People with Disabilities Collecting Social Security Disability Insurance (SSDI) may have Limited Medicare Coverage Options when they try to enroll in Medicare
Medicare Advantage Plans are a good option for those who qualify, but is it your only option?
Suppose you are within your 24-month waiting period and are wondering what Medicare benefits are available to you. In that case, you should reach out to your local Social Security office before automatically enrolling in Medicare.
You need to understand your Medicare options before becoming Medicare eligible.
This blog post examines whether a Medicare Advantage plan or a Medigap Plan may be an appropriate choice for you to consider.
Table of Contents
What is Original Medicare?
Original Medicare is a health insurance program that the federal government administers. It is available to all U.S. citizens and legal residents who are 65 years of age or older or have been determined to be disabled by the Social Security Administration.
Most Medicare Beneficiaries will not pay a Part A premium but will be required to pay a premium for Part B of Medicare.
It is critical to ensure you are enrolled in both Medicare Parts as both parts of Medicare provide your essential medical coverage.
Once you receive a Medicare card showing Medicare coverage and your Medicare eligibility dates, you can sign up for a Medicare Advantage or Medigap plan and your Medicare Part D prescription drug benefits.
What are Medicare Advantage Plans?
Medicare Advantage is a type of Medicare coverage that handles your health care instead of Original Medicare.
While you are required to maintain your Medicare Part A and Part B enrollment when you sign up for a Medicare Advantage plan, you are transferring your health insurance rights over to a private health insurance company.
Medicare Advantage plans can be seen as a more affordable healthcare option as many plans do not charge an additional monthly premium.
Medicare Advantage plans are required to provide the same core benefits as Original Medicare. Still, they can offer additional benefits such as essential vision, dental and hearing aid coverage.
Medicare Advantage plans are not standardized, meaning they can and do change from year to year. This means you will need to review your current plan to ensure it will continue to meet your medical needs each year.
While Medicare Advantage plans are an excellent choice for many Medicare Beneficiaries, some drawbacks should be discussed with one of our Medicare insurance agents as compared to Original Medicare with a Medigap plan.
What are the benefits of Medicare Advantage Plans for those on SSDI and seeking Medicare Coverage?
There are many benefits to Medicare Advantage Plans for those on SSDI and seeking Medicare Coverage.
These plans can provide comprehensive coverage, including prescription drug coverage, at a lower monthly premium cost than traditional Medicare. They can also offer extra benefits such as dental and vision coverage.
In addition, Medicare Advantage Plans often have no or low deductibles, making them more affordable for those on a fixed income.
Because many Medicare Advantage plans do not charge an additional monthly premium, it allows Medicare Beneficiaries to qualify and enroll in the plan of their choice quickly.
As of 2022, all Medicare Advantage plans are available for those individuals with end-stage renal disease ESRD.
Medicare Beneficiaries will need to pay a monthly premium for their Medicare Part B, which covers outpatient, preventative, and some Part A services.
While there are many benefits for people disabled and under 65 to sign up for Medicare Advantage plans, there are also some disadvantages.
Some of the disadvantages include:
- Medicare Advantage plans are not as comprehensive as Original Medicare with a Medigap Plan G and may not cover all the healthcare needs of the beneficiary
- High annual out-of-pocket limits for healthcare costs, which may be necessary for some beneficiaries
- Some Medicare Advantage plans may not be as convenient as other plans that offer the same amount of coverage
- Medicare Advantage plans include copays, deductibles, and coinsurance costs, making them more costly than a Medicare Supplement plan.
- Network restrictions are part of Medicare Advantage HMO Plans, restricting access to doctors and medical facilities.
- Most Medicare Advantage plans require referrals and prior authorizations
- Step therapy can impact your treating physician’s overall care and treatment plan options.
Medicare Advantage plans are a good option for those receiving social security disability benefits for at least 24 months. You will automatically get Medicare on the 25th month of receiving SSDI benefits.
