SSD and Medicare ??? | Lupus Forums at The Lupus Site
  1. As you can see we have transferred to new forum software which is much more stable and will eliminate problems that we had with the old software.
    *** To login you will all need to reset your passwords. To do this simply click login (top right) then click the forgot password link. You will receive an email with a link to reset your password. You can then use the forums as normal.
    Dismiss Notice

SSD and Medicare ???

Discussion in 'Social Security / Disability Benefits' started by Jenkay, Dec 15, 2009.

  1. Jenkay

    Jenkay Jen

    Looking for information from those of you who have gone on SSD and what decision did you make about Medicare. I've read some about it but if you had other insurance options (like staying on your spouse's insurance policy through their work) what did you do, or were you able to stay on their's? Has anyone waived the Medicare part B with other insurance you were able to keep? For those who are on Medicare what are the pros/cons compared to insurance you had prior and did you get a supplemental policy.

    It's all so confusing :wacko:!
  2. KarolH

    KarolH Registered

    Hi Jenn,

    It is confusing but here is what I did. I am on my husbands plan with his job but also pay $94.00 a month, comes right out of my medicare check to have Parts A & B. What this does is basically cover all of my co pays that I would have to pay with my husbands plan which is $30 for a doctor, specialist, mri, ct scan, etc...

    If your husbands company has less then 100 employees then Medicare would be your primary insurance and hubbys would be your secondary. If his company has more then 100 employees then his insurance is your primary and Medicare is your secondary.

    I hope this makes sense. PM me if your confused and maybe I can help you more if need be. Look at the cost you pay in co pays and how many times you visit doctors annually. This makes the decision a bit easier to make.:wink2::wink2::wink2:
  3. sam101360

    sam101360 Registered


    I did exactally the same as Karol. Medicare is my primary and my husbands insurance is the secondary. Medicare covers most everything but my hubby's insurance covers that nicely (almost...LOL).

    If you decline the medicare, and then need it, you may have come difficulty and delay in getting that coverage (I have heard nightmare stories...but cannot attest if they are true or not).

    Good Luck - Stephanie
  4. KarolH

    KarolH Registered

    If you decline Medicare then need it there is a long wait period before you can get into the system. Stephanie is right in that I have also heard horror stories.

    I think unless your husband has great benefits you may want to consider it, at least parts A and B.;););)
  5. Jenkay

    Jenkay Jen

    Thank you!

    Karol, I'll PM you as I still have some questions.
  6. KarolH

    KarolH Registered

    Hi Jen,

    I replied to your PM.

    Let me know if you understand it better once you read it.;)
  7. lazylegs

    lazylegs Moderator

    I accepted Part A and deferred Part B until there is a change in circumstances. The reason I did it that way was because I read that some employers will drop both husband and wife from their primary insurance. I suggest you contact your husband's HR department before making your decision.

    Take care,
  8. Carly

    Carly Guest

    There are a lot of options out there, it is hard to know which way to go.
    In my case, I originally opted for A and B and supplemented. But, the supplemental did not seem to cover much, if any at all. When I felt healthy enough (it still is on again, off agian) I returned to work and their plan was as long as you worked 32 hours I qualify. That insurance has a much better prescription plan.

    If you do go on a spouse's plan, depending on how many employees, you may be able to run it through medicare first and then your personal insurance. That kind of replaces the supplemental insurance and I found it to work for me.

    You may also want to find out the actual costs of your prescriptions average for a year to see how much you would rely on supplemental to cover. Wal-Mart has a list of $4.00 prescriptions they offer and will fill a three month prescription for $10.00. the list is not inclusive and you may want to confirm if yours apply (generic versus brand name)

    I found that if you find one person to contact at social security (mine is fantastic) and explain the situation, he or she can really provide useful info and explain what options there are for you.

    When I worked enough hours to enable me to drop the medicare, they explained that for the next three years, if I am unable to work that much, I can return for the wage benefits and that for several years, the medicare insurance can be "turned on and off" to speak. You are allowed to make so much a month, then you deduct what you spent out of pocket for medical expenses (co-pays and such) and that may enable you to both medical and wage benefits

    Best of luck,

  9. Jenkay

    Jenkay Jen

    Thanks for all the information, I have some research to do with my husband's insurance. I'm going to looking through his HR manual prior to contacting them. My fear is once they know I'm eligible for medicare they'll force me to make changes but I'm not sure.

    It is very helpful to hear the different options you all have used.

    Thanks again.
  10. sam101360

    sam101360 Registered


    I have never had a problem with my husbands insurance. He works for a small company, and they are usually the ones who are the pains. Large corporations do seem not care...

    Originally their comapny had more than 100 employees, so medicare was my secondary insurance and really offered little to no value, as his plan picked up pretty much everything...I kept it just in-case.

    Then there were layoffs, and the new insurance is for less than 100 employees, so medicare is now my primary and his insurance is my secondary. Medicare basically covers everything (although all the drs submit to his insurance after they get medicare approval) and that covers any missing fees. So now I pay nothing when I go to the Drs...not even the co-pay.

    Since I did not take a prescription option on medicare, I use my husbands insurance for that. Only take part D if you do not have medicare approved prescription coverage through your husbands insurance. It works out fine, althouh some of my meds are expensice no matter how I get them.

    The only confusion I had was when I had my renal biopsy, hubbys insurance required that I pay the 250 hospital deductible as if they were the primary. So we did...medicare paid, his insurance picked up the balance and the hospital refunded me $100+ of the deductible...medicare's deductible is around $130 per year.

    I do not believe that your husbands insurance will force any changes based on your coverage...they are ususally happy to have some additional participation in the payment.

    The only issue will be the number of employees covered (less than 100 - MEDICARE is PRIMARY for you. greater than 100 - MEDICARE is SECONDARY for you). And Prescription plan - ONLY get PART D if his insurance does not have a MEDICARE approved plan.

    It is VERY easy to call you husbands insurance company and inquire on these issues without any impact to present coverage.

    Hope this helps - Stephanie
  11. Jenkay

    Jenkay Jen

    Time to make the decision so I talked to Medicare, my current insurance carrier and my husbands employer and it seems like there is no benefit to me taking Medicare part B as my husbands emp is well over 100 and Medicare told me they would not pick up the copays when they are secondary (KarolH, I think you said they did for you?, I'm still confused). They also said if my husband lost his insurance for any reason I would call them and automatically be enrolled in Medicare as long as I do it within 8 month of his ending (of course I would do it right away). I'm on hold with Medicare again to ask more questions...
  12. sam101360

    sam101360 Registered


    This is definately yhe right way to go. Keep his insurance, don't pay for medicare until you need to...You already met the waiting period requirements so any change in status (insurance coverage changes or other life changes) one phone call and you are covered immediately. Bank the money you would have paid to have medicare and use it for co-pays or deductibles!

  13. Jenkay

    Jenkay Jen

    Thanks Stephanie, after all my calls yesterday this seems like it is going to be my plan, they are sending me paperwork to decline part B so I have a few more days to check everything but I can't see any benefit to it in my situation. Thanks again!

Share This Page