Disability and Medicare

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Eligibility

If you are under 65, you can get premium-free Medicare Part A benefits and Medicare Part B (monthly premium), if you have been a disabled beneficiary under Social Security or Railroad Retirement Board for more than twenty-four (24) months.

Certain government employees and certain members of their families can also get Medicare when they are disabled for more than twenty-nine (29) months. They should apply at the Social Security Administration office as soon as they become disabled.


Enrollment

If you are disabled, you will automatically get a Medicare card in the mail when you have been a disability beneficiary under Social Security or Railroad Retirement for twenty-four (24) months.

The Medicare card will show that you can get both Medicare Hospital Insurance (Part A) and Medical Insurance (Part B) benefits. If you do not want Part B, follow the instructions that come with the card. Premium-free Part A may not be declined. Under the Waiver of Health Insurance (HI) of the Social Security Operational Manual, it is stated that a Disability Beneficiary may NOT waive HI entitlement (Part A). Not taking Part A when eligible will result in the beneficiary having to repay all benefits. This includes "for religious or philosophical reasons, or for reasons of other insurance."

You may be able to buy Medicare Parts A and B if you are determined to be eligible for Social Security Disability and you have lost your premium-free Part A solely because you are working. See "Special Enrollment Period."


Medicare as a Secondary Payer

Medicare is the secondary payer for certain disabled people who have premium-free Medicare Part A and are covered under a health plan through their current employment or a health plan based on current employment of a family member. This secondary payer provision applies to group health plans of employers that employ 100 or more people. The secondary payer provision also applies to group health plans of employers with fewer than 100 employees if their employers are part of a multi-employer plan in which at least one employer has 100 or more employees.

If Medicare has been the secondary payer because you or your spouse has been working, When you or your spouse quit working, Medicare may become your primary payer. See "Special Enrollment Period" and contact your local Social Security Administration office.


A Rule That Protects You

If you are disabled, group health plans cannot deny you coverage, reduce your coverage, or charge you a higher premium because you have Medicare.


Special Enrollment Period

If you are covered by a group health plan when first able to get Medicare, you may be able to delay enrollment in Part B or premium Part A without premium penalties and without waiting for a general enrollment period to enroll.

You can sign up for Part B or premium Part A at any time while you are covered under a group health plan if:

  • You are disabled and your group health coverage is based on your own or a family member's current employment.

If you have chosen to delay enrolling in Part B or premium Part A because you don't need Medicare coverage while you are covered under a group health plan, you may enroll during an eight-month period.

  • Your eight-month period begins when the current employment ends; the plan is no longer classifiable as a large group health plan (one that covers 100 or more employees); or when the plan coverage is terminated, whichever comes first.

Contact the local Social Security Administration office as soon as employment ends, or the plan coverage ends or changes, to be sure that you get the information you need about enrolling in Part B.

NOTE: Special enrollment period rules do not apply to you if you stop working or lose group health plan coverage during your initial enrollment period.


Disability and COBRA

Federal COBRA provides continuing health coverage to qualifying beneficiaries for up to eighteen (18) months following a qualifying event. In the case of individuals who qualify for Social Security disability benefits, special rules apply that may extend coverage up to eleven (11) additional months.

This disability extension applies to each qualified beneficiary (whether or not they are the covered employee) in connection with the qualifying event. The extension requirements are met if the beneficiary is determined under Title II or XVI of the Social Security Act to be disabled at any time before or during the first sixty (60) days of COBRA continuation coverage. Notice must be provided to the plan administrator on a date that is both within sixty (60) days after the Notice of Determination is issued and before the end of the original eighteen (18) month maximum coverage period that applies to the qualifying event.

If the beneficiary is on Medicare before the qualifying event, the beneficiary may be eligible for eighteen (18) more months of COBRA coverage. If a beneficiary is on COBRA and then becomes eligible for Medicare, the COBRA may end.


Talking with Medicare

Nationwide toll-free help line: 1-800-medicare 800-633-4227
Telecommunications device for the deaf to talk with Medicare: TTY - 877-486-2048


Medicare Supplement

Disabled Medicare beneficiaries have equal access to all Medicare supplement polices sold in Kansas.