Because they include coverage for prescription drugs, gym membership, vision, and basic dental coverage at no cost, these value-added benefits can be significant for disabled enrollees.
What is the Average Social Security Disability Monthly Income?
The average social security disability monthly income is $1,358 for 2022. This figure is based on the most recent Social Security Administration (SSA) data.
The SSA provides monthly benefits to eligible disabled workers and their families. The benefit amount is based on the earnings of the disabled worker.
Medicare beneficiaries under age 65 and disabled will face higher than average Medigap premiums. These higher insurance premiums can prevent individuals from being able to afford Medicare Supplement plans once they become eligible for Medicare Parts A and B.
What are the Costs of Medigap plans for disabled people under 65?
A Medigap plan is a secondary insurance policy that helps cover healthcare costs. Instead of replacing Original Medicare, it fills in the gaps left behind by Medicare for an additional monthly premium.
Medigap plans are available to people with disabilities in most states and provide tremendous benefits by expanding your coverage even further. Medigap plans can cover many healthcare costs, including doctor and hospital bills and mental health services.
Private Medicare insurance providers offer Medicare Supplemental plans. However, these plans are standardized by the federal government. This means they do not change yearly or from insurance company to insurance company.
Each Medigap insurance company must provide the same standardized insurance coverage.
The costs for people receiving social security disability insurance and under age 65 can be substantially higher than for those 65 and older. For instance, we calculated the cost for a 45-year-old male in Los Angeles, California, and the costs ranged from $483 to $824 per month for Medicare Supplement Plan G.
This same plan for a 65-year-old would only cost around $150 per month.
It is critical to remember you will also have a Monthly Part B premium of $170.10 for the 2022 plan year. If you are receiving a disability income of $1,358 a month to live on, this can make a Medigap plan seem unattainable.
Why Medigap Plans may not be Afforded for Individuals with Disabilities?
It is no secret that you have some primary medical conditions if you qualify for disability and receive social security benefits. Now that you are medically disabled, you need superior health insurance coverage.
However, your lower income and the identical high bills, significantly increasing inflation, can make receiving Medicare benefits impossible.
Those receiving disability compensation need a Medigap plan the most out of all individuals. They need the freedom to see the best doctors to help treat their medical conditions.
The preferred Medicare Supplement plan by many Medicare Beneficiaries is Plan G. Not every state makes Medigap insurance companies offer Medicare Supplement plans for those individuals under 65 with disabilities.
And if they are available, the costs of these plans may not be affordable. The increased cost of Medigap plans for people with disability and under 65 makes a Medicare Advantage plan one of the best and most affordable options.
What is Medicaid and how does it help people with Disabilities?
Medicaid is a government-funded health insurance program that provides coverage to low-income individuals and families. Medicaid is jointly administered by the federal government and each state’s individual Medicaid office.
Eligibility for Medicaid is determined by income and asset limits, which vary by state. Medicaid generally covers pregnant women, children, parents or caretakers of minor children, people with disabilities, and seniors with limited incomes and resources.
Medicaid benefits can include doctor visits, hospital stays, prescription drug coverage, transportation to medical appointments, and long-term care services. Some states offer additional benefits, such as dental care or vision services.
Does Medicaid Pay For My Medicare Deductibles, Copays and Coinsurance?
Yes, Medicaid may pay for some or most of your Medicare deductibles, copays, and coinsurance related to your Medicare Advantage plan and Part D prescription drug coverage.
If you are enrolled in both Medicare and Medicaid, you should speak to your Medicaid case worker to see if you are eligible for any assistance with your Medicare costs.
Does Medicaid help Pay Medigap Premiums, Medicare Advantage Premiums, and Medicare Part D premiums
Do Medicaid Pay Medigap Premiums?
No, Medicaid does not pay Medigap premiums.
Does Medicaid Pay Medicare Advantage Insurance Premiums?
No, Medicaid does not pay Medicare Advantage insurance premiums.
Does Medicaid Pay Medicare Part D Premiums?
