Medicare and Disability under 65

[montanawind1]

There is a group out there I never hear anything about and I am one of those individuals:  those on disability and under 65.  There are all types of programs for medicare supplements for those 65 and older, but NOTHING for this gap group.  Medicare Advantage only basically does your paper work........and perhaps some dental, but that is easy and cheap enough to provide for myself.  WHY HAS AARP NOT ASSISTED THIS GROUP...............there are no programs in Montana and I pay the same dues as everyone else.  I was lucky enough to obtain a fully paid individual insurance plan before the 'affordable care act' went into effect, something you can not do at this time due to the enrollment period and what I could get with the same company is nothing that comes any where near the benefits of the private policy.  With rheumatoid arthritis since 1986, I have high drug costs which are covered by the private insurance plan.  WHERE ARE YOU AARP?

[SharonM39171]

Iam 48 been on s.s.d.i. for almost 10 years mental illness was getting Medicaid in New Jersey, but they stopped it. Wondering what can I do I read NJ has horizon under 65 I can use is it with it? I am paying the 144.60$ which hurts but it's better than 400$ especially with Trump and his republicans party. Well I hope Saul doesn't change anything I see my drs monthly and Bipolar 1 ocd addgad ect is not getting better. I can't be off my meds I lose it. 

[GailL1]

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@SharonM39171 wrote:

Iam 48 been on s.s.d.i. for almost 10 years mental illness was getting Medicaid in New Jersey, but they stopped it. Wondering what can I do I read NJ has horizon under 65 I can use is it with it? I am paying the 144.60$

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You are now on Medicare.  You pay, as most people,  the $ 144.60 a month (2020) for Part B of Medicare.  Center for Medicare and Medicaid Services (CMS).gov - 2020 Medicare Cost

You will pay that regardless of whether you are enrolled in original Medicare or any Medicare Advantage plan for which you might be eligible.  However, there are both state and federal help programs that can pay this premium and perhaps some other medical cost IF you meet the income eligibility guidelines.

There is EXTRA HELP available via Medicare IF you meet certain eligibility requirements - mostly low income related.  This Medicare pamphlet will explain the various programs.

Medicare.gov Publication 05/2019 - Get Help With Your Medicare Cost

This has 2019 eligibility limits - they probably have changed a little for 2020 - Call Medicare - the number is on the pamphlet.

Another way for some financial relief for your medical cost is IF you qualify for some help via the rules in New Jersey.  This will describe (2019) eligibility qualifiers, they haven't updated it yet for 2020.

New Jersy Dept of Human Services - Getting Help with your Medicare Cost 

Since you were previously on Medicaid and have evidently been removed, I will assume that you are not now a "dual eligible", meaning a Medicare beneficiary that also has Medicaid help too.

If that is the case, you were probably removed from Medicaid when you switched disability from SSI (Supplemental Security Income), [ which is the government's charity disability payment that comes out of the General Fund ]  to SSDI [which is the Social Security benefits which you earned while working or as a qualified dependent of someone who worked long enough to earn this benefit] and your income increased as a result.

Just check it out with Medicare and your state to see if you might qualify if your income is relatively  close to the eligibility limits.

[p500733s]

Is there any recent information about Medicare under 65 getting Advantage or other supplement?

[KeeleyM720574]

I am on advantage of waiver services in my state and I don't know if it's different state to state, but I'm under 65. It does not help me with the 20 percent, but it does pay my co pay for prescriptions up to 13. It also gives me so many hours a week to have somebody come and help me with things like cleaning, laundry and errands.I can also get things inconsistent and supplies and other medical suppliessupplies.  I got a chair for my bathtub. I'd like to be able to get one of those walk in bath tubs and need to check into it because I'm in them an apartment, and I don't know if Medicare pays all of it or advantage. I don't know if it's different than AARP advantage, but advantage waver in my state is really good and I'm glad I have it. You have to qualify medically and financially. I assume any state that has it you have to be nursing home level of care, but well enough to stay home with someone coming to help you so many hours a week. Is there a different advantage program with AARP because I saw someone say ugh, and I can't imagine not liking advantage waiver services that's through my state, so it makes me wonder if they offer a different one. From what I see plan F is not good because of the cost compared to the services that you get? 

