First, I always thought that with SSDI benefits you got Medicaid, but from what I'm reading on the web today it looks like Medicare benefits. Can anyone confirm this?
Here's what's going on. My employer had generously extended my health coverage up to this month, meaning I was just transitioning to COBRA when I received the news. The change to COBRA would mean that instead of paying 4/mo for my husband and me, it would jump to a whopping 1/mo. However we were elated to find out that by qualifying for the COBRA premium reduction law, we'd only pay 3/mo. The catch is that if you are eligible for Medicare (which it now seems I might be) you are not eligible for the premium reduction!
I am trying to keep coverage for my husband (his part time jobs don't offer coverage and he's not eligible for Medicare himself for a couple years) as well as coverage for my biologicals (I just started Actemra). And I'm trying to afford it! In retrospect, it would have been better if Social Security hadn't approved me for another 18 months....
Link below with Q&A's, fact sheets, etc. You can also call your employer's COBRA administrator or the DOL at 1.866.444.32721.866.444.3272.
It may be wise to elect the coverage for both of you for now until you call medicaid and medicare and find out what your coverage is? Also it may take time for medicaid to kick in if you are just now applying. Different States have different laws and coverage as well as income requirements.
I would think that you could always let the cobra go later if you do not need it for yourself?
Best to stay covered until you get your questions answered. Apply for medicaid and see what they say? It may take sometime to get the answer?
Congrats on being deemed eligible for the SSI benefits..... I know that is a long and grueling process... I hope this insurance question is answered well for you....
so many worries when you are living with chronic illness..
Best to you, Inner Glow!
When I was approved it had been 3 yrs from the date of my applying for it. I made to much in social security with just my income to quilify for medicaid. In florida I think the income cap for house of 4 is 8000 dollars ( If I remember right). and my medicare was retroactive all the way back to my application date. Plus I recieved all my ss pay back to the application date. In fact the judge that heard my case made it retroactive all thje way back to my last day of work- 4 yrs. My kids did not quilify for medicaid either. But I was not getting cobra because my employee didnt offer it cheap enough for us to afford. But the back pay will kill you on your taxes that year.
Mostly cause my husband was working.
oops and the part D plans have just changed here in florida. The copays have gone up and the amount of coverage has gone down. I only tried remicade because thats all my RD could get approved and it was just an office visit to recieve the infusion.
Some States have a federal and State subsidies program that you only get if you apply for medicaid. It is income based. I do not think it matters what your spouse makes. Your medical is usually based soley on your income not other family members? The subsidies program covers the high cost of copays. So it is best to apply for medicaid and see what happens.
It is sort of strange because the medicaid may not really pay for your medicine but your medicine will possibly get payed by a seperate program. So instead of the copays being in the hundreds it may be .30 a big difference. You have to apply for it every year. So I would recommend appling for a medicaid card. The subsidies program has a more leanient income standard and you automatically get enrolled when you apply for medicaid. It may take a few months to show up on the computers and you could get some reimbursments.
That is sort of why I think the Cobra may be a good idea for a short time period. Well I do not know what your State has? I would think something scince it is partly a federal program?
If you have not yet reached the two year mark for medicare I think the medicaid would probably cover your meds until then?
What state are you in? Here in MA I have MAssHealth and they will cover Biologicals and RA meds, but need prior authorizations.
My husband had to wait for medicare, I think it was 2 years after he got his ssdi. He was working at the time, He was 57. I had to wait till I was 65, because I worked in homes. and they didn't pay ss. I was only 40, when I got down with RA and stopped working, Got back on my feet and started working in homes, because by being my own boss I could control how and when I worked by the way I was feeling, (most of the time). We had blue cross/blue sheild, that we kept for years till it got more then we could paid. Then we got medicaid with a share of cost, that we had to fight for.
Now with the new health care comeing, we will be in a fight for are lifes, trying to get just basic care. They have made so many cut in medicare. They are cutting the fee paid to doctors, so our RD is no longer taking medicare after June and our heart doctor is cutting back on Medicare, so we still waiting to see what care we will get or go to the clinic. A lot of our meds have been cut. and we did not get any raise in checks, because there was not a cost of living raise, this year. But everything will be ok, Because everyone can set on their big fat behind and get health care, without working.
GOOD LUCK and welcome to the world of SS.
Just to clarify a couple of things, this is SSDI rather than SSI, and I only asked about the Medicaid because I had erroneously thought that's what you get with disability benefits. Now that I understand better, I am sure I will not qualify for Medicaid (I receive private disability insurance benefits), but I will get Medicare. They determined I was disabled back to my last day of work, which was 2.5 years ago, so I don't think I will have any waiting period. I am in NJ.
If it's true that my husband can keep the COBRA without me, then that will be our answer for now, although an expensive one if he's not eligible for the premium reduction without me (not sure how that works). I am seeing my RD today and I am praying that he accepts Medicare.
We already sent back the completed COBRA enrollment and premium reduction forms, so I will wait til I hear from Social Security about the Medicare before making any changes. Thanks for the replies!
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