Social Security / Medicare How To opting out etc

[LuvOrlando]

OP -- be aware of the statement bolded below, taken directly from the form link you provided above:

WHAT IS THE PURPOSE OF THIS FORM?​

In order to apply for Medicare in a Special Enrollment Period, you must have or had group health plan coverage within the last 8 months through your or your spouse’s current employment. People with disabilities must have large group health plan coverage based on your, your spouse’s or a family member’s current employment.​

This form is used for proof of group health care coverage based on current employment. This information is needed to process your Medicare enrollment application.​

The employer that provides the group health plan coverage completes the information about your health care coverage and dates of employment.​

You've stated your husband has a small business employer. The group health plan may or may not be considered "creditable coverage" for Medicare purposes. In a nutshell, the employer's coverage must be equivalent or better than Medicare. (the link refers to Part D but there is penalty for Part B as well)

Thank you again!

It is excellent insurance, but I really don't know what makes it or breaks the definition, good thing I have a while. Guess I know what I will be doing tomorrow. Ounce of prevention pound of cure and all that, you are a gem!

 

[tvguy]

Not accurate. Deductibles and pre-authorization may be required for Medicare, similar to commercial insurance. It all depends on the plan.

Okay, there is a $233 annual deductible for Medicare. I consider that nothing compared to the $5,000 my group insurance had.

And this best describes pre-authorization. Almost NEVER is pre-authorization required. From https://medicareadvocacy.org/prior-authorization/

Traditional Medicare, historically, has rarely required prior authorization. Originally, the Social Security Act did not authorize any form of "prior authorization" for Medicare services, but the law has subsequently been changed to allow prior authorization for limited items of Durable Medical Equipment and physicians’ services. Despite this change, there are still very few services requiring Prior Authorization in traditional Medicare.* Enrollees in traditional Medicare Parts A and B can generally see specialists, visit hospitals, get care out of state, and so on, without having to ask Medicare's permission.

 

[tvguy]

Who is the expert though? The offices will answer direct questions but I don't know what questions to ask so I am bumbling through, I would have totally missed this important point if I didn't just randomly look up my account and notice an error and then have the time and patience to wait on hold a bunch to ask. As far as I can tell this entire process is 100% learn as you go and older people share in social groups but since I am so much younger than typical there is noone I know who has done it except maybe the pool of people on here who can make suggestions.

I used a SSDI attorney because the process was horrendous and the attorney gave absolutely no guidance.

I'm just sharing what I discover because I want to know what other people seem to know.

There are non-profit medicare advocacy groups across the U.S. not affiliated with any insurance company that offering counseling and advice.
Here in California, HICAP is on such group. https://cahealthadvocates.org/hicap/

 

[LuvOrlando]

There are non-profit medicare advocacy groups across the U.S. not affiliated with any insurance company that offering counseling and advice.
Here in California, HICAP is on such group. https://cahealthadvocates.org/hicap/

This is useful, maybe there is one for the disability related SSDI.

Honestly, I used to wonder how on earth disabled people end up homeless when the programs exist. At this point, the mystery is gone. I genuinely can't imagine any person with any sort of disruptive mental health troubles having the discipline to navigatie what I am doing. So far this has taken years of careful documentation, hiring an attorney, being able to explain myself and advocate for myself, Drs who are willing to advocate for me, a supportive family, computer access and time plus the ability to focus my mind. The experience has been eye opening and makes me deeply sad for many people.

 

[lanejudy]

Okay, there is a $233 annual deductible for Medicare. I consider that nothing compared to the $5,000 my group insurance had.

And this best describes pre-authorization. Almost NEVER is pre-authorization required. From https://medicareadvocacy.org/prior-authorization/

Your plan's deductible was higher, and I agree there are many Americans with HDHPs. My choices include both HDHPs and more traditional POS plans, one with a deductible that works out to less than Medicare's $226. I know many people who still have plans with deductibles $500 or less.

As to pre-authorizations -- I speak from first-hand experience over several years dealing with Medicare. Some Medicare plans definitely do require pre-authorizations, though it is the doctor's responsibility to obtain it. While they all must meet some minimum standards, there are many different Medicare plans with some broad differences.

 

[tvguy]

Your plan's deductible was higher, and I agree there are many Americans with HDHPs. My choices include both HDHPs and more traditional POS plans, one with a deductible that works out to less than Medicare's $226. I know many people who still have plans with deductibles $500 or less.

As to pre-authorizations -- I speak from first-hand experience over several years dealing with Medicare. Some Medicare plans definitely do require pre-authorizations, though it is the doctor's responsibility to obtain it. While they all must meet some minimum standards, there are many different Medicare plans with some broad differences.

Okay, we need to be specific. Medicare Part A and B do not require pre-authorization. Private Medicare ADVANTAGE plans certainly can require pre-authorization (known as Part C). Private Medicare Gap plans like Part G do not require pre-authorization. And I also speak from experience.

 

[barkley]

OP is going on SSDI which automatically qualifies for Medicare regardless of age.

with the exception of people with amyotrophic lateral sclerosis (ALS) or end-stage renal disease ssdi recipients qualify AFTER a 24 month waiting period. if, like myself, you are approved for ssdi on the first try you have to wait that 24 months from your date of eligibility until medicare kicks in. if, like the op, you've had to involve a lawyer it likely means you've had to apply, have been denied, appealed, done a reconsideration appeal, asked for an ALJ hearing, waited for response, asked for an appeals counsel review...a process that in the best of times takes 2-3 years (the wait for a hearing is over a year out these days). if it takes over 2 years and you are awarded retroactively then you've effectively 'eaten up' your waiting period so medicare just kicks in and you have to deal with your enrollment or disenrollment AFTER the fact of it activating (my dh's took over 2 years and he received a medicare card BEFORE they got around to issuing any of his current or retro social security monies).

Honestly, I used to wonder how on earth disabled people end up homeless when the programs exist. At this point, the mystery is gone. I genuinely can't imagine any person with any sort of disruptive mental health troubles having the discipline to navigatie what I am doing. So far this has taken years of careful documentation, hiring an attorney, being able to explain myself and advocate for myself, Drs who are willing to advocate for me, a supportive family, computer access and time plus the ability to focus my mind. The experience has been eye opening and makes me deeply sad for many people.

you are SPOT ON! when i worked for dshs and we observed our clients trying to navigate the process (far different from that of applying for our services) we firmly felt that it was intentional on the social security administration's part to make it as difficult as possible with the mindset that if someone with a mental health disability was capable of navigating it then it justified their department in denying the individual's claim. it finally got to a point that the agency i was employed by established a division of staff that worked exclusively helping disabled individuals apply for and navigate the social security disability process. it is a horrific process i would wish on no-one.

 

[MrsCobraBubbles]

So I work for an insurance company and everything you said sounds accurate, except I can't verify the name of the form or how often you have to file it. But you are correct, medicare will charge penalties if you dencline any part of the coverage once you are eligible, unless you prove that you had other sufficient coverage (usually through employment). My understanding was that this applies to part A as well but again, I don't work for the gov't so I'm not sure about that. So who told you all the info, was it a rep from 1800medicare? Because you will hear different things from them depending on what rep you get when you call, I advise people to call twice if the first call left them confused. And if you got your info from someone other than 1800medicare I'd just give them a call to make sure that all checks out. In PA you can contact PA Medi for advice on navigating Medicare, other states probably have similar departments. PA Area on Aging can help too.