My husband was so adamant that nothing was wrong with him until he saw the words small cell lung cancer & cognitive impairment combined. When I was researching AD, he was not interested & thought I was messed up to suspect something. I think, maybe I'm wrong (you know how they can be) that he might be more cooperative now. I was thinking that he might qualify for disability.
I don't know if he could qualify, wondered if any of you have experience with this. I honestly don't know how long he can continue working. I listened in to a phone conversation with one of his clients yesterday & the client said he would be available after 11 am Friday. My husband jumped to Saturday, the guy said today is Friday, totally ignored by my husband who set the appointment up for Saturday at 4.
We will have been married for 10 years in April, and also wondered if he could get disability based on my income then, since it has been way higher than his.
Yes your husband should qualify for social security disability. My husband was diagnosed on June 16, 2006 with rapidly progressive dementia at the age of 59. I applied for SSDI and got it 6 months later back dated to 6/16/06. My cousin has small cell lung cancer (without any MCI or cognitive issues) and is 55 and has just been awarded social security disability. Your husband should qualify if he has paid into the social security system. I still work, but the extra social security benefit we receive helped me be able to take a 4-month leave of absence last summer to spend time with DH. DH was diagnosed with Alzheimer's Dementia and semantic dementia on October of 2006, but social security dates it back to the first discovery they see in the medical records which was June of 2006.
My wife was not allowed to collect disability in 07 because she had not worked since 1999 even though she was showing signs of AD in 01-02 but was not DX till 06.. ( you must have worked 5 of the last 10 years ) My plan was to take the disability $ and put it aside for her future care as we have no long term health care plan,, I will have to pay out of pocket
My husband did. We applied because we were selling our half of the business to my husband's brother/partner, since he could no longer work effectively, and we wanted to relieve the business of carrying health insurance for us since I have had to be a token employee to keep it legal. I figured no insurer would take him with his pre-existing Dx, so Medicare would be his only option. That's why I pursued the SSD. We used a law firm with experience in that area to process our claim, although I'm told this is unnecessary. I also hear frequent horror stories about claims stuck in the cogs of the machinery and people waiting and waiting. Jeff's claim was approved on the first try--maybe because of the lawyer, I don't know. His Medicare starts in August. (the two year wait thing.)
Having him approved so quickly was one of the little shocks to my system...I mean, I believed the Dx...after all, we had the PET scan, right? But still there's this little lingering feeling that maybe it's all a mistake. But for SSD to look over his documentation and find it so irrefutable--well...I guess I can't pretend he doesn't have AD.
Do you know if they count 5 of the last 10 years of self employment? I assume you have to have a diagnosis.
Polly, your cousin got it just based on having SCLC? I thought it had to be something that you had that could never get better. My husband is a 6 year survivor & did well up until the cognitive part.
I wonder if my husband's radiologist documented my complain about confusion back in 2005 & if so, even though nothing showed up on the brain scan, it could count.
He's been self employed most of his life, a contractor. Do self emplyed people pay into the system?
How much did the attorney charge to process the claim?
The attorney took a percentage of the money due up to that point, or $4000 + change (don't remember the exact amount.) So, there was a cap, in other words. It was taken straight out of the first lump payment from the SSA. Turned out to be the total allowable, capped, amount of course. Seems large, but in the long run it feels worth it to me.
My DH got SS disability for his black lung and heart condition prior to diagnosis of AD. It was very easy and had no problems at all. I read every thing I could about the process on the net. There was one site I went to that had former employees of SS that will answer your questions and that was helpful. The SS people suggest you do it on your own and if you are denied your claim then get an attorney. There really is little need for an attorney when you first apply. The young man at the SS office was very helpful and told us to wait a certain number of weeks to hear from them and if we didn't hear to keep calling them every two weeks. We called once and within days it was approved...with the back pay. We filed this claim just a couple of years ago.
if i were applying for disability i would use an atty too. they get things passed thru faster and know the ropes. i would hope your husband paid into his soc sec while he was self employed so he could use that later if he draws. you should check that out. he wouldhave paperwork with his tax stuff for those yrs i would think. i would also think an official diagnosis would be needed to justify the disability claim. i know others here have better info on this subject. i hate that i missed filing for diability when my DH quit work 2yrs prior to medicare. he quit his atty practice and i had no clue he could get benefits back then. i was so wrapped up in the AD itself. it would have been alot in 2yrs if they based on his last income. i also didnt know i we should have applied for 65yr homestead exemption when he turned 65, as it meant alot of saving on our property tax!! missed out on that too finally got that reduced and its a big help.you live and learn the hard way. divvi
My husband was approved for his SS Disability back in 1998 with no problem at all. In fact, he was still "with it" enough that he went and dropped the paperwork off at the SS office! But, all the documentation from several doctors proved that he would no longer be able to do any kind of meaningful work. I remember that all the people we worked with were very helpful and we never needed the help of an attorney. Thankfully, he also had carried a disability policy and I submitted the same paperwork to them and they also approved him. I think a lot of it has to do with the proper documentation.
