As I mentioned previously, it takes a special kind of person to sacrificially give of their time and energy to care for another. In the process, these unsung heroes are posed with many questions that can derail a well-thought-out plan. Having been through this and THEN becoming a Medicare/Medicare Advantage fiduciary agent, I am sharing answers to commonly asked questions. If you missed Part 1, click here to read it.

Last week we answered the following questions:

1. How do I find out what my care receiver is eligible for?
2. Is there any help to lower prescription drugs costs?
3. Even though my care receiver has insurance, he or she still can’t afford the bills. What are his or her options?
4. How do I know I’ve chosen the right plan for my care receiver?

This week we will answer the following questions.

1. What’s the difference between SSD/SSDI (Social Security Disability) and SSI (Supplemental Security Income)?
2. How does SSD or SSI affect when my care receiver is eligible for Medicare, and what to do in the interim?
3. My SSD care receiver is now eligible for Medicare. What should I do?
4. My SSD care receiver didn’t take Part-B because of the premium, but now wants it. What do I need to know?

So, let’s get started!

What’s the difference between SSD/SSDI and SSI?

SSD or SSDI (Social Security Disability Insurance) was created for people with disabilities. While SSI (Supplemental Security Income) was created for people who fall within the federal poverty levels. While they both provide income for an individual struggling to provide for himself or herself, it’s for two different reasons:

1. SSD/SSDI is for individuals who, due to a disability, cannot provide for themselves.
2. SSI is mainly for the financially challenged who meet federal poverty guidelines.

You may argue, “Whether it’s because they are physically unable to work or just cannot find gainful employment, who cares; it’s still income being provided by the government.” We may see it that way, but there is a key difference, which I will answer in the next question.

How does SSD or SSI affect when my care receiver is eligible for Medicare, and what do I do in the interim?

If a person qualifies for SSD/SSDI, he or she will be eligible for Medicare after 24 months; immediately if the disability is for ESRD (End-Stage Renal Disease or kidney failure) or for ALS (Lou Gehrig’s Disease). SSI recipients must wait until their IEP (Initial Enrollment Period) when they are turning 65. However, due to their low income, most are eligible for Medicaid, and certain states automatically enroll them.

From a dollars and cents perspective, those who are eligible for Medicare have their benefits provided by the federal government. Those on SSI who have Medicaid fall under their state’s program. If everyone were eligible for Medicare, that would put serious stress on the program covering 63 million people, currently. By putting SSI recipients on Medicaid, it helps preserve Medicare. Medicaid benefits are not as robust as Medicare’s.

My SSD care receiver is now eligible for Medicare. What should I do?

Just because you are eligible for Medicare doesn’t mean it’s free. Medicare Part A costs $471 per month if the beneficiary worked 29 or fewer quarters (seven years and three months), and $259 per month for those who’ve worked 30 to 39 quarters paying FICA (Federal Insurance Contributions Act) taxes. Part B is $148.50 per month. These are 2021’s rates; they go up annually.

If an individual is on SSD/SSDI, chances are they are not working and accumulating quarters paying FICA. At the same time, their income may fall into the federal poverty levels, making them eligible for Medicaid. I recommend applying for Extra Help and a Medicare Savings Program (Medicaid), because one will help cover prescription drugs and the other medical services. Upon being qualified, depending at what level he or she qualifies, it would pay for Part-A and Part-B premiums, and possibly any deductibles, copays and coinsurances that Medicare will have.

Once you are eligible, keep in mind Medicare Advantage. Besides providing all the benefits Medicare provides, it will provide additional benefits that your care receiver will need, like:

• Dental
• Vision
• Hearing
• Over-the-counter allowances for items typically purchased at Walmart, Walgreens and CVS.
• Some have food cards
• Gym memberships
• And more, depending on the plan.

My SSD care receiver didn’t take Part-B due to the premium, but now needs it. What do I need to know?

Assuming your care receiver has Part A (hence he or she would not be eligible for Part B) and they qualified for full benefits, so they do not have to pay the premium for Part A, there are two things to consider.

1. They are under 65 and have not incurred penalties, or…
2. They are over 65 and have incurred penalties.

The answer to the previous question would help in both scenarios and help them with the $148.50 premium (applying for Extra Help and Medicaid). However, if they do not qualify, they would need to pay the $148.50 and any penalties incurred.

One way of minimizing this is to look for a Medicare Advantage plan with a Part-B premium credit or giveback. Depending on where you live, there are givebacks that may run from $30 to $144 per month.

As in the last article, if you are a bit confused or overwhelmed, contact a fiduciary agent like YourCareRep.com. We can help you find out what your care receiver is eligible for and assist with enrolling in any necessary programs. Moreover, we can also look at the Medicare Advantage plans available in your area and see which would help minimize or eliminate any costs possible.

Stay tuned for next week’s article where we will answer questions from an SSI recipient’s perspective. We will also cover which states automatically enroll SSI recipients into Medicaid and in which ones you must initiate the enrollment.