what is your health insurance if you go on SSDI?

Fearless_One

Do you then go on Medicare?  Medicaid?   Or does SSDI automatically cover you for health insurance?

Sorry if this is a dumb question - I am trying to familiarize myself with these things and am confused about the health insurance portion of it.

Chickadee

If you are approved for SSDI then you will be eligible for Medicare 2 years from your disability date.

If you were on SSI, which is income based, then Medicaid would come into play.

Not dumb.  Lots of folks are confusing SSI and SSDI.   The Social Security webpage is really excellent and you should read as much as you can to understand it.

On edit: Insurance during the two years is your responsibility.  Hopefully you have something from work to tide you over like LTD?

Alpal

You're eligible for Medicare 2 years after you start drawing SSDI. Medicaid is income dependent, so you may or may not be eligible for it. Medicare has nothing to do with income.

Alpal

If you have to go on Cobra, it should last 24 instead of the usual 18 months, if you're on SSDI and waiting for the 2 year period to end. I don't think Health Care Reform has changed that, but not sure.

Fearless_One

No, I have no LTD.   If I am no longer able to work full-time at some point, I would have to carry Cobra for the 2 years, I guess.  

Fearless_One

I don't know what the medicaid income limit is, but I suspect I may qualify.  

Fearless_One

yes, I just checked the Medicaid eligibility requirements for my state, and I would qualify.  Not sure how that figures into things...so then I could be on Medicaid during that 2 year waiting period?

Anonymous

My brother was on Medicaid during the time that he was waiting for Medicare.  Now he actually has both.  Look into it - the Medicaid benefits can vary from state to state - he is in NY and the benefits there have been good.  Also depends on how long you have lived in your state.  My brother has stayed in NY rather than moving to PA or CO because the benefits are better there.

Anonymous

Forgot to add that my brother is in a subsidized apartment - I believe that this is tied to his income and Medicaid.

petjunkie

I'm on SSDI and am making COBRA payments to my former employer to cover my medical insurance until I hit the 2-year-mark and get Medicare.

You might want to get a consult at the SS office in your area, or even with an attorney that specializes in disability cases. Stage IV breast cancer is an automatic approval, but other stages are not, so I think you have to do quite a bit of work to get them all the documentation to show you are unable to work. I've heard that it is a difficult process.

To prepare, I might even suggest that every time you meet with your oncologist you discuss your difficulty in working full-time. That will give you a history in the chart notes of having trouble working, which the doc can then use when writing the letter to SS and submitting your medical records. 

After you are approved, there is a 6-month waiting period before you start to get disability checks from SS. So you could start planning for that now, too, and trying to build some savings if you can. The downside of that is that any savings are counted against you for SSI, the one that is income based. At least in my state of WA, they considered any amount in savings as well as retirement accounts, etc. 

Fearless_One

Petjunkie, you are right- I am only stage IIA so it will be difficult ( I am glad stage IV is automatic SSDI - it should be).    I don't think it impossible, though - I do have some legitimate issues that I do wish to discuss with my onc.    I just was concerned about the insurance issue and wasn't sure how it all came together.

petjunkie

I don't think it's impossible, either! You paid into the system and it should support you if you need it. I just think that it's always a good idea to be a squeaky wheel. I know that I often downplay things and say "oh, i'm doing fine." If you do that, the docs won't have documentation that you're struggling to work. So complain, complain, complain! Be honest about what you are struggling with. Set yourself up to have evidence so that if you do need SSDI, they have the info they need to approve your claim. I wish it were an easier process for people. I understand that it's a system that gets abused at times, but a cancer diagnosis and the crappy treatments we have to take are pretty clear-cut. It's not like faking a back injury or something that can't be proven medically.

Fearless_One

You are so right.   At my last visit I just smiled and said everything was fine because I didn't want to be sent for a battery of new tests and scans.   I am currently able to work, but is getting harder, especially after my mastectomy (I thought recovery would be easier, to be honest - unless I just am a big baby with a low pain tolerance).   Chemo went well, but I never have felt 100% since then and it's been awhile.  

