Medicare

Applying for Social Security Disability Insurance (SSDI) benefits early is very important. The sooner you apply, the sooner you can start receiving the benefits you are entitled to. One important benefit is qualifying for the federal Medicare program.

But understanding your Medicare plan options can be confusing. It's important to review your options to ensure you're getting the level of coverage you need at a cost you can afford. You should know:

• People with disabilities become eligible for Medicare 24 months after receiving SSDI; sooner in some instances.
• Medicare has 4 primary parts. The coverage, costs and enrollment vary.
  • Medicare Part A (hospital insurance - part of traditional Medicare)
  • Medicare Part B (medical insurance - part of traditional Medicare)
  • Medicare Part C or Medicare Advantage
  • Medicare Part D (prescription drug coverage)

Qualifying for Medicare
While many people think of Medicare as health insurance for those who are 65 or older, Medicare is also available to those under age 65 who have received SSDI benefits for 24 months. However, due to the five-month waiting period from the start of the disabling condition for individuals to qualify for SSDI benefits, Medicare coverage cannot start sooner than the beginning of the 30th month after the start of the qualifying disability.

SSDI beneficiaries with specific conditions may qualify for Medicare sooner. This includes people with:

• ALS, or Lou Gehrig’s Disease - you qualify for Medicare the first month SSDI benefits are received.
• End-stage renal disease or kidney failure - you qualify for Medicare after the third month of receiving SSDI benefits.
• A kidney problem in which you receive a kidney transplant - you qualify for Medicare in the month you receive the transplant.

A Medicare card, along with an explanation of enrollment details, is automatically mailed to you once you become eligible for Medicare benefits.

Understanding the Various Parts of Medicare

To better understand Medicare basics, features of each Medicare program are compared in the chart below.

	Medicare Part A (Hospital Insurance)	Medicare Part B (Medical Insurance)	Medicare Part C (Medicare Advantage)	Medicare Part D (prescription drug coverage)
What it covers:	Hospitalization, limited skilled nursing facility care, home health care, hospice care and blood	Doctors’ services, outpatient medical, hospital and surgical services, clinical laboratory services, home health care, blood and various preventive services	Part C is an alternative to Parts A and B. This type of plan is offered by private insurance companies that contract with Medicare to provide all Medicare Part A and Part B benefits. At a minimum, these plans cover all Medicare Part A and B services. In most cases, there are extra benefits, including prescription drug coverage.	Optional brand-name and generic prescription drug coverage insurance (provided by private companies approved by Medicare)
How to enroll:	Automatic once Medicare eligibility requirements are met	Must sign up during your initial enrollment period, during the general enrollment period (Jan. 1 – March 31 of each year) or during a special enrollment period (up to eight months after you or your spouse lose employer health coverage or either of your employment ends – whichever is first	During your initial enrollment period; you can also switch to it during the general enrollment period (Jan. 1 – March 31 of each year) or during a special enrollment period (up to eight months after you or your spouse lose employer health coverage or either of your employment ends – whichever is first).	Those enrolled in traditional Medicare (Parts A & B) or Medicare Advantage plans that don’t offer prescription drug coverage can enroll during their initial enrollment period, or add it doing the general enrollment period (Jan. 1 – March 31 of each year).
Costs:	No monthly premium costs – you pay deductibles or copayments	Tied to your annual income and adjusted each year; standard Part B premium = $96.40 per month in 2010 (if your annual income is not more than $85,000 as single taxpayer or $170,000 if filing a joint tax return) – you still have deductibles and copayments (these may be covered with an optional Medigap policy)	The costs of Medicare Advantage plans vary depending on the services offered. For services comparable to Part A and Part B (traditional Medicare), the costs are usually less because Medicare Advantage plans generally have lower copayments than in the traditional	Costs vary based on plan and medications
Watch out for:	Without supplemental coverage, your out-of-pocket costs can quickly add up.	If you don’t sign up for Part B when originally eligible, there is a premium surcharge (translation, a penalty) of 10 percent for each 12 month period you could have had it, but didn’t. This is bad because the extra amount must be paid for as long as you have Part B. So you really should sign up for Part B when you first become eligible.	Because most peole have dozens of Medicare Advantage plans to choose from, each with various coverage optins, selecting the right plan can be difficult without some help.	There is a gap in prescription drug coverage (also known as the donut hole) during which individuals are expected to pay for all their prescription drug costs.

Comparing Traditional Medicare to Medicare Advantage Plans

To better understand your Medicare plan options and how everything fits together, here is a summary of the choices:

Available Medicare Health Plan Options Choose One of Two Possible Coverage Paths
Traditional Medicare Plan	Medicare Advantage Plan
- Includes Part A (Hospital) and Part B (Medical) - Coverage provided by Medicare - Deductibles, coverage, and costs are standardized	- Includes everything offered by Medicare Parts A and B - Private insurers approved by Medicare provide this coverage - Usually includes extra coverage not offered by Parts A and B - Costs, extra benefits, and details vary by plan - Can’t be turned down for coverage
Prescription Drug Coverage - Decide if you want to join separate Medicare Part D - Plans run by private Medicare approved insurers - If no choice is made, you pay entire prescription costs	Prescription Drug Coverage - Most Medicare Advantage plans already include this coverage - If not, you can still join a traditional Medicare Part D plan separately - Without drug coverage, you pay entire prescription costs - Unlike traditional Medicare, some Medicare Advantage plans cover the gap in prescription drug coverage
Supplemental Coverage - Decide if you want supplemental coverage, like a Medigap policy, to pay for gaps in Parts A and B coverage - Offered by private insurance companies - Costs and coverage varies by policy and company - Similar coverage may be offered by employers or unions - Medigap policies may exclude coverage for pre-existing conditions	Supplemental Coverage - With Medicare Advantage plans, you don’t need and can’t buy a a Medigap policy - If you already have a Medigap policy, you can keep it, but Medigap won’t pay for any copayments or other plan costs

Medicare plan options can be confusing and making a choice without considering all the options can mean not receiving the coverage you need or paying more than expected.

More information on Medicare coverage is available:

• Medicare FAQs: Your most frequently asked questions about Medicare are answered here.
• Medicare Advantage Plans: Learn why Medicare Advantage plans offer the most complete coverage available for those receiving SSDI benefits.
• Medigap: Though generally not the best option for SSDI recipients, we cover the basics of Medicare supplement insurance here for those who want it.
• Medicare and the ARRA: Learn whether the American Recovery and Reinvestment Act of 2009 impacts your Medicare coverage options.
• Maximizing Your Medicare Drug Costs: Find out more about the Medicare prescription drug coverage gap or "donut hole" and what you can do to avoid thousands of dollars in potential out-of-pocket costs.
• Medicare Savings Programs: States have programs for people with limited income and resources to pay for some or all of their Medicare premiums, plus Medicare deductibles and co-insurance. Find out what these programs are and if you qualify.