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SSI & medical insurance ?????

nmacnnmac Posts: 112
edited 06/11/2012 - 8:42 AM in Health Insurance Issues
I am considering applying for SSI. Next OCT. my new LTD & STD disability policy at work will cover my prexisting severe spinal condition.( one year waiting period) I am the medical insurance carrier for myself and Hubby.The disability policy money that I would receive would cover my premiums under COBRA. Once I am accepted by SSI how do I get coverage or access medical care? Money will be definitely be an issue for us. Anyone have any ideas?
Severe DDD. Klippel Feil Deformity. Cervical Foraminatomy that turned into Lamy. I have tried so many treatments, therapy's and medications.


  • SpineAZSpineAZ WiscPosts: 1,084
    If you have a substantial work history then you would likely be eligible for SSDI instead of SSI. SSDI is based on your work history and earning sufficient quarters of credit. SSI is a needs based program for people without enough recent work history. You'll want to check the difference out at www.ssa.gov

    Most LTD plans will continue while you receive SSDI. The LTD will deduct what you receive from SS under a provision in the plan that deducts other sources of income being paid to you for the disability. For example, if you are getting $2000/mo LTD and are awarded $1000/mo SS then you'd get $1000/mo from LTD and $1000/mo from SS. In addition most LTD plans will require that you file for SSDI if they determine you will be out of work for an extended time. So you may not have a choice as to when you apply - if you get an approval for LTD they can require you apply for SSDI to continue LTD benefits. Be sure to get a copy of the exact LTD plan under which you are covered so you can review it and be able to refer to it as needed. This is vital.

    I have been out of work since April 2009. Since my LTD carrier wasn't sure if they could determine if I would be out of work and be considered disabled for a long period they have not yet required that I apply for SSDI.

    If you are still working please keep in mind that STD and LTD are not guaranteed. You'll have to be able to provide substantial medical evidence (especially for LTD) that any disabling conditions you have prevent you from doing your job . So be prepared to lay out exactly what it is, medically, that prevents you from doing each of your job tasks.

    If you will be on true COBRA, then when that ends you are on your own for medical insurance. If you are married, and your spouse has medical coverage, you are eligible to be put on your spouse's plan as soon as your coverage ends. As such, there is no pre-ex provision for the medical insurance if you make the change to the spouse coverage due to your coverage ending. After COBBRA ends, if you have no option for spousal coverage, you are on your own for medical insurance. SSDI will provide Medicare coverage but only after you have had 2 years of SSDI benefits and the Medicare is for you only.

    I'm lucky that my employers practice is that as long as I am on LTD I pay retiree medical rates and am covered for medical coverage as long as I am approved for LTD and remain on LTD. Being on LTD I am frequently contacted, as is my physician, for updates to see if/when I can return to work. I'm on the cusp of having to determine if any return to work is viable. If my LTD claim ends (if they end the claim by determining I am not disabled) then I can go on COBRA or my husband's medical insurance if he has a job with benefits (currently he is laid off and on COBRA).

    2 ACDFs, 2 PCDF, 3 LIFs; Rt TKR; Rt thumb fusion ; Lt thumb arthroplasty; Ehlers Danlos 
  • having gone through this myself & just getting my approval a few days ago, is that you can get SSDI & SSI both at the same time (which is what I will be getting). I'm guessing that's based on the amount of SSDI you're eligible for according to your last Social Security statement (these are mailed to you yearly). I was also told that when a person is on SSI, they are automatically eligible for M'Caid-now whether or not that would apply to other family members I don't know-again, it would depend on income, but it would definitely cover you. As far as SSDI-yes, you have to generally wait 2 years before getting M'Care if you are approved for SSDI, however, depending upon how long you wait before getting that approval, and when your 'date of disability' is determined, that could influence that (for instance, I was told that I will NOT have to wait 2 years for my M'Care benefits because I have waited well beyond the 29month requirement for SSDI to be eligible for M'Care, thus mine will begin when my SSDI kicks in, which hopefully will be very soon-I should be receiving my info in the mail-I only know what my atty told me after he spoke with the Judge...he asked for the Judge to rule w/o another appeal hearing b/c my condition has deteriorated so much & having 2 torn discs along with 6 others protruding, the Judge agreed & did give me a fully favorable decision last Thursday; 1 week prior to when my Remand Hearing was scheduled to be).

    I know there are differences in situations, but I wanted to give you MY situation, because in MY case, I was told that YES if you get SSI, you ARE eligible for M'Caid (which I likely won't be by the time they factor in the income from SSDI/SSI/Child Support so I will likely just have the M'Care coverage for myself, but my son will retain M'Caid).

    Do you have an attorney? If so I would ask him/her. If not, you can go to the Social Security Admin's website & look for your answer there, or another EXCELLENT website for info is: www.disabilitysecrets.com You may even find this answer there-I've learned a LOT from that site over the past 5 years!

    Good luck, & do keep us posted, OK?
  • Nancy is your HR department any help? Often they or the diability carrier can give you info that you will need.

    A few things to keep in mind. Cobra is 18 months and very expensive since you are paying all of your medical premium not just your share(assuming your employer contributes). After 18 months you are on your own. Also the disability carrier is going to require proof that you cannot work. It is not automatic. So you will need your doctors agreement that it is necessary for you to be out of work. As karin said, and she is the most expert in this field on spine health, once you hit LTD after 6 months they will want you to file for SSDI. It won't get you more money but it subsidizes the insurance policy and should get you medicaid (not spouse).

    This is not an easy process to deal with. If your HR department is not helpful try the disability carrier. If you don't feel comfortable with them you might want to talk to a disability lawyer.

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