[somarco]

This is a very old thread, dating to 2014, with a wide range of responses. Admittedly, I have not read them all so there may be a few repeats here. But Medicare for folks under 65 is challenging in most states if you want/need something beyond original Medicare.

If you are under 65 and on SSDI for 24 months you are eligible for Medicare.

https://www.ssa.gov/planners/disability/approval.html

Some states, but not all, have Medicare supplement plans for those under 65. To my knowledge every state has Medicare Advantage for the under 65 crowd.

Medigap pricing for under 65 is incredibly high in many states. Typically 3x to 10x or more the monthly premium for the same plan from the same carrier if you were 65.

Medicare Advantage has lower premiums, often $0, but comes with considerably higher OOP (out of pocket) for approved, in-network expenses. All are managed care with about half HMO.

In addition to Medicare you may qualify for Medicaid. Some specific medical conditions may have organizations that provide financial assistance. For example, if you are on dialysis there may be groups that can help you pay for medical bills and/or insurance.

[AndyM579679]

I would suggest contacting a gent/broker like myself who specializes in Medicare.  We can go over all the options for you and let you know what you can and cannot get.  

[AndyM579679]

It really depends on what state you are in.

[JaniceSchacterLintz]

Please sign our petition to have Medicare cover hearing aids under HR 3150. http://petitions.moveon.org/sign/to-pass-hr-3150.fb73?source=c.fb&r_by=6379786 Please repost to all social media. Janice Schacter Lintz, Chair, Hearing Access Program

[LanceHenderson1]

Here in California, there is the opportunity (depending on if you have an election period) to enroll in either a Medicare Advantage OR a Medicare Supplement (for AARP members over 50).  The plans available vary depending on where you live though.

[drawpoker]

Lance,  if you somehow feel that being challenged by others after making one of your broad,  sweeping statements is being attacked,  you don't have a real good  understanding what is "attacking" on message boards.  You also used the term "splitting hairs" the last time you were challenged on one of your generalities.  Later,  this morphed into  telling others when you were challenged on some other detail that other posters had "agendas".  

So,  I would ask you,  again,  to please re-read your last post.  

"Here in California, there is the opportunity (depending on if you have an election period) to enroll in either a Medicare Advantage OR a Medicare Supplement (for AARP members over 50)." 

The use of the parenthetical phrase  for AARP members over 50  is a bit disingenuous,  isn't it.   For any Golden State folks  unfamiliar with Medicare supplemental insurance you aren't just  implyng.  You are making a declarative sentence that this "opportunity" you write of is somehow available only to AARP members,  not to non-AARP members.    

When we all know that NOTHING could be further from the truth,  there are many insurance companies in Calif. for seniors to choose from,   aren't there.  

To be blunt     -   If you are an AARP  plant here  you can hardly be considered an objective source of information.    We are fortunate here that there is another insurance agent on these boards who has considerable experience  in the senior market.   

However,   this gentleman is an Independent Insurance Broker who represents many lines and carriers,  and has no vested interest in plugging any single source.  We value and appreciate his input,   as I think I can speak for many of us in saying that his contributions in threads concerning Medicare and insurance matters are 100% objective and without bias. 

(That is not to say we don't value and appreciate your input,  so please don't take offense) 

[patwuschke611]

What is of utmost importance is once you have your Medicare coverage is choosing your supplement
Plan. Once it is chosen, you can NOT change the plan except to change over to an Advantage plan.
They are not generally " Preferred". I chose an F plan and premiums increase at 10 percent each year.
I am now at close to $500 per month and it is a real burden. No one shared that "Rule" in advance.
I must now choose an Advantage plan that my 25 plus year Primary Dr doesn't accept Any Advantage plan
VERY deceitful to stick disabled folks with a financial burden they can't get out from under but once a year

[patwuschke611]

I totally empathize with you.  No one explained that when you receive your Medicare when

disabled, that whichever plan you choose is a permanent one.  I also chose the F plan due to

the need for several joint replacements.  However, when i tried to down grade,  I was tole NO!

Almost $500 a month PLUS persciption coverage is OVERWHELMING.

