I Am Eligible for Medicare Because I Was Found Disabled. Can I Decline Medicare if I Have Other Insurance Coverage?
As we discussed in prior blog posts, the resolution to a Social Security Disability claim can take years. Well, guess what? The road to Medicare eligibility can also prove to be a long one. Medicare entitlement is considered to be an added benefit to the monthly disability income you receive.
What do you need to know about Medicare entitlement? First, you are automatically enrolled into Medicare after you have received disability benefits for two years. For example, if you begin receiving disability benefits as of January of 2016, your Medicare entitlement will begin in January of 2018. During this period you will be responsible for paying your medical expenses however you can.
The other thing to know is that there’s Medicare Part A and Medicare Part B. Part B is the “medical insurance” part of Medicare and the premium for Medicare Part B will be taken directly out of your monthly disability payment. Medicare Part A is the “hospital insurance” part of Medicare—which is useful should you require any hospital stays. There is no premium for Medicare Part A.
Then there’s the question: should you decide to take Medicare Part B once you become entitled? If you have no other means to cover your medical insurance then the obvious answer is “yes.” However, some individuals may be able to decline Medicare Part B. Let’s say your spouse has a group health plan that allows for a cheaper monthly premium than Part B based on this current employment. If you take this option, you must stay on top of your healthcare and act immediately if there are changes to that employer’s plan.
If you do decide to enroll in Medicare Part B, certain criteria must be met in order to qualify for enrollment during what is called a Special Enrollment Period. You’ve probably heard of COBRA—that stands for Consolidated Omnibus Budget Reconciliation Act, and not the venomous snake with the flat, wide head. Well, COBRA and retiree health plans are NOT considered coverage based on current employment. You’re not eligible for a Special Enrollment Period when that coverage ends. If that is the case, you would have to wait for the General Enrollment Period. The sign up for the General Enrollment Period typically runs from January 1 through March 31, and your coverage would start July 1 of that same year. If you don’t navigate this process correctly, you could be left with a gap or lapse in your healthcare coverage.
Medicare is a good thing because it provides healthcare for millions of Americans each year, but it does present a variety of questions. Be sure to ask all the right questions before making a decision regarding your health are. Give us a call if you need help figuring it all out.
Robert L. Heller has practiced law in Ohio for nearly 40 years, devoting his entire career to helping disabled people in the Mahoning Valley to pursue needed benefits. A native of Warren, Ohio, Robert earned his undergraduate degree from Miami University of Ohio and his law degree from the University of Toledo College of Law. He also studied public administration at American University in Washington, D.C. He is admitted to practice in Ohio state courts, U.S. District Court for the Northern District of Ohio and Sixth Circuit U.S. Court of Appeals as well as a member of the National Organization of Social Security Claimant Representatives (NOSSCR).