Fearless_One

I would definitely have to carry Cobra in the interim (if I was approved).   While my income qualifies me for medicaid, I do not (at this point) meet their requirements (i.e. not pregnant, no kids under 18, etc.).     I don't think I could afford Cobra if I had to leave my job.   What a mess.   I guess a lot of people just go without insurance during the waiting period.

jacee

Can you stay on your spouse's health insurance if you are on SSDI?

Kezzie62

My Husband gets SSDI and he is on my health insurance from my work, it worked out cheaper for him to be on my insurance than pay part B and part D for medicare.

jacee

Thanks Kezzie.

Chickadee

Yes you can but when you are eligible for Medicare after 2 years, it will become primary and your spouse's insurance secondary.   Mostly an administrative headache but it can have ramifications if your Dr. is not a Medicare approved practitioner. 

Fearless_One

I guess I am pretty much s*rewed as I would not be able to afford Cobra and have no spouse.   I don't know what I will do if the cancer progresses.   Don't you have to not have worked for a year before you can even apply for SSDI?

Mazy1959

Fearless,

I applied for SSDI as soon as we realized I would not be able to return to work, which was 2 months after my diagnosis of stage 4. My docs had told me I would not be able to but I wanted to wait and see. I couldve applied as soon as my docs said that. Benefits start 5 months after you can no longer work but you dont get your first check until the 6th month. Do you have other serious health issues that would help qualify you? You most likely will not qualify having stage 2A alone unless you have some debilitating effects etc from treatment and/or surgery. Its hard on people when you have to stop working and then apply and wait and see. If you get to the point where you simply cant work, maybe you would qualify for some kind of aid..I dont know. Perhaps theres something new I dont know about, I hope so. It never hurts to ask. I know one woman who had stage 3B, has 3 other serious health conditions as has been refused SSDI repeatedly. Good luck, Mazy

Kezzie62

"Liane wrote:

Yes you can but when you are eligible for Medicare after 2 years, it will become primary and your spouse's insurance secondary.   Mostly an administrative headache but it can have ramifications if your Dr. is not a Medicare approved practitioner.  "

My Husbands medicare is not his Primary insurance the insurance he gets through me, is his primary insurance, his medicare part A will pick-up anything not covered by his primary.  Medicare will only be primary if you are paying for part B and part D.  He does not have part B & D as they worked out more expensive than adding him to my insurance from my employer. My husbands PCP is not a Medicare approved practitioner and we have never had any issues with him being seen.  As I said his Medicare is secondery so its not a problem.

 Kezzie

Fearless_One

Thanks, Mazy....I do know that you can't be making more than 1K a month (gross) at the time you apply or you will be denied (no matter what your illness).   Does your friend make more than that?  

I guess I will just wait and hope it does not progress.   I only know it's VERY difficult (if not impossible) to get SSDI unless you have made less than 1K a month for a year or more.

gale1525

Fearless one, do you know if the thousand dollar amount is for the person applying or is it a combined income total for husband and wife?

jdootoo

Fearless one: I was able to get on SSDI at stage IIIA, thanks in part to advice from a friend who is a social worker. She told me to have everything well documented, and talk about PAIN, PAIN, PAIN. You need to convince them that you cannot work because of pain or the medication you are taking. Also, it helps to get your doctors on your side, ie: talk to them before you apply. Apply as soon as you can, though. Good luck!

lluistro 1525: They count combined income.

One love, Jackie 

Fearless_One

Ilustrio, they go by the household tax return.   So if you file jointly, they will combine income.

Jackie, may I ask if you were working at the time?   It is my understanding that you can't have made more than 1K a month for 12 months before they will even consider you (no matter what stage you are).    That is why I worry.   If it progresses, I won't even be able to file until one year after I leave my job - and I don't even know how I would do that.

reesie

Depending on the state you're in you might be able to qualify for a state sponsored short term disability (NJ has one).  You might qualify for short term even though you wouldn't for long term SSDI (I would assume that it's easier to qualify for short term than the long term SSDI).  This would also help while in the SSDI waiting period.  I know it didn't take much for me but I was bedridden for 5 months and am stage IV from the outset.

Edited to add: I know this doesn't help with the insurance, but at least it would be income during the period you couldn't work while you recover.

Chickadee

Thank you Kezzie, I didn't know about that difference.  We are not paying for Part D so there obviously are a number of issues that have to be explored when Medicare comes into play.

Fearless_One

So what happens if you are working full time at the time you learn your cancer has progressed?   They won't review your case until you are no longer working?   Someone could be homeless by then!   I don't understand how this works.....I am fortunate it has not progressed, but I don't know what I would do (being as I am single and go paycheck to paycheck).

petjunkie

Yes, it's crazy but you don't qualify for SSDI unless you are unable to work, but then there is a 6-month waiting period before you get the first check. I don't know how most people pull this off, unless they get short-term disability benefits through their employer during the waiting period.

My employer gave me 12 weeks of medical leave, though it was unpaid. But at least I didn't have to start COBRA payments for 3 months, as I was still considered an "employee." I didn't have any savings to speak of. I ended up cashing out my retirement account to get enough money to let me pay bills and everything until SSDI kicked in.

Since I was only 35 I didn't have much in my 401K. And then I had to pay income tax on it, so I lost about 25%. I was able to get the 10% early withdrawl penalty waived because of disability. So I walked away with about $20k that let me pay off credit cards, pay bills, and was enough to pay my COBRA for the first year. It gave me a little bit of a safety net.

One thing you should be able to find out now on the SS website is what your benefit amount would be. It all depends on how long you've worked, what you've paid into the system, etc. I didn't work in college and then went to grad school an a stipend, so I had only paid into the system for about 8 years as a full-time worker. My benefit is $1600 a month. My COBRA payment is $550, my prescription co-pays are $250, and I pay $2500 out of pocket before my insurance covers everything, so January and February are tough (my chemo infusions are $16k each!).

Sorry, I know it makes some people uncomfortable to talk in such detail about money. But I wish I had known about all this stuff when I was younger and could have maybe made different choices about my savings, living expenses, etc. I am lucky enough to have parents who are well-off and help me with expenses. Otherwise, I'd be left with about $800 a month to pay a mortgage, car, groceries, utilities, etc. It just wouldn't be possible. Going on SSDI without help, I would have had to sell my house and car and probably move into some kind of housing assistance situation. 

Fearless_One

Petjunkie, yes, I have been working nearly 30 years (full-time), however, my payout wouldn't be much since I don't make much.   But I think I could make it.   I get the statement each year that you are referring to.    It's not significantly less than I make now.

But if I was to stop working (such as if the cancer progressed), I wouldn't be able to pay rent. car, etc, so I guess I would just have to keep working, even if it metastasizes, since they won't review you unless you have made less than 1K a month for a year (I think).   It's like a circle that you can't get out of unless you have a spouse or a years worth of savings.

lookingforward4more

I am applying for SSDI. I have nueropothy in both my feet and hands form the chemo treatment that is quite painful. I am taking round the clock pain killers and have trouble walking, etc. when it it really bad. I have two herniated discs in my back and one in my neck. I also have advanced lymphodema in my right arm and hand that requires 24/7 compression wrapping and is also painful.  I met with the social security case worker and have an attorney. They both tell me that I will get approved but will most likely have to go to the hearing level so that equates to over two years without any income. It is scary and a long shot but I am truly unable to work a full time job due to  my limitations from the breast cancer treatment and the pain that in my daily challenge. I am also depressed and seeing a psychiatrist and a therapist. It is vital that you document everything that you are experiencing so that your case can be adequetly judged. Believe me I would rather turn the clock back four years and be healthy and work. I LOVED my job and miss it every day.