You can choose an Advantage plan (yuck) or straight Medicare at 80%.  

The premiums are the same everywhere I am told. Not much of a choice

[GailL1]

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@patwuschke611 wrote:

I totally empathize with you.  No one explained that when you receive your Medicare when

disabled, that whichever plan you choose is a permanent one.  I also chose the F plan due to

the need for several joint replacements.  However, when i tried to down grade,  I was tole NO!

Almost $500 a month PLUS persciption coverage is OVERWHELMING.

You can choose an Advantage plan (yuck) or straight Medicare at 80%.  

The premiums are the same everywhere I am told. Not much of a choice

---

patwuschke611,

In some states, a Medigap (Medicare Supplemental) plan is not even offered to those who are younger than 65 years old. 

Depending upon the state that you live in, different methods are also used to establish premiums for these type of (Medigap) plans.  The premiums are not the same everywhere but the plans are the same - example a Plan F is the same everywhere.

During the initial enrollment period to Medicare for those who are 65 (about 3-months before and 3-months after) a Medigap plan can be purchased with out regards to health status but after that period, people can be turned down for coverage for a Medigap because of their health or age.

[LanceHenderson1]

Draw.. In the original post, there was mention of no Medigap plans available to the GROUP of people that are under 65 and on disability.  The post further went on to call out AARP for this.   As you have to have a Medicare to have Medigap coverage, and I have personal knowledge of evidence to the contrary of the post, I felt compelled to mention it.  Two significant points of the original post.

Gail:  I agree, I can't speak to the plans available in a given area of Montana, without actually looking into those options.  But in generality, which the original post eluded to, the exception needed to be noted.  Yes.. there was a place where he mentions Montana.  But, this isn't a "montana only" community. So, I wanted to be sure others reading were able to have some clarity.

I can feel for the OP's plight.  My own adult daughter has Cerebral Palsy, which keeps her in a wheelchair, and unable to speak.  So, I have a particular interest in her medical needs and the conversation regarding role of Insurance and programs available.  Perhaps this is one of the reasons I am passionate in my desire to help in this arena.

[drawpoker]

Lance,  what I was referring to has nothing to do with the OP.  Clearly that person made it plain he was in the state of Montana.

What I object to is your response to the poster from Calif.     critalee,    Remember him/her? 

______________________________________________________________________________

"They never told me about Medicaid. Jan 2015 will be 24 mos. Who do I call in CA for Medicaid info? "

______________________________________________________________________________

By promptly responding with the needed information critalee was seeking,  yes,  you were being very helpful.   No one is criticizing that,  or aguing with you there.      

But,  in the next breath,  you just had to insert a plug for " AARP endorsed- United Heatlhcare" Medicare supplements,  and worded it in such a way to attempt to  leave an impression that Calif seniors must somehow also be AARP members over 50  in order to buy Medicare supplement plans.     

T H A T   was my point.     

[LanceHenderson1]

you said:

leave an impression that Calif seniors must somehow also be AARP members over 50  in order to buy Medicare supplement plans.     

In California you DO need to be over 50 (so UNDER 65) and an AARP Member to get the AARP Medicare Supplement Plan.  The OP repeated AARP and Medigap, and my reply addressed both in one breath.

[LanceHenderson1]

That next Breath.. was a SEPARATE response to the Original Post, as I had FINISHED the one to Critalee. 

I have only be communicating in this forum a short time, and I am just learning about the ways you can indicate WHICH post you are responding to.  I hit reply in the window of what I am replying to, but it never includes that in my post..  Eventually I will learn how to do so, without using cut and paste like I have been trying lately, and people can see for themselves. 

[drawpoker]

Lance,  if you going to persist in making plugs here for AARP endorsed UHC Medicare insurance plans,   don't you think,   in the interest of full and fair disclosure,    that you should state that you are a licensed sales agent for United Healthcare insurance company,   and derive financial compensation thereof.  

[LanceHenderson1]

You seem bent on attacking..  but, instead of debating you I will simply smile and continue to volunteer my time here to assist people here in understanding aspects of Medicare that I am trained in. 

