is arbitrary, irrational, or stingy, but because it is the the responsibility of the applicant to prove the severity of their impairments and the extent to which the impairments limit their ability to work which typically are not addressed in the progress notes of the physician.

Upon receiving the first denial notice, counsel should be retained. Let me explain how this works too, as sadly not all of my colleagues deserve your trust. Be very careful about any lawfirm that wants to "sign you up" without reviewing the merits of your case. Too many attorneys are too ready to get a client to commit to the fee agreement. They know that a certain percentage of cases will be awarded whether they develop the case or not. Then when you get denied at the administrative hearing they won't appeal further. Lawfirms who advertise heavily are suspect. For a reliable referral contact NOSSCR through nosscr.org. Your case is important enough to consult with more than one attorney before you choose. Ask questions to learn not just the extent of the attorney's experience but their methods. How closely will the attorney be working with your treating physician?

Attorneys who agree in writing to a contingent 25% of past-due benefits finally awarded (maximum $6,000) are allowed to receive the fee directly from the Social Security Administration.

I wish you well. Autism is one of those conditions that are particularly difficult to prove. After all, they now characterize it as a "spectrum." Your result will more favorable and sooner if you take the time to find an attorney that is familiar with the disorder and willing to work to develop the evidence.

Ms. Passepartout
Paula Brown Sinclair
Attorney at Law
Twin Falls, Idaho