Disability: Pain Insurance: 12/24 months? Who goes first?

New Topic Post Reply Printable Version
[ << Previous Thread | Next Thread >> ]

Tony McGuire
Regular Member


Date Joined Feb 2009
Total Posts : 483
   Posted 6/19/2009 1:22 PM (GMT -7)   
I am looking for documentation on how the system works where there are 2 insurances once a timeframe passes. I would like to find the lowdown on things like

1. Which insurance pays first?
2. Does this mean private insurance charges more?
3. ls the bottom line better once the retirement health insurance kicks in?
4. Is the timeframe for it to kick in 12 months? Something in the back of my mind is tickling, saying that because it is disability retirement, the wait period is 12 rather than 24 months.


Can anyone help with any of these questions? Or, simply point to the right place (even the right gov site would be appreciated).

Assistance greatly appreciated!!
Wife: Liz, the choice of a lifetime
Dogs: Koshka Prayer & Chomp Prayer
Meet My Wife And Me


straydog
Forum Moderator


Date Joined Feb 2003
Total Posts : 13451
   Posted 6/19/2009 1:33 PM (GMT -7)   
Tony I worked with insurance at my job, you are not being specific enough about which types of insurance you are asking about. Give me some more info and I will try to help.
Straydog/Susie
Moderator Chronic Pain
 
crohns disease dx 2002 & small bowel resection, still looking for remission whatever that is, chronic pain 22 yrs, added ulcerative colitis 6-05 to the mix, high blood pressure 28 yrs, aortic heart valve insuffiency, depression, osteoarthritis, osteoporosis lumbar spine, scoliosis lumbar spine, peripheral neuropathy hands & feet, COPD & on oxygen therapy, lupus & decreased circulation in both legs. Too many surgeries to list and too many medications to list. Currently on 16 different daily medications. Intrathecal pain pump implanted June 05.


modelmaker
Regular Member


Date Joined Feb 2009
Total Posts : 168
   Posted 6/19/2009 1:57 PM (GMT -7)   
Tony,

I, too, am a little confused by your question. I can tell you what happened with me.
I retired on disability when I was 59. Because it was work related, my former employer agreed to let me continue insurance at my expense to age 65, well beyond the COBRA provisions. And because I was disabled early, I got the full Social Security that would have been paid if I had waited to 65 to claim benefits. From the time I retired until now, when I turn 65, I only had the one private insurance. Now that I am 65 Medicare has kicked in so I deal with the coordination of benefits issue. I also have a Medicare supplement. Medicare pays first and the private insurance picks up the rest.

In your case, what two insurances do you have? Do you have any options as to coordination of benefits?

I am not an insurance expert by any means but if I had a little more perhaps I could help.

Modelmaker
Degenerative disc disease since 1985, 4 back surgeries, fused from L2-S1, instrumentation. Being treated for chronic pain. Oxycodone 30 mg. IR. Candidate for SCS in the future.


PAlady
Veteran Member


Date Joined Nov 2007
Total Posts : 6795
   Posted 6/19/2009 3:27 PM (GMT -7)   
Tony,
I think I know SOME of what you're asking, but am a little confused, too. Since Susie has worked with this, I'd take whatever info. she gives you as more accurate than mine.

I think what you're referring to as "retirement" insurance is Medicare, which you will receive now that you're officially disabled. However, from my reading that does not kick in until 2 years after the date your disability started (the date your doctor says you were first disabled, not necessarily the date you got your approval). So that, for example, if you were determined to have been disabled starting a year ago, you'd have to wait another year to receive Medicare, unless you were older and then you'd be eligible for Medicare because of age (I believe age 62).

What you seem to be asking is what is your primary insurance (who pays first) and what's considered secondary (who pays what's left, subject to the limits of your policies). I believe once you receive Medicare, it's considered primary for all your health care but I could be wrong. It could be that Medicare is only considered primary for disability related conditions. But what would happen is that bills would likely be submitted to Medicare first, and if they're denied and you set it all up properly with any second ary carriers, the bill should automatically be submitted to the secondary carrier for payment. But again, it's all subject to the limits of your policies.

If your wife has insurance through her employer, and you are on her policy that may be considered primary until you get Medicare. The private insurance can't charge anymore, as they have contracts with the health care providers for certain amounts. If you don't have another private insurer, you'll have to do what most people with Medicare do, and that's get a supplemental policy, of which there are many. You'll have to pay for this (yes, even in retirement, unless you have an employer that's offering this kind of coverage. Most are stopping those programs to cut costs).

Anyway, I don't know if this helps or confuses, but it's a little of what I know.

Oh - and with what's going on in Washington, anything can change!

PaLady

Tony McGuire
Regular Member


Date Joined Feb 2009
Total Posts : 483
   Posted 6/19/2009 4:23 PM (GMT -7)   
WOW, I am amazed.

Reading back over my initial question and each question in that post, I am completely amazed by how accurately you figured out what I was trying to ask. I musta been writing in my sleep.

OK. Here goes my second attempt.

I have insurance under my wife's work.

I just got disabled, official date for that was April 27th, but pay doesn't start for it for the standard 6 months. (Probably more confusing than helpful, but I'm not sure which date is used for insurance purposes.)

I'm guessing that I become eligible for Medicare April of 2010, is that correct?

Once that happens, is Medicare first or second in line?

I've got many ducks that will be lining up around that time. I'm hoping to NOT make disastrous mistakes that cost me a lot.

Like, If I can get approved for the C-PAP machine and the STS machine. I'm guessing those 2 are in the $30k range. They could be a pretty big disaster if I approach them wrong.

If I can help anyone to better understand this better, please let me know and I'll try to explain them better.

Thank you for your help. Truly.
Wife: Liz, the choice of a lifetime
Dogs: Koshka Prayer & Chomp Prayer
Meet My Wife And Me

Post Edited (TonyMcGuire) : 6/19/2009 11:36:50 PM (GMT-6)


PAlady
Veteran Member


Date Joined Nov 2007
Total Posts : 6795
   Posted 6/19/2009 4:58 PM (GMT -7)   
Tony,
From what I know - and I could be wrong here - if you were determined to be disabled starting on April 27, 2009, you wouldn't be eligible for Medicare until April 27, 2011 - a 2 year wait. Unless your age would make you eligible sooner. It makes no sense to me why the wait is so long.

I think I'll wait for Susie to respond and see what she has to say as she's worked with this so much.

I think you'd have to stay on your wife's insurance (unless you have a plan of your own) until you're eligible for Medicare.

I hope I haven't made more of a mess of this with my response! LOL

PaLady

Tony McGuire
Regular Member


Date Joined Feb 2009
Total Posts : 483
   Posted 6/19/2009 10:47 PM (GMT -7)   
PAlady: Would my start date be april 27 2011, or would it be based on aprril 27 2008 (the original date of claim saying "I was disabled starting here")?

That is the date everything is starting from. Even payment. It is just that payment doesn't start until 6 months after being disabled.

So in my case, I just received a lump sum bases on 6 months after april 27th 2008. And then the monthly payments kick in each month after that.

Yes, I know you aren't an expert. And I can probably look up the information as easily as you. But if you do have it handy I'd appreciate the info.

Thank you for your vigilance on my behalf. I appreciate it, truly.
Wife: Liz, the choice of a lifetime
Dogs: Koshka Prayer & Chomp Prayer
Meet My Wife And Me


PAlady
Veteran Member


Date Joined Nov 2007
Total Posts : 6795
   Posted 6/19/2009 11:17 PM (GMT -7)   
Tony,
I guess I was confused. I thought you wrote that your disability started in 2009. Since it's 4/27/08, as far as I know - and Susie is the expert here - it would be 24 momths after that, so yes, 2010.

The www.ssa.gov site (I put the link to someone else in one of the other threads) answers a lot of questions.

PaLady

edt
Veteran Member


Date Joined Dec 2008
Total Posts : 773
   Posted 6/20/2009 6:09 AM (GMT -7)   

Hi Family,

Medicare kicks in 24 months from the day you were approved for SSD.  From what I know Tony you are correct Medicare will kick in 4/2010.  I just spoke to my friend who is a Medical Biller, Medicare will be your Primary!  Its my understanding if you have Medicare and a secondary insurance if Medicare does NOT cover something then neither will your secondary!  Medicare guidelines rule!

Its definitely a confusing issue....the sad thing is when we apply for SSD we need Medicare to kick in STAT!  When I rec'd that little card with the red and blue stripe I felt so relieved. 

Hope this helps!

XXOO
Patti


Tony McGuire
Regular Member


Date Joined Feb 2009
Total Posts : 483
   Posted 6/20/2009 6:48 AM (GMT -7)   
If I understand, then there is no confusion, really, until April 2010 (in my case) since Medicare doesn't kick in until then - is that right?

Or is there confusion because Medicare is about to kick in?
Wife: Liz, the choice of a lifetime
Dogs: Koshka Prayer & Chomp Prayer
Meet My Wife And Me


edt
Veteran Member


Date Joined Dec 2008
Total Posts : 773
   Posted 6/20/2009 9:09 AM (GMT -7)   

Tony,

I was approved in Dec. 2005, my 1st SSD check came in 4th Wed of Jan (got paid for Dec too), you get paid from SSD based on the day of the month you were born, mine is the 23rd, they told me thats how it works (don't think its changed much since then) .....my Medicare kicked in Dec. 2007...hope that clarifies!

XXOO
Patti

New Topic Post Reply Printable Version
Forum Information
Currently it is Saturday, December 03, 2016 9:06 PM (GMT -7)
There are a total of 2,732,388 posts in 301,013 threads.
View Active Threads


Who's Online
This forum has 151175 registered members. Please welcome our newest member, melissapsa.
276 Guest(s), 10 Registered Member(s) are currently online.  Details
desert bound, Ides, Gear, mbisoux, Hawaii3654, poohcheez, bdavis, BostonMarigold, LymeMother, julymorning


Follow HealingWell.com on Facebook  Follow HealingWell.com on Twitter  Follow HealingWell.com on Pinterest
Advertisement
Advertisement

©1996-2016 HealingWell.com LLC  All rights reserved.

Advertise | Privacy Policy & Disclaimer