Question: I am 51 years old and approved for Social Security Disability benefits. I have been told I will get Medicare. When does my Medicare begin? What do I need to do to start Medicare and what else will I need to add?

Answer: When a person qualifies for Social Security Disability (SSD) they usually receive Medicare on the 25th month of eligibility for SSD benefits. Your Medicare card will automatically be mailed to you about three months before it is scheduled to begin. You should watch your mail and always open everything you receive. The Medicare card is a paper card and comes in a very plain envelope for your protection. You don’t want to throw away your card by mistake.

There are situations or diagnosis that make those receiving SSD eligible for Medicare much sooner than 24 months. The most common situations are Amyotrophic Lateral Sclerosis (ALS) and Kidney Failure/Renal Dialysis. If this is your situation, your Medicare card will come significantly sooner.

As we’ve covered in the past, Medicare Part A is hospitalization coverage, Medicare Part B is outpatient coverage and Medicare Part D is for prescription drugs. All three of these “Parts” have different rules and costs.

Medicare Part A is free to you as long as you have worked 40 quarters (ten years). Medicare Part B is optional coverage that you pay a monthly premium for, (2020 = $144.60) which comes directly out of your monthly Social Security benefit. If you have creditable insurance coverage from another source (like an employee plan), you may not need Medicare.

There are many different scenarios to consider. Some individuals have been without insurance up until that 25th month and are therefore thrilled to have Medicare now available to them. Others have insurance through the Marketplace (Affordable Care Act, or Obamacare), can cancel that product and then review their Medicare options and alternatives, signing up for products that meet their needs. Then some individuals have an Employee Group Health Plan (EGHP) and for SSD that creditable standard is more than 100 employees. Each situation depends on the variables involved and the answer is different for everyone. It is helpful to review your options with someone who understands all the factors in your decision and the rules involved.

I speak with individuals regularly who have had Medicare A only for a number of years due to a disability or age, and had insurance through an employed spouse. Once that spouse is no longer working, you MUST sign up for Medicare B within 8 months. For those individuals who don’t sign up when they should have, there is a penalty and a delay in the ability to enroll in Medicare Part B when you want. This can be very frustrating and expensive.

Last but not least, there is Medicare Part D with its own set of rules to consider! In order to be eligible for Medicare Part D (Prescription Drug Coverage) you must be eligible for Medicare A or B or both.

Medicare Part D is also optional coverage and if you have Medicare Part A and/or Part B, you need prescription drug coverage. If you have Prescription drug coverage from another source, you can choose not to enroll in Medicare Part D. This drug coverage must be creditable (equal to or better than Medicare Part D Standard Plan). If you don’t have drug coverage and decide to not enroll in a Medicare Part D plan, you will have a premium penalty.

I have talked with a number of younger Medicare eligible individuals who think that Medicare rules do NOT apply to them, because they received Medicare due to a Disability. They are wrong. Medicare Part A, B & D rules apply to EVERYONE who becomes eligible for Medicare.

This information is confusing but there is help available to you. I know I am repeating myself, but I don’t want anyone to make a decision that could jeopardize their comprehensive insurance coverage now and cost them more money in the future.

Senior Life Matters is a community based program sponsored by Lutheran Jamestown. For questions and concerns or to reach Janell Sluga, GCMC, call us at 716-720-9797 or e-mail at SLM@lutheran-jamestown.org.