Covering the Bases: Options for supplementing Medicare [Capital (Annapolis, MD)]

Last week I read your article about the person who just was awarded their Social Security Disability benefit and was waiting the two years for their Medicare to begin. I am in a similar situation but am closing in on my two-year wait. Medicare is due to begin in March. How do get my Medicare card and what do I need to consider?

To recap for the readers, the eligibility rules for Medicare differ greatly for disabled people under age 65 that the rules for people eligible for Medicare by turning age 65. Social Security Disability Insurance (SSDI) is a cash benefit that is awarded to workers who are no longer able to engage in "gainful" employment due to a long-term disability.

People receiving SSDI are eligible for Medicare. Typically, there is a two-year waiting period from the month a person receives their SSDI cash benefit until their health insurance begins under Medicare. A Medicare card is mailed to the person receiving SSDI. If a Medicare card does not arrive within two months of your Medicare eligibility date, contact Social Security (1-800-772-1212) to request your card. Once Medicare becomes effective, the monthly premium for Part B ($104.90/month) will be deducted from your SSDI check.

When a person receives Medicare under the SSDI rules the options for supplementing their Medicare are as follows:

1. Can you be covered under your (or your spouse's) former employer's health plan? Contact your former employer's benefit adviser to discuss this option.

2. Is your spouse currently working and is your spouse carrying employer-group benefits through their current employer? Could you be covered under this insurance? Discuss this option with your spouse's employer's benefit adviser. If you are covered under your spouse's current employer, you may be able to post-pone enrolling into Medicare Part B. Contact your local Senior Health Insurance Assistance Program (SHIP) at 410-222-4464, Ext. 3080 for more information on this option.

3. Could you qualify for Medical Assistance? Is your income below $951/month ($1281 for a married couple) and are your assets below $8,440 ($13,410 for a married couple? You may qualify for the Qualified Medicare Beneficiary Program (QMB) to supplement your Medicare.

Please note, even if you do not qualify for the QMB program, you may qualify for another program that can pay the $104.90/month for your Medicare Part B premium. The income limits for this program is $1,277/month for an individual ($1,723/month for a couple); assets are the same as above. Contact your local SHIP office for more information.

4. Should you consider a Medicare Supplement Policy (a.k.a. Medigap)? Medigap plans are federally-regulated plans that are designed to cover your out-of-pocket costs for Medicare Part A (hospital) and Part B (medical). Maryland State law allows a person receiving Medicare under SSDI a six-month window to purchase certain Medigap plans.

This six-month window begins the month your Medicare Part B becomes effective. If you purchase a Medigap plan, you may want to consider enrolling into a Medicare Part D (drug) plan. To discuss these options, contact your local SHIP office.

5. Should you consider a Medicare Advantage Plan? Medicare Advantage Plans are private insurances that have contracted with Medicare to offer the basic Medicare benefits. Medicare Advantage Plans may also have added benefits such as vision, dental and hearing services. Medicare Advantage Plans may also include a Part D (drug) benefit.

If considering a Medicare Advantage Plan, request a Summary of Benefits to better understand their coverage. These plans may limit the doctors and hospitals you must use. There will be co-pay requirements for services. Make sure the medicines you are prescribed are covered under such a plan. More information about Medicare Advantage Plans is available by visiting www.medicare.gov.

The rules for Medicare are complex; do not hesitate to contact your local SHIP office for guidance.

Amy Rubino is director of the Senior Health Insurance Assistance Program and the Senior Medicare Patrol for the Anne Arundel County Department of Aging & Disabilities. SHIP assists people with their Medicare-related questions; SMP assists people with issues related to Medicare fraud. You may contact either program by calling 410- 222-4464 or [email protected].