person with arm in slingHealth Insurance for People Receiving Social Security Disability Benefits

Health insurance benefits are not as “cut and dried” as it seems when it comes to Social Security disability benefits. A disability beneficiary is eligible to receive Medicare after they have received SSDI for 24 months. This time period starts from the date the Administration determines your disability started, so many people receive insurance right away once their benefits are approved. Currently, Social Security deducts between $104 to $122 per month from most benefit checks to pay the premium for Medicare.

 

Once you have been approved for Medicare you will need to decide to stay with Medicare as your primary insurance or contract with a Medicare Advantage Plan instead. This decision must be made soon after receiving your benefits because, like everything, there is a time limit.

Should I Stay With Medicare?

Medicare is government provided insurance. Medicare parts A & B cover hospital, facilities, doctors and tests while part D covers medications. Normally people who are receiving SSDI do not receive part D. You will probably want an insurance that covers prescription medications as these can get very expensive rapidly! In addition, Medicare only pays a percentage of the allowed bills which will leave you paying the remainder out of pocket.

Should I Look Elsewhere?

 An alternative to Medicare are Medicare Advantage Plans. These plans vary from state to state but provide much of the same coverage that Medicare provides and also include prescription medications. The nice thing about them is that you can generally find a plan that covers more than Medicare does without having to pay any additional money above the amount already being deducted from your check! Most people find contracting with an Advantage Plan is, well, an advantage financially.

Changes

In addition to varying by state, the plans also vary greatly by company. Once on a plan you may not be able to change to another company before open enrollment, so it is important that you research which plan is best for you before committing.

Researching

Many insurance salesmen will be glad to sell you a plan in their portfolio that works for them, but it may not work for you. The best way to research plans is to initially skip the salesman. Call your primary care doctor and your specialists. Ask to speak to the billing department, and then ask them what Advantage plans are paying the best for their patients. The billing person can review your past history and tell you which insurance, based on what other people have, is most likely to continue to pay for your treatments with the least amount of hassle. Most doctors’ offices are glad to provide you with this information as it will make their life easier in the end.

Take the list of companies that you have been provided with and make sure that all of your doctors and facilities are in their networks. Some companies may be removed from your list at this step. Now is the time to contact a sales person. You can call the insurance company directly and they will refer you to a local salesperson or you may call around until you find one that sells for that company. Either process works, but calling the company directly may save you some time.

Final Decision

Confirm with the sales person that your doctors and facilities are covered. Compare plans with your future in mind, especially if your disability is expected to worsen over time. Often it is good to sit and reflect on the plans for a couple of days instead of making a decision immediately. A push salesperson may sign you up for a plan that is not in your favor down the road. Be sure to compare each plan’s co-pays as this will be money out of your pocket every time you visit a doctor. Lastly, compare the deductible to make sure it is not too high for your budget. Some plans will charge an additional amount per month above the amount the SSA deducts but there are plenty of really good plans that do not, so be sure to look for those.

A Story

After one of our clients received their benefits they considered the choices I have outlined above. Medicare was only going to pay about eighty percent of allowed expenses leaving her to pay co-pays plus the remainder plus all of her prescription medication costs.

After initially choosing an Advantage Plan recommended by a salesperson, she discovered that only one doctor in her specialist’s office was accepted by the plan and that the particular insurance company rarely approved any procedures! She then followed the steps I have outlined here to find a new company that paid claims the best without hassles and selected a plan by that company.   The new insurance does not cost her any additional monthly premium but covers almost everything. After nearly a year of coverage she has only had to pay her co-pay for office visits and medical procedures.

Final Word

I know this article may sound like a sales pitch for Medicare Advantage Plans, but it really is not. Many people may feel that Medicare is the proper insurance for them and that is fine, but all Social Security disability beneficiaries should be aware of other options even if they do not choose them.

 

 

 

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About the Cochran Firm Disability Lawyers
Recognized as one of the nation’s premier law firms, The Cochran Firm handles cases on behalf of clients seeking a Personal Injury Lawyer, Criminal Defense, Medical Malpractice, Bankruptcy Attorney in Atlanta or Social Security Disability Lawyer.The Firm can be reached at 1-800-THE-FIRM (1-800-843-3476) or fill out the form on this page. “Working for You.” Article by Benjamin A. Irwin, Esq.


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