BTW, I get ZERO compensation for helping you understand what's available or sharing how Medicare actually works, nor for correcting some of the misinformation that is out there.  When I do sit down with those wanting to talk to me as an Agent, then I certainly share that information, because in those cases I am able to derive financial compensation. 

I appreciate your passion, in lieu of your repeated attacks, but I like to give people the benefit of the doubt.  I am certain you mean well.

The question was about the ability to get a supplement instead of a Medicare Advantage plan.  Because I actually work in the industry, I am able to share that there are other options available, such as the one I mentioned available in California.

[GailL1]

Lance,
Maybe I missed it but I did not see "California " mentioned by the questioning poster and what Ca does is not available in all state.

So here you either have to talk in generalities about programs that are regulated at the state level or see how it works in the state where they live if they mention it or refer them to the state dept that can help them.

Medicaid has always been available to those that are disabled and less than 65 years old when they have low income and few financial assets. After 2-years on SSDI they can qualify for Medicare, pass that, other options are determined by state rules.

[LanceHenderson1]

The Original Post:

There is a group out there I never hear anything about and I am one of those individuals:  those on disability and under 65.  There are all types of programs for medicare supplements for those 65 and older, but NOTHING for this gap group.  Medicare Advantage only basically does your paper work........and perhaps some dental, but that is easy and cheap enough to provide for myself.  WHY HAS AARP NOT ASSISTED THIS GROUP...............there are no programs in Montana and I pay the same dues as everyone else.  I was lucky enough to obtain a fully paid individual insurance plan before the 'affordable care act' went into effect, something you can not do at this time due to the enrollment period and what I could get with the same company is nothing that comes any where near the benefits of the private policy.  With rheumatoid arthritis since 1986, I have high drug costs which are covered by the private insurance plan.  WHERE ARE YOU AARP?

These are the two poits I responded to in generailty, as they were made in generality about the under 65 group on disability and how it pertained to Medi-Gap

" There are all types of programs for medicare supplements for those 65 and older, but NOTHING for this gap group"

My response.. was that there ARE Medicare Supplements, Depending on where you live" available to those under 65.  YES, they are more exxpensive, and NO, not all plans are available in all areas.  But, the statement that there aqre NO options to those under 65 and disabled was incorrect.

The next point was:

" WHY HAS AARP NOT ASSISTED THIS GROUP"

I pointed out the existance of a plan, which actually carries the AARP brand, and IS a Medicare Supplement.  Maybe not available in his area, but there are plans, which differs from the statement that there are None.

[critalee]

Interesting. I was denied Medicare until 24 mos on disability. They never told me about Medicaid. Jan 2015 will be 24 mos. Who do I call in CA for Medicaid info?

[LanceHenderson1]

there are Various places you can look for Medi-Cal (Medicaid for here in California). 

Frst place I would look is http://www.dhcs.ca.gov/services/medi-cal/pages/applyformedi-cal.aspx

[communityhost]

You may want to contact AARP Montana,
Go to AARP In Your State, at the bottom, or ,copy this link: http://states.aarp.org/category/montana/

[drawpoker]

Why are you blaming AARP?   What can they do?  

The blame lies with the Repugs in your state.  That is where you should be directing  your ire. 

                 Montana: Republicans in the statehouse in April 2013 rejected plans to opt into the        Medicaid  expansion, which could have added another 70,000 state residents to the program.

Under Medicaid expansion as part of ACA,   assets are not counted anymore in establishing Medicaid eligibility.  It goes strictly by income.   This has been a godsend to people who had to quit working before becoming eligible for Medicare.   You likely would have been one of those 70,000     

[as566311]

To those who want to 'blame' whatever party:

I have found out the exact same thing myself. I belong to AARP, and have done so for 6 years. That makes me the young age of 56. Now I am on SS disability, and sure enough: AARP does not provide a Medicare plan if you are under 65, but they sure will take your money for becoming a member! Something seems wrong here.

[GailL1]

ah5887

What Medicare plans that are offered to those less than 65 years old is governed by state law unless you have ESRD.

Go to Medicare.gov and learn all about how it works.

[retiredtraveler]

Aren't we talking about Medicaid, or do I not understand?