My husband was also approved for SSD. Our neighbor at the time worked at the Social Security office. She took the interview over the phone. The papers were mailed to me, which I submitted. It took about 4 months after submitting all medical records from the time he started having problems. He also, was evaluated by a Psychologist & had a medical evaluation. After about 10 mintues with the Psychologist was all that was needed. He only answered one question correctly. He is not eligible for Medicare yet, however, we have insurance through the company he retired from. We were one of the lucky ones. My brother (liver transplant) applied 4 times before he was accepted.
I applied for Sociasl Scurity Disabiolity in June 1984, and my case went right through, including a support check for my daughter(my share of support for a minor child). I gave them every scrap of medical history possible, met every deadline, kept the medical exam appointment they wanted, and signed enough permissions to release information to paper a closet. My sister's application didn't go as smoothly, because (she was told) when the workers desks get too loaded they'll deny some files just to get them off their desks--then those applicants can appeal and somebody else can handle it. She had to wait longer, and an appeal judge had to look everything over and approve it, but because she missed no deadlines, they had to count time from her original application date, and she got a nice back payment check. My Hubby's went through just fine, and did my brother-in-law's. Again, I provided every stitch of info possible and told my brother-in-law to do the same with his case. There's a lot of bureaucratic b-- you have to get through, but it can be done. My Hubby's was converted to Social Security automatically last Fall when he turned 65, as mine will in a few years. The process can be frustrating with all the waiting, but well worth the effort.
Emily, I do not know how old your husband is, but please remember this, once the Medicare kicks in be sure and take both part A and B, then within 6 months of having part B your husband will automatically qualify for a Medigap policy regardless of his pre-existing condition. He will not be charged more or have a rider attached due to the disease. If you will select plan F, it will pick up all charges approved by Medicare that Medicare does not pay, in otherwords the co-pay. The 6 month period is his open enrollment, first and only time he will be allowed this, unless he is not yet 65, if he is not yet 65 then he will also have one more open enrollment period in his lifetime and that will be within 6 months of turning 65. The open enrollment can be postponed if he does not take part B and IF you are still working and carry him on a policy where you work, but please remember, this is very important, if you want a supplemental insurance this will be your only chance since he has been diagnosed. If you need to ask any thing about this that I have not made clear or have not covered please ask.
Jane I am so nervous after reading your post that I just wrote a long, long post and then by mistake erased it. Let me try again! My husband recieved back SSA in 2007. He became eligible for medicare in November of 2007. I was thrilled thinking that when I got him Supplemental Insurance I could take him of my policy at work ( expensive). He was at that time 62 and is 63 now. I contacted Alzheimers Ass. for assistance and they directed me to an insurance advocate in my own state through Senior Citizens.Everyone I spoke to told me that the cost of Drug coverage and Supplemental would be so high due to his age( one quote 750. monthly) that I should keep him on my group policy and cancel his Part B. They told me there would be no benefit to keep it. This went against my grain so I also spoke with our benefit representative from work ( independent insurance broker) and a representative from SSA. EAch told me the same thing ... keep my group coverage and cancel his Part B. And so reluctantly I did.
Are you saying that if I had waited six months I could have gotten lower cost coverage for him? And if so , have I messed everthing up by cancelling his Part B?
The thing is my husband is in a period of decline and I doubt that I will be able to work for an extended period of time. I will be able to pay for my own coverage after I leave work but no way could I pay large premiums to keep him insured. I believe that I will have the opportunity to re-enroll him again in the fall and if that is so.. should I do it.
I was totally frustrated by the apparent lack of easy to understand information about Medicare/ Supplemental and Drug coverage out there so I really did try to talk to people who were supposedly the "experts."
I hope you can follow this. I may not have been as clear as I should be. My husband currently only has Part A, is covered by by group plan and is 63 years old. What should I do at this point to maximize his coverage?
