Recently, a great blog run by a cancer pal called Help Keep A Sister Alive www.helpkeepasisteralive.com (what’s not to love about that name?) asked me to write a guest post on Medicare basics. Now they know I am no expert but they also know peer to peer sharing of the basics can be more powerful than confusing expertise. We all know someone younger dealing with a medical crisis. What they and you might not know is that Medicare and Disability/Social Security can help. Another truth is that Medicare and Social Security are increasingly presented as programs that could be cut – symbols of big government and we hate that. Right?
Medicare and Social Security may be two of the greatest programs of our government. They insure very basic safety nets, unless we think homelessness combines well with a cancer diagnosis or old age. People need to know about them. Read the below and share so that folks facing a crisis may find some financial help albeit fairly modest.
And consider what kind of shape our communities might be in if we tossed aside our current sick health care system chaos and instituted Medicare for All.
Medicare for Anyone with a Medical Catastrophe & Under Age 65
By Marcy Westerling November — 2014
Medicare is more than the medical program offered to seniors over the age of 65. Medicare provides health care coverage to catastrophically ill people at any age. Those under 65 may enroll in Medicare if
- their disease is listed under the Compassionate Allowances
- they enroll in disability under Social Security Disability Insurance (SSDI) (should be easy for those who qualify for SSDI under the compassionate allowance aka automatic disability impairments)
- they can survive, literally and financially, for the two years of receiving SSDI before Medicare kicks in.
Accessing Medicare when you are under 65 can be confusing. First, few of us are aware of our eligibility and able to afford the waiting period. Second, the system is geared for elders. Other younger people on disability and Medicare can be your best guides.
In 2010 after I was diagnosed with stage 4 ovarian cancer, I slowly recognized that I needed Medicare so that I could leave my good but not good enough HMO. Medicare was my ticket to being able to access the best doctors for my disease wherever they are located and to compete for the best clinical trials.
A chance comment overheard shortly after my diagnosis suggested that I might be eligible for disability. I learned basics like disability is actually SSDI – social security disability insurance. Days later I called the local social security office and a friendly woman not only affirmed this new information but also quickly offered to complete all my paperwork, the short forms of the compassion clause, and to mail them to me. She then asked, “Honey, do you think you can get it from the mailbox, sign the three spots I flag and return it in the return envelope I provide?” This was a far cry from the harsh fight for disability claims I had heard from ill friends where they needed to “lawyer –up” and plan to fight for years. The compassion allowance is a zippy, user-friendly process but you need to be catastrophically ill.
Finding a local social security office to call and using the right language welcomed me into an easy process. Do not give up if your initial contact is a little less perfect. It took me awhile to understand the different rules – five months from start of disease before the first check will arrive, another two years before Medicare enrollment, who to contact when, but despite confusion, it has been relatively easy process. Two years and four months after being diagnosed, my invitation to Medicare arrived in the mail. (Actually, it got lost in the mail but that is another story.)
I knew from other patients that I needed not only to make decisions about enrollment in Medicare but also to select a supplemental policy (aka Medigap). Medicare Part B medical insurance typically only covers 80% of approved costs for cancer care. A supplemental policy is key because it covers the remainders of costs on whatever Medicare has paid for but not fully.
I have been on Medicare since October of 2012 and have had all my numerous medical bills from four different states paid in full. I have faced no restrictions under Medicare Part B and I have needed significant medical treatment. Unfortunately not all states require insurers to offer supplementary plans to those under 65 on Medicare. A list of the states that require the offering of Medigap policies can be found here. http://www.medicare.gov/supplement-other-insurance/when-can-i-buy-medigap/when-can-i-buy-medigap.html#collapse-2239 General information about Medicare and Medigap can be found here. http://www.medicare.gov/pubs/pdf/02110.pdf
The prescription drug plan, Medicare Part D, is a tougher story. Selecting a plan is typically based on the drugs you are currently on. For medically needy people it is much better to imagine the medications that you might go on and select a future oriented plan. For cancer patients in particular, we are in a tough position where infused drugs (covered under the very generous Medicare Part B) are increasingly being produced in pill form (covered under the very inadequate Medicare Part D). I am currently navigating these waters. It is clear that we would all benefit from pushing for categories of pills to fall under Medicare Part B through what are called Oral Parity laws.
Finding a Medicare insurance broker in your state to navigate the many choices is ideal. They should not need any payment from you and can plug you into the system to seek the best matches for your medical concerns. This New York Times article http://www.nytimes.com/2014/10/04/your-money/beware-of-shifting-options-within-medicare-plans.html?emc=edit_th_20141004&nl=todaysheadlines&nlid=55177073&_r=0 narrates the basics of Medicare today.
Medicare and Social Security are threatened with changes that may make them less available. If you like the programs, share why with your neighbors and family and the basics of what they do – this will allow others to realize they might be eligible and for our country to consider the merit of maintaining such a safety net for hard times. These programs have allowed me to stay alive.