No, Medicaid does not pay Medicare Part D premiums.
What are the Different Types of Medicare Advantage Plans?
Health Maintenance Organization (HMO) plans are designed for individuals who want flexibility in their coverage. You typically have a choice of a primary care physician (PCP) and a network of doctors and hospitals that you are affiliated with.
HMO plans typically have lower premiums than other Medicare Advantage plans but may have a higher deductible. Some HMO plans also have a lifetime maximum on the benefits you receive. HMO plans are unavailable in all areas and are not as comprehensive as Part A and Part B Medicare.
PPO plans are designed for individuals who want to be on a single plan, usually administered by a hospital or HMO. PPO plans typically offer less coverage than Medicare Advantage plans but are not as popular. PPO plans are not as comprehensive as Part A and Part B Medicare.
A PPO plan is a type of Medicare Advantage plan negotiated between the Medicare program and a group of health care providers known as preferred providers. A PPO plan may offer more benefits than a traditional Medicare plan, such as coverage for a broader range of medications.
A PPO plan may be a good choice for people who want to use a single doctor or health care provider. HMO plans are another Medicare Advantage plan sponsored by a health maintenance organization (HMO).
HMO plans may have more restrictive coverage than PPO plans but may be a good choice for people who want to use a single doctor or health care provider. Some people with disabilities opt for PPO plans because they offer additional benefits that Original Medicare doesn’t, such as dental, hearing, and vision coverage.
PPO plans also offer an increased focus on preventive and coordinated continued care.
PFFS plans are operated by private insurance companies and are not part of Medicare. They offer beneficiaries the freedom to choose any doctor or hospital that accepts the plan’s payment terms and typically does not require referrals or prior authorization for services. However, these plans may charge higher out-of-pocket costs than other Medicare Advantage plans.
People with PFFS plans still have access to the same benefits as those enrolled in Medicare Advantage plans, including prescription drug coverage (Part D). In addition, some PFFS plans offer extra benefits such as dental, vision, and wellness programs.
PFFS plans are a good option for people who want the flexibility to see any doctor or visit any hospital that accepts the plan. However, these plans may have higher out-of-pocket costs than other Medicare Advantage plans, so comparing options is essential before enrolling.
Some people with disabilities or chronic medical conditions may opt for a Medicare Advantage plan, known as Special Needs Plans (SNPs). These plans are specifically tailored to provide extra care and services to those with unique health care needs.
SNPs are required to cover all of the benefits that Original Medicare covers, but they may also offer additional benefits, such as routine dental and vision care.
If you think a Special Needs Plan might be right for you, contact one of our Medicare Agents to learn more about your options. We receive additional training from the insurance companies to offer these other plans.
What are the Costs of Medicare Advantage Plans?
With Medicare Advantage plans, beneficiaries with disabilities can avoid certain costs and choose a plan that meets their individual needs.
Many Medicare Advantage Plans also offer vision and dental coverage. Medicare Advantage plans may be a better choice for enrollees with disabilities who may incur costs regularly for receiving treatment for their health conditions.
While your Medicare Advantage plan does include costs as part of their plans, they are required to provide a max out-of-pocket maximum. This is mainly because a Medicare Beneficiary will have to pay deductibles, copays, and coinsurance for the entire year.
How does Medicare Advantage compare to other health insurance options?
Medicare Advantage plans do come with several benefits and costs. While they are not perfect for everyone, they help keep your Medicare coverage intact and affordable.
If you’re disabled, health insurance is a top priority. Let us discuss some of the benefits you need to be aware of when it comes to Medicare.
- Cost: One of the things to consider before enrolling in a Medicare Advantage plan is the cost of the plan. The monthly premium for a Medicare Advantage plan can vary depending on the plan and the insurance company you choose. You will also be responsible for paying any deductibles, copayments, and coinsurance required by your plan.
- Benefits: Another thing to consider before enrolling in a Medicare Advantage plan is the benefits offered by the plan. Each Medicare Advantage plan must provide at least the same level of coverage as Original Medicare, but many plans offer additional benefits such as dental, vision, and prescription drug coverage. It is essential to compare the benefits of different plans to find one that meets your needs.
- Limited Network: Medicare Advantage plans typically have a limited network of doctors, hospitals, and other health care providers. This means that you may not be able to see the doctor or hospital of your choice if they are not in the plan’s network. Before enrolling in a Medicare Advantage plan, check the plan’s network to ensure it includes the providers you need.
- Prior Authorizations: Another thing to consider before enrolling in a Medicare Advantage plan is that some plans require prior authorization for certain services. If you think you may need a service that requires prior authorization, be sure to check with the plan before enrolling. Your doctor will need approval from the insurance company before you can receive the service.
- Referrals: Some Medicare Advantage plans also require referrals for certain services. This means that you will need to see your primary care doctor before seeing a specialist. If you think you may need to see a specialist, be sure to check with the plan before enrolling.
- Step Therapy: Some Medicare Advantage plans require step therapy for certain drugs. This means that you will need to try a less expensive drug first before the insurance company covers the cost of a more expensive drug. If you think you may need a more expensive prescription, be sure to check with the plan before enrolling.
Enrolling in a Medicare Advantage plan is a big decision. Before enrolling, there are many things to consider, such as cost, benefits, network, and prior authorization requirements. Be sure to research and compare different plans before making a decision.
The following are some of the reasons why Medicare Advantage plans could be a better choice for you:
If you qualify for Medicare and are in need of a health plan, here are some reasons to consider a Medicare Advantage plan.
- You’re looking for more comprehensive coverage than what Original Medicare provides.
- You want prescription drug coverage.
- You want lower out-of-pocket costs.
- You want the convenience of one plan that covers both your medical and prescription drug needs.
- You’re interested in extra benefits that Original Medicare doesn’t cover, such as dental, vision, or fitness memberships.
Do I need to sign up for Medicare Part B if I am Disabled and Under 65?
No, you don’t need to sign up for Medicare Part B if you are disabled and under 65. However, you may want to consider signing up for Part B since it would give you access to more comprehensive medical coverage.
How Do I Get Medicare and Start the Enrollment Process if I am Receiving Disability Insurance?
If you are receiving disability insurance, you may be eligible for Medicare.
To start the enrollment process, you will need to contact the Social Security Administration and provide them with proof of your disability. Once your eligibility has been confirmed, you will be able to enroll in Medicare and start receiving benefits.
What Coverage Options are Available for People with ALS to ESRD?
There are several coverage options available for people with amyotrophic lateral sclerosis (ALS) who develop the end-stage renal disease (ESRD). Medicare, Medicaid, and private insurance all offer some coverage for ESRD, though the specific benefits and coverage levels vary.
People with ALS may also be eligible for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI), which can provide additional financial assistance.
There are also a number of charitable organizations that offer financial assistance to people with ESRD, though eligibility requirements and benefit levels vary.
I was recently diagnosed with ESRD do I have a Waiting Period to Sign up for Medicare?
ESRD is a serious condition that can require expensive treatment. Fortunately, Medicare will help cover the costs of treatment for those who are eligible. There is no waiting period to sign up for Medicare if you are diagnosed with ESRD, but you will need to meet other eligibility requirements.
Where can I get more information about Medicare Advantage Plans & SSDI Benefits?
It is critical to understand how Medicare works and when to start your Medicare enrollment. You may be eligible for Medicare if you’ve been approved for SSDI and have been receiving benefits for 24 months.
At the start of your 25th month, you’ll automatically get Medicare and you should be on the lookout for your Medicare card in the mail. You may qualify for Medicaid or Medical which is based on your financial need to help pay for some of your out-of-pocket costs.
More information about Medicare Advantage can be found on the Centers for Medicare and Medicaid Services website at www.medicare.gov/advantage. You can also reach out to a licensed Medicare insurance agent who can help you find the appropriate Medicare program.
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