My DH, now 64, started collecting SS at ag3 62 after retiring at 61 (sadly, I didn't realize how bad he was at work and they never told me). I went to the local SS office last week and they said he could apply for SS disability and gave me 2 medical release forms for him to sign and send back to them with the SS disability application. Am I brain dead or what...I can't find the form on line. I can only find where you can apply on line, but I want to fill it out and send it back to the local office. Does anyone have a solution?
Thanks Jane. My husband is 60, and will be 61 in September. We opted for parts A and B, as well as AARP/United Healthcare part D Rx program. I don't THINK I'm really looking for more coverage right now. The 4 young adult kids and I are all on private insurance (since all are still <25) with a low premium and very high deductible. In general, I'm accustomed to paying a lot out of pocket due the restrictions of the HMO we had through the business, so it just seems a normal practice to me to pay for things myself but have catastrophic health insurance. Because my husband, (on Medicare starting Aug.1) is on the usual, expensive, AD meds (aricept, namenda) it is mathematically more sensible that he have an Rx plan, whereas the rest of us will just use an online discount pharmacy as needed.
Anita 41, don't be worried, he will have another open enrollment for the supplement when he turns 65 regardless that you cancelled the Part B. 3 months before he turns 65 and once you get Part B for him he can get it then. The fact that you dropped the part B will not matter at that time.
Emily, He can still have the RX plan and also the supplement with co-pay he does not have to drop the health plan, the problem is that you may not be in the market for other insurance now, but it could change in the future and you must be aware of the open enrollment laws, once he turns 65 he will only have this chance once in a lifetime. It does not mean you have to drop the other plans. What you might not need now you might need a few years down the road. Just remember this.
I've got the medical release forms ssa-827, but there doesn't seem to be a paper form I can get to actually apply. The website says you can apply online or over the phone. I want to fill out all the forms and send them to the local office.
Are you talking about the HIPAA form? If so, just print it out and send it in as a paper form. For that matter you can do that with any of the forms. If you need help finding the right buttons to push, just say so and I'll walk you through it.
Anita 41, I am sorry, I just read your post again and realized that I failed to answer your question how you could expand your husbands coverage in the event you cannot work until you are 65. There are only certain states that allow the medigap policy under age 65, they are as follow: CALIFORNIA, COLORAD, CONNECTICUT, KANSAS LOUISIANA, MAINE, MARYLAND, MASSACHUSETTS, MICHIGAN, MINNESOTA, MISSOURI MISSISSIPPI, NEW HAMPSHIRE, NEW JERSEY, NEW YORK, NORTH CAROLINA, OKLAHOMA, OREGON, PENNSYLVANIA, SOUTH DAKOTA, TEXAS, VERMONT WASHINGTON, WISCONSIN. if you live in one of these States and your husband has the Medicare original Plan, then the fact that you dropped Part B, as long as you kept your husband covered under your group plan and he was not without that coverage even for one day, should not matter. You should still be allowed the disability enrollment if you re-apply for Part B.
I would talk face to face to a representative from Blue Cross or Mutual of Omaha if they are licensed to sell the Medigap in your State. I would not do this by phone because the representative needs to be aware of the rules regarding under age 65 open enrollment and AARP gave me incorrect advice by phone when we first applied for my husband, having worked in the Medicare field I realized that. If you don't ask the correct question and phrase it right you can get the wrong answer by people.
I would check on Plan F with the Medigap and Plan D Rx plan.
Like I told Emily one you do not need today you may wish you had tomorrow and you do not want to let this slip by. Just be aware though you are still ok on the age 65.
Jane, is Plan F what I call an Advantage Plan. I have one that is a PPO, which means I can go to almost any doctor I want to go to without permission from my family doctor. Not that I would. She knows the BEST specialists, and when I tell them who sent me they are impressed by the medical group she belongs to.
It is close to half the price of my husband's Plan C + Plan D. I never changed his because I was frankly afraid to since they are paying out a huge amount of money on him every year. And he had too many things wrong with me to take a change on messing things up to save under $1000 a year.
By accident we ended up with different Blue Cross/Blue Shield companies. They are both very good companies, but mine pushes the advice nurses on you. It was their advice nurse who called me to find out what I was doing about my knee, and who basically told me to go and get it seen. They recently sent me a list of tests they think everyone my age should have including some that are very expensive. I've had most of them already, but still.
The only thing my Advantage Plan ever refused to pay for was the drugs for my nebulizer because Plan B requires you to be in the hospital for you to be getting that drug. If I hadn't taken the drug I would have ended up in the hospital. It cost me $12 a box at the local drug store, but mostly I don't use the nebulizer. It is a true emergency drug for me.
If you can get an Advantage plan that is a PPO, I'd suggest you look into it.
