self-employed & SS & health insurance ?? oh, boy!

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Lynnwood
Forum Moderator


Date Joined May 2005
Total Posts : 7019
   Posted 2/9/2009 1:25 PM (GMT -7)   
I know it's rather a long shot, as this is a very unusual situation, but I'm wondering if anyone has a situation at all similar to mine....and if so, I'd like to have some email communication.

I owned my own company for many years prior to my lupus symptoms & subsequent diagnosis. As a business owner, I was able to obtain group health insurance for me & my employees. As I became ill, I gradually had decrease my work & thus dropped clients & employees. The last few years the employees have been pared down to just myself and another company officer, the secretary. There is some small amount of work to do to keep the books etc, but neither of us has been paid (thus no W2) for years. I've been able to keep the group health insurance policy thru the company.

Now comes the complication -- when I was finally approved for SSD in October, that automatically makes me eligible for Medicare. I chose NOT to use the optional portion, as I didn't want to figure out the interactions between my health insurance and Medicare.

Two weeks ago I got a call from the health insurance company, verifying that I & my secretary are still employed. I said yes. Today I get a form from them asking if I am employed/not employed and if I'm entitled to Medicare Part A and/or Part B -- that brings up a lot of questions in my mind!!!

So I'm being dragged into this whether I want to be or not -- has anyone had any kind of situation at all similar? I'd like to discuss with someone, but can't figure out who that would be. Maybe you guys have some ideas.

Thanks so much for reading this far, and I hope everyone is having a good day!

Lynnwood, Co-Moderator: Lupus Forum
SLE(’00), Sjogren's Syndrome, Raynaud's Syndrome, Seasonal Affective Disorder, Depression, Herpes Simplex 1
Plaquenil, Prednisone(15 6mg), Piroxicam, Xanax, Trazodone, Boniva, Wellbutrin, Valtrex

Links: DIAGNOSING LUPUS (4 of 11), LUPUS INFORMATION, LUPUS RESOURCES, Donate to HealingWell, Drug Interactions

"Life is far too important to be taken seriously." –Oscar Wilde, 1982

 


jhmom
Veteran Member


Date Joined Oct 2004
Total Posts : 2244
   Posted 2/9/2009 4:29 PM (GMT -7)   
Lynn, I have no experience with this but wanted to say I hope it all works out for you. Dealing with insurance co can be very stressful, hang in there and I hope you get the answers you are looking for. Hugs
Stacie
Trust in the Lord with all thine heart, and lean not unto thine own understanding ~ Proverbs 3:5 ~

DX: Lupus, Sjogrens, Raynaud's, Hashimoto's and Celiac Disease
RX: Imuran, Plaquenil, Methotrexate, Flexeril, Piroxicam, Levoxyl, Folic Acid, Folgard OS (B12), Vitamin D-50,000 IU, Darvocet (as needed) and magic mouthwash (for mouth sores)


Ginny
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Date Joined Feb 2003
Total Posts : 5514
   Posted 2/9/2009 5:32 PM (GMT -7)   
Hey Lynn,
 
I have some experience with the Canadian side of things, but not with your American medicare.  What a pain to have to deal with.  I hope someone comes along with some advice and ideas for you. Keep us posted!
 
Blessings,
Ginny
I can do anything through Jesus Christ who strengthens me. I have learned in whatever state I am in,to be content. Phillipians 4:11-13

34 years old. Diagnosed with Lupus in 2000. Fibromyalgia, Anti-phospholipid syndrome(APS)(stroke, 2002), Sjogren's, Raynaud's, Libman Sach's Endocarditis, vasculitis, sacroiliitis, arthritis (neck), anxiety. Prednisone, Imuran, Coumadin, Clobazam, Amitriptyline, Didrocal, Cozaar, Zoloft, Neurontin, calcium, multi-vitamin, vitamin D, Magnesium, vitamin B6, Acidophilus
 
Moderator for the Lupus and Fibromyalgia forums


Ides
Forum Moderator


Date Joined Nov 2003
Total Posts : 7077
   Posted 2/9/2009 6:15 PM (GMT -7)   
Lynn - Medicare does not begin immediately for those that become a Social Security Disability Insurance beneficiary.
"If you are a Social Security Disability Insurance (SSDI) beneficiary, benefits automatically begin in the 25th month following SSDI payments or in the 30th month after Social Security’s determination of your disability onset date."

Did Social Security set a disability date more than 2 years before the award date? If so, then you probably are eligible for Medicare and must answer truthfully. Medicare would become the primary payer and your work health insurance would become second payer. If your current insurer finds out later that you were eligible for Medicare and did not tell them, you might then become responsible to repay them for all that they have paid out on your behalf. If your disability date was set as of the date in October, then you are not eligible for Medicare just yet.

Actually if you were eligible for Medicare now, you would have been mailed a Medicare card and asked if you wanted to participate in Part B. Remember if you decline to take Part B, you might be subject to a penalty when you do need to enroll in Part B.
 
PS Feel free to shoot me an email if you want more info on this.


Moderator Crohn's Disease Forum
CD, Ankylosing Spondylitis, lupus, small fiber peripheral neuropathy, avascular necrosis, peripheral artery disease, degenerative disc disease, and a host of other medical problems.
 


Melissa D.
Regular Member


Date Joined Aug 2008
Total Posts : 342
   Posted 2/9/2009 7:42 PM (GMT -7)   
Hi Lynnwood,

I just dropped you an email, I have a sort of simular situation as my husband is self employed.

Melissa
Lupus - 1997   Fibro - 2001    Sjorens  -  2007   Raynauds  -  2008
Plaquenil, Imuran, Prednisone, Synthroid, Topomax, Effexor, Norco, Prilsec, Xanex, Elidel, Restasis


Lynnwood
Forum Moderator


Date Joined May 2005
Total Posts : 7019
   Posted 2/9/2009 8:21 PM (GMT -7)   
I was most surprised to find my health insurance knew I had become eligible for Medicare practically before I knew! lol


Melissa, thanks so much for the email, I'll be responding later this week. Sound like yours & mine are quite similar.

Cheers everyone,

Lynnwood, Co-Moderator: Lupus Forum
SLE(’00), Sjogren's Syndrome, Raynaud's Syndrome, Seasonal Affective Disorder, Depression, Herpes Simplex 1
Plaquenil, Prednisone(15 6mg), Piroxicam, Xanax, Trazodone, Boniva, Wellbutrin, Valtrex

Links: DIAGNOSING LUPUS (4 of 11), LUPUS INFORMATION, LUPUS RESOURCES, Donate to HealingWell, Drug Interactions

"Life is far too important to be taken seriously." –Oscar Wilde, 1982

 


BigBry
Regular Member


Date Joined Nov 2008
Total Posts : 106
   Posted 2/10/2009 12:53 AM (GMT -7)   
OH yes the private insurance companies are always looking for ways to lower their liability and pass it on to someone else.
DX: IBS 00, +ANA 05, Depression 06, MCTD & Sjogren's 07, GER 08, NO Sjogren's 09, ?????  
Meds: Plaquenil 400mg, Prednisone 10mg, Celebrex 200mg, Effexor 150mg, Nexium 40mg and Amitriptyline 10mg
Life is what you make of it.  Just something I try to remind myself every day.


Butterflake
Forum Moderator


Date Joined Jun 2006
Total Posts : 1547
   Posted 2/10/2009 5:50 AM (GMT -7)   
Hey Lynnwood. I sure don't have an answer, but I'm sending lots of positive energy your way. Ides seems to have a great answer. I remember you told me that once disability is approved, one spends at least 2 days a week on the phone with insurance companies. Sounds like more than 2 for you sad   Love ya, Butterflake

Systemic Lupus ('05), depression, diabetes, fibro, gerd, hypertension, IBS, sleep apnea  Rx: Cellcept, plaquenil, prednisone, celebrex, lisinopril, actos, lipitor, nexeum, prozac, seroquel, wellbutrin, actonel, tylenol arthritis, neurontin, phenegren, flexeril, vit C, multi vit, flaxseed oil.  Acupuncture  "Welcome to lupus, where the strange is ordinary and nothing is normal." Donna 
 


Lynnwood
Forum Moderator


Date Joined May 2005
Total Posts : 7019
   Posted 2/10/2009 8:39 AM (GMT -7)   
Yes, Ides information is correct. However it's the complication of owning the company which is paying for a group health insurance plan that is my issue.

Thanks everyone

Lynnwood, Co-Moderator: Lupus Forum
SLE(’00), Sjogren's Syndrome, Raynaud's Syndrome, Seasonal Affective Disorder, Depression, Herpes Simplex 1
Plaquenil, Prednisone(15 6mg), Piroxicam, Xanax, Trazodone, Boniva, Wellbutrin, Valtrex

Links: DIAGNOSING LUPUS (4 of 11), LUPUS INFORMATION, LUPUS RESOURCES, Donate to HealingWell, Drug Interactions

"Life is far too important to be taken seriously." –Oscar Wilde, 1982

 

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