What Is Disability Medicare?

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disability

There is no difference in the coverage one receives under Disability Medicare as compared to the coverage one receives under Original Medicare. The difference is in who can qualify for it.

If you are under age 65 and have been on Social Security by virtue of a disability for 24 months, you will automatically qualify for Medicare Disability. You won’t have to apply for it.  Medicare will send you a red, white and blue Medicare Card in the mail which will have your name, you Medicare Number and your eligibility dates for Hospital Insurance (Part A) and Medical Insurance (Part B).  If you have End Stage Renal Disease (total kidney failure) you qualify for Disability Medicare immediately upon diagnosis.

What you need to know and what is not at all well advertised is that you can get an A Plan Medicare Supplement policy as soon as you qualify for Medicare.

Like anyone else who qualifies for Medicare, you will have a 6 month Open Enrollment Period, beginning with the first day you qualify for Medicare Part B, during which your application for an A Plan Medicare Supplement cannot be declined. If you wait until that 6 month period is over, very few, if any, Medicare Supplement Insurance Companies will sell you their A Plan Medicare Supplement, even if you can qualify for it medically. Let’s face it…if you’re on Medicare due to a disability, your claims ratio is almost surely going to be higher than the average and, if an insurance company can legitimately avoid taking that risk, they are going to do it. You would be wise, indeed, to get that coverage in force while you’re in your Open Enrollment Period.

The A Plan Medicare Supplement does not cover the In-Patient Hospital Deductible. In 2016, that amount is $1,288. It also does not cover the Medicare Part B deductible which, in 2016, is $166.

Other than that, it pays like every other Medicare Supplement on the Hospital bill and pays the 20% that Medicare approves but does not pay on Medicare Part B expenses such as Doctors bills, Hospital Out-Patient bills and expenses for Durable Medical Equipment (DME) or Ambulance bills.

Practically speaking, as long as you see Physicians who accept assignment from Medicare (allow Medicare to pay them instead of you) and you don’t go into the hospital, your total medical expenses for the year will not exceed the Medicare Part B Deductible which, as I said earlier, is $166 this year. If you do go into the hospital this year, your out-of-pocket responsibility will increase by $1,288 for each new Benefit Period you begin.  A Benefit Period begins on the first day you are in the hospital for an in-patient confinement.  It continues all the time you are in the hospital (up to 150 days) and continues for another 60 days after you get out of the hospital or Skilled Nursing Facility.  Theoretically, you can have as many as 6 Benefit Periods in a year, as long as each one is separated from the prior one by 60 days or more but it is highly unlikely that you will ever have more than one Benefit Period in a calendar year.  I’ve seen it happen but it is extremely rare.

If you are readmitted to the hospital after you have been discharged and that re admittance comes less than 60 days from your previous Benefit Period, Medicare considers you to still be in the same Benefit Period and you will not be charged another b$1,288 In-patient Hospital Deductible.  Stay out longer than 60 days and then go back in and you WILL be responsible for that $1,288 deductible again.  But, as I said, such occurrences are, indeed, very rare.

I realize that the total of those two figures is $1,454 and that is a lot of money but it is not a lot of medical expense. And, in the grand scheme of things, to be so disabled that you are on Social Security Disability and Medicare Disability and still have a policy that has, what is effectively a maximum $1,454 deductible but then pays 100% of your Medicare approved and covered expenses, in concert with Medicare, is really quite good coverage.

The premiums for an A Plan Medicare Supplement are necessarily higher than the premiums for a Medicare Supplement for someone who is 65 or older but that is because the claims ratios on the A Plans are generally a good deal higher than normal. That’s because people who are disabled, generally, have more medical expenses than the non-disabled segment of the Senior population.

Keep one important point in mind. When a Medicare Disabled person with an A Plan Medicare Supplement turns 65, they will get another bite at the apple, so to speak. They will have another 6 month Open Enrollment Period which will begin on the first day of the month in which they turn 65. They can, at this time, if they wish, buy an F Plan or a G Plan Medicare Supplement and be covered better for less money.

There is another option. Medicare Advantage or Medicare Part C. I’ll cover that in the tab entitled “What is Medicare Part C and how does it work?