Starling, believe me I know what the Medicare plans pay and what to watch for. No, Plan F has nothing to do with the Advantage Plan. I plan to stick with the Medicare Original Plan and Plan F Medicare supplemental. We have NOTHING WHATSOEVER TO PAY ON OUR PLANS.
I agree with Jane. I know I'm paying more for for the Medicare and AARP medigap-but I can go where I want to and have no deductables. I go to an opthalmologist and MC pays for everything but the refraction which is only $20.
Jane Thank you for getting back to me again. My concern is not whether I can wait until I 65... but until my husband does reach 65 in just less than two years. I will continue to have coverage even if I need to quit work. But back to my husband... I live in Virginia so its not one of the states you mention. But if I understand you when I have the opportunity to re-enroll him in Medicare I also need to look into plan F with Medigap and Plan D Rx. IS this the same as a supplemental plan? Knowing that I live in Virginia and he is covered right now.... is there anyhting I need to be doing right now? If I have a chance to re-enroll him in next open enrollment period should I.?When I was checking into this I remember that the list of providers for under 65 Supplemental coverage was very small in Va. I am somewhat familar with having to ask the "right" question to get the answer you need. I have worked with goverment agencies for years, and I really thought I had done that in this case. I kept re-checking with them, but I also realize this was at a bad time for me in terms of pressure. And, of course, they don't make it easy...
Anita41, yes I did realize that you would continue to have coverage but that you were concerned that you would not be able to continue his coverage through your work until HE becomes 65.
Let me be sure I understand you. I am speaking of regular ORIGINAL MEDICARE and not one of the Medicare Advantage plans. Only Original Medicare.
If this is what you are covered under, then NO, I would not re-enroll your husband during the next open enrollment just because you anticipate that you may have to quite work and he would not be covered. If you loose your job, quit work, he will at that time have a Special Enrollment Period. As long as he is STILL covered by an employer or union group health plan through your active employment. Be sure not to drop him on yours.
During the eight months following the month when the employer or Union group health plan coverage ends, OR when your employment ends (whichever comes first) You can elect his Part B then or any time while you are still working. So don't panic and do something until you need to. He will be fine. You can get it when he looses it due to your job loss, don't just drop him unless you loose your job.
When you do elect the Part B coverage then look into seeing if your State does allow the Medigap supplemental also for a disabled person. I don't think Virginia does, but if it does look for Plan F
If he is not allowed the Medigap, just wait until three months before he turns 65 even if you have already gotten the part B Medicare for him, he will still qualify again once he becomes 65.
Now remember Anita, I am speaking of the Original Medicare Plan Only. That is the one to have, that along with the Part B Medicare, and then the Plan F Medigap from whatever company you choose and also the Plan D which is the RX medicare plan.
If I have not been clear with this please do not hestitate to question again. I know it is all a lot to take in and I hope I have not forgotten anything.
He will be fine, don't worry, just keep these dates in your mind and you will be ok.
Jane ... Still needing a little clarification and I TRUST your answers.. When you speak of Original Medicare Plan only , what do you mean? My husband was originally notified that he had recieved Medicare Part A and Part B. I made no changes from that . Only later after speaking with individuals I did drop the Part B. I dropped it less because of money but more because I was told that there would be confusion with my group plan which is Anthem ( and I didn't need any more confusion on paying for medical costs) and that there would be no benefit to keeping it. Am I correct that Plan F Medigap is administered thru private companies? And do I later look for a separate Drug Plan? I am sorry I seem so dense on this. As I understand you , currently I should keep my husband covered under my group plan and not feel a need to try an enroll him again in Part B. Should I leave work or he reach 65 ( seems like light years away right now) I can re-enroll him. At that time I should keep his regular Medicare and look for Plan F and Plan D. And at 65 the cost of these plans should be significantly lower than I was quoted. Am I right on that? I sincerely appreciate you taking the time to go over this with me. For some reason I have more stress over making these type of decisions for my husband than any other. In my work I have dealt with government agencies on behalf of other people and over the years have unfortunately seen the results of people not asking the right questions.
Thanks again. I will print your replies and keep.
I may not have told you this , but earlier when you responded to questions about wills, trusts, etc. I took a copy of your reply to my lawyer who agreed totally with your comments. I felt so much better at the time. When you are making tough choices, it is so wonderful to have some common ground.
Yes, the Medigap plans are all from private companies. I get my husbands though a local Blue Cross company. You can buy it though whatever company AARP is providing these plans too as well. In addition, both Humana and Aetