Medicare and Social Security Disability Coverage

What Is Medicare?

Medicare insurance is a sponsored government health insurance program for individuals 65 years of age and older. It also provides coverage for individuals who have received Social Security Disability Insurance (SSDI) for 24 months. SSDI is for individuals that have earned enough social security to be insured, and for people that have a medical impairment preventing the person from working for 12 consecutive months or awaiting death. There are four parts to medicare: Parts A, B, C, and D. The descriptions are as follows:

Medicare Part A

Medicare Part A is a hospital insurance without the premium monthly payments, although there is a yearly deductible. If a retired 65-year-old individual has not paid 40 quarters of FICA taxes, Part A will not be available to that individual unless it is purchased. Part A covers inpatient hospital stays or a skilled nursing facility that offers rehabilitation services, especially, for example, those who have just had major heart surgery. It also covers home health care services such as physical therapy, occupational therapy or speech-language therapy.

Medicare Part B

Medicare Part B is available to the Part A beneficiaries. It is a medical insurance that covers doctor and health care provider services, nonlong-term health care, durable medical equipment, and a few preventative services. Durable medical equipment includes oxygen, traction equipment, crutches, and powered scooters. Preventative services include diabetes screenings, flu/pneumonia shot, bone density studies and more. Unlike Part A, Part B is fee-for-service and has a premium payment. It is, also, increased for individuals with higher incomes. Additionally, there is a yearly deductible for participants.

Medicare Part C

Medicare Part C, also known as Medicare Advantage, includes all benefits and services that are covered under Part A and B. Private insurance companies charge premiums, but the premium amount could be less than Part B. Medicare Advantage offers additional coverage like vision, dental and hearing. These plans do have specific doctors and hospitals that need to be utilized.

Medicare Part D

Medicare Part D is an optional prescription drug coverage. There is an additional premium payment, unless it is under the Medicare Advantage Health Plan. In order to be covered in Medicare Part D, enrollment in Part A and Part B, live in a service area and cannot have ESRD are required. There is also a penalty if the application for open enrollment is missed.

Medicare Disability

If the applicant is already on SSDI, there is no need in applying for Medicare disability. Automatic enrollment in Medicare will begin three months before the 24th SSDI payment. A Medicare card will show the eligibility for Part A and B. Medicare is not mandatory. However, if the plan is declined because of a current healthcare plan, the individual cannot reapply for Medicare coverage until open enrollment. There will be a penalty for coverage applications if done outside of open enrollment. If the individual decides to return to work, there are multiple trial periods to see if the beneficiary is eligible for Social Security’s ticket to work. After the first 9 month trial period, SSDI will act as a secondary payer to receive payments when wages are below the number of substantial earnings.

Social Security Disability

Social Security Disability programs are one of the largest federal programs assisting people with disabilities. The program collects medical information, work history and education history from the individual via an application, and a decision is made whether the applicant meets the disability definition. Once approved, SSDI pays benefits to the individual and certain family members. Those individuals will be insured if the primary person has worked long enough to pay Social Security taxes.

Long-Term Coverage

Medicare does not cover long-term care. It is considered custodial care instead of medical care, which Medicare does not pay for. Custodial care includes grooming, dressing and helping with the everyday normal activities that a person would need each day. However, if occupational therapy, physical therapy, speech therapy, skilled rehabilitation services or visiting nurse services are required, it will be covered through Medicare.

Author: Jenna Smith