Once working while disabled, can I definitely keep Medicare for several years?

I have a question about something I read in the SS Redbook for work incentives handbook. It states the following:
“Most individuals with disabilities who work will continue to receive at least 93 consecutive months of hospital and supplementary medical insurance under Medicare. Although cash benefits may cease due to work, you have the assurance of continued health insurance. You qualify by working and perform SGA, but not be medically improved."
I have two questions:
1) What do they mean by “most” individuals... Why not ALL individuals? Who are they excluding and why?
2) If you are not medically improved and your doctors’ records support that, is that enough to satisfy SS? Or does SS use some other criteria to evaluate this? For example - do they consider how many hours over SGA you are working or what type of work you are doing in order to make their decision?
It’s ironic and confusing that they allow this benefit of continuing Medicare coverage, since SS uses working as a criteria for NOT allowing people to get disability benefits in the first place. What are the detailed guidelines?

http://ssa-custhelp.ssa.gov/cgi-bin/ssa.cfg/php/enduser/std_adp.php?p_faqid=276&p_created=958490793&p_sid=x3Rdr7th&p_lva=&p_sp=cF9zcmNoPTEmcF9zb3J0X2J5PSZwX2dyaWRzb3J0PSZwX3Jvd19jbnQ9MiZwX3NlYXJjaF90eXBlPXNlYXJjaF9ubCZwX2NhdF9sdmwxPTEwNSZwX2NhdF9sdmwyPTE3JnBfcGFnZT0xJnBfc2VhcmNoX3RleHQ9bWVkaWNhbCAgaW5zdXJhbmNl&p_li=

It looks like you read right.

SS provides incentives for persons who want to return to work, from or on a disability.

The Government gives incentives all the time , in hopes that in a long run the person or entity gets back into the mainstream, and then it's able to collect taxes again , and the person or entity will become self sufficient.

I'm having trouble understanding...

Blonde Lebinese, SS takes away one's cash benefits due to the fact that one is working at/above SGA and is therefore, by their very definition, no longer disabled. If this is true, then what criteria do they use to determine that you concurrently ARE still disabled and qualify for getting 90 months of Medicare while working?

If this is true, then what criteria do they use to determine that you concurrently ARE still disabled and qualify for getting 90 months of Medicare while working? [ quote ]

I don't think they are saying you are still disabled. It's just something they allow. Maybe they figure it's enough time to see if you can keep working and if not be able to fall back into disability status. I don't really know, You could always call them and ask,but they would probably give you the same answer as the web site gives .

flirtypurse
Medicare usually continues for several years after a disabled person returns to work. I'll have to read the information again; I am thinking it is for less time than you have stated.

This provision of Medicare's extended coverage is to provide health insurance for a disabled worker who remains with a diagnosis that prevents the person from being able to gain health insurance, personal or through employer/group plans, (permanently or with a two-year waiting period). The disabled worker has to pay the monthly Medicare premium, on time, or the coverage stops.

The expectations are that if the disabled worker is able to qualify for health insurance, the Medicare will be discontinued. If the disabled worker is not able to qualify for health insurance, chances are the worker is not going to continue in the workforce for longer than the Medicare benefits are extended, not without periods of being totally disabled and receiving SS disability benefits again, which would restart the continued/extended period of Medicare coverage benefits when the worker again returns to work.

Not one of my more concise answers; hope you can understand what I am trying to say.

EC

ellencee,
I'm confused by your statement -"The expectations are that if the disabled worker is able to qualify for health insurance, the Medicare will be discontinued."

Anyone and everyone can get GROUP insurance because it is not underwritten and they take everyone, no matter what their health status. If this is true, and I believe it is, than that would mean that nobody at all ever gets the continuing Medicare coverage.

Do you see my point?

flirtypurse
No, I do not see your point. Apparently, you do not understand that disability benefits (income) and Medicare insurance benefits are separate issues managed by separate departments within the Social Security Administration.

There are certain illness, diseases, conditions, whatever you wish to call them, that will NOT be covered by group insurance benefits no matter how the insurance policy is gained (through employment or through a spouse's insurance). Most diseases in this category will not be covered by insurance benefits for a minimum of two years AFTER the insurance policy is in effect.

For up to 36 months, Social Security Disability benefits will continue to be available to the disabled worker who returns to work. That means that if during the 36 months, the worker's monthly earnings fall below the maximum allowed earnings, the worker can apply for disability benefit payment for that month WITHOUT a waiting period or new disabilty determination. Except under certain return to work programs, SS may require the worker to qualify for continued disabilty benefits as described for the 36 month period. If the worker is found to no longer be disabled, then all disability benefit income ceases and the worker must reapply for benefits. If the worker is smart, the worker will make sure he or she is in one of the return to work programs (ie: Ticket to Work).

Just because SS determines a worker to no longer be disabled DOES NOT MEAN the worker has suddenly become fully covered or eligible for benefits by private or group insurance plans. Therefore, Medicare will continue in force during those 36 months as long as the worker pays the monthly Medicare premium on time.

Any worker who is able to gain insurance coverage and does so can withdraw from the Medicare program. Medicare will be secondary to any group or private insurance benefit and will only pay up to the Medicare scheduled benefits amount(s); therefore, it may be cost-effective for the worker to stop paying Medicare premiums and pay only their new insurance premiums (once any waiting period has ended).

After the 36 months and for a period of up to two years, Medicare insurance will be available to those workers who remain in the two-year waiting period of coverage for certain illnesses or for workers who do not have group insurance offered or available from their employers.

Obviously, an additional 33 months of Medicare eligibility exists for a certain group of workers. I can only assume that those workers are not going to gain sufficient health insurance benefits through their employers or are not going to be able to afford the costs of private or group health insurance. Not all workers will earn enough to pay the higher insurance premiums.

Whether or not a disabled worker is allowed to keep Medicare insurance past the 36 months is up to the Medicare department of Social Security. Medicare evaluations/determinations for eligibility are entirely separate from Disability evaluations/determinations.

The ability to work 20 hours a week or the ability to earn the SGA is the criteria for determining disability benefit (income) eligibility.

A worker's continued healthcare needs for management of a disabling disease or conditon and/or the ability to obtain full coverage health insurance, either private or group insurance, are part of the criteria for determining Medicare insurance eligibility.

Write to your Medicare insurance provider (name and address are on the Medicare benefit statements you receive for charges submitted); ask for an explanation that directly relates to your physical condition.

EC

Ellencee,

Thanks very much for your comprehensive answers and your patience. A couple more things:

1) What if the individual qualifies for group insurance but he/she personally finds it completely unaffordable? In this case, does Medicare let the individual choose to keep their Medicare insurance?

2) Another scenerio: In my state, if you are self-employed, in order to qualify for group insurance you must work at least 30 hours a week. But let’s say that the individual is unable to work this much because of their medical condition. In this case, would Medicare let that individual keep their Medicare insurance?

The two scenarios you presented are valid reasons to apply for continued benefits or to appeal a denial of continued benefits.

I can't predict what Medicare will grant. Sometimes I think the whole department gets drunk, draws "yes" and "no" circles on the floor, throws the applications up in the air and where the applications land is what the answer is, including those applications that just don't make the a proper landing--in the trash, no questions asked!

Good luck,
EC

Ellencee,
I know that you can only give an educated opinion, but I forgot to ask you - given these two particular scenerios, what total amount of months would they likely let someone hold onto their Medicare? - in a nutshell. 36 months? - or more/less than this?

P.S. Once Medicare benfits continue, are they willing to take premium payments via an automatic deduction from a checking account, so the beneficiary doesn't have to send out a check every month via certified mail and runs the risk of losing their insurance due to a mail snafu?

Thanks again.

flirtypurse
I think the 36 months is pretty much a guarantee. I have no idea about auto-paying the premiums.
EC

EC, Do you have any links or references you can give me, so I can read up on this in detail regarding the information that you gave me? The Redbook handbook is too vague. Thanks again.

www.ssa.gov
Ticket to Work (has information about the 36 month eligibililty period and the extended period of up to 8 years (96 months)

General Information on:
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Ticket To Work
On October 1, 2000, a new law extended Medicare coverage for an additional 4 1/2 years beyond the current limit. This law is for people who receive Social Security disability benefits and who go to work.

Under this law, how long will I get to keep Medicare if I return to work?

As long as your disabling condition still meets our rules, you can keep your Medicare coverage for at least 8 ½ years after you return to work. (The 8 ½ years includes your nine month trial work period.)

Click to expand...

EC

EC,
One more thing - I'd be self-employed and I would not be working under the Ticket to Work program. Do these laws you quote also apply to people working but NOT using Ticket to Work? I sure hope so. I should have specified this in the beginning...

flirtypurse
You should at least check out the Ticket to Work program even if you are going to be self-employed. Whatever service or business that you choose to facilitate your work efforts is supposed to provide you with resources to succeed. In addition, for 5 years, Ticket to Work will pay you an additional benefit that is abour $400 a month.

I do think the 8 years of continued benefits is part of the Ticket to Work. Without it, I think the benefits are 36 months to 60 months in most situations. Don't consider that to be the facts, though. It's just that if I understand the information, that I the way I understand it to be.

EC