  • Upon becoming enrolled in Medicare Part B, a disabled beneficiary will have a six (6) month open enrollment period to buy supplemental coverage. The open enrollment period begins on the effective date of coverage when first enrolled in Medicare Part B.
  • The policies must be sold at the same rate as for seniors who turn 65 and are eligible for Medicare.
  • Disabled Medicare beneficiaries cannot be turned down for any Medicare supplement plan being sold in Kansas during the initial enrollment period. Coverage will be guaranteed issue, but companies may still apply a preexisting condition waiting period for preexisting conditions that are contained in non-open enrollment policies. Be sure to ask about this.
  • A second open enrollment period will apply when the disabled beneficiary reaches age 65.

Before you purchase any kind of supplement or health care plan to coordinate with Medicare, you should call and request a copy of the current year's edition of the Kansas Medicare Supplement Insurance Shopper's Guide from the Kansas Insurance Department. You are eligible for a Medicare Advantage plan if:

  • You are an eligible Medicare beneficiary.
  • You reside in an area served by a Medicare Advantage plan.
  • You DO NOT already have end stage renal disease.
  • You ARE NOT already receiving Medicare hospice benefits.

What if You Lose Your Health Coverage?

You do have some guarantees.

New laws protect Medicare beneficiaries who lose their health coverage. Under certain circumstances, you have sixty-three (63) days to purchase Medicare supplement insurance with no health questions asked. Details for each are described below:

If you lose your coverage for one of the following reasons, you will be eligible to return to Original Medicare and purchase a Medicare supplement policy (Plan A, B, C, F, K or L) from any company selling these policies in Kansas.

  • The MA terminates or stops providing care in your area.
  • You move outside the MA service area.
  • You leave the plan because it failed to meet its required obligations to you.

If you decided to try an MA plan or Medicare SELECT policy, drop your supplement policy, and then decided you don't like it, you may return to your original Medicare Supplement policy if you meet these requirements:

  • This must be the first time that you enrolled in an MA plan or Medicare SELECT plan.
  • You must decide to leave the plan within one year after joining.
  • You must apply for the Medicare Supplement policy within sixty-three (63) days after leaving the other plan.

If you meet these requirements, you can return to your original Medicare supplement policy, if it is still offered, or choose from policies A, B, C, F, K or L.

If you lose employer group health plan benefits: Under certain circumstances, if you are enrolled as an employee under a group health plan and the plan terminates your health benefits, you have the right to purchase a Medicare Supplement policy (Plans A, B, C, F, K or L) from any insurance company selling these policies in Kansas. If you apply within sixty-three (63) days from losing coverage, the company is required to issue you the policy, even if you have a health problem.

If you lose Medicare Supplement coverage: If you lose your Medicare Supplement coverage for one of the reasons shown below, you will be eligible to purchase another Medicare Supplement policy. (Plans A, B, C, F, K or L) from any insurance company selling these policies in Kansas. If you apply within sixty-three (63) days from losing coverage, the company is required to issue you the policy.

  • Insurance company is insolvent or bankrupt
  • Involuntary termination of coverage or enrollment
  • Company substantially violates material provision of the policy
  • Representative of the company materially misrepresents policy provisions in marketing the policy.

If you lose your Medicaid: If you lose eligibility for health benefits under Title XIX of the Social Security Act (Medicaid), you are guaranteed any Medicare supplement offered by any issuer if you apply within 63 days of loss of eligibility.


Extended Medicare Coverage for Working People with Disabilities

As long as a person's disabling condition still meets Social Security rules, a person may keep Medicare coverage for at least 8 1/2 years after returning to work. (The 8 1/2 years includes the nine month trial work period.)

If Social Security Disability Insurance cash benefits stop due to your work, you or a third party (if applicable) will be billed every 3 months for your medical insurance premiums. If you are receiving cash benefits, your medical insurance premiums will be deducted monthly from your check.

There is a program that may help with Medicare Part A and/or Part B premiums. To be eligible for this help, you must:

  • Have limited income and resources.
  • Not already be eligible for Medicaid. To find out about this program, contact a Kansas Social and Rehabilitation Office near you and ask about the Medicare buy-in program.

Who to Call for More Information

You may call your local SHICK Coordinator, the State SHICK Hotline (800-860-5260) or the Kansas Insurance Department (800-432-2484) if you have questions regarding Disability and Medicare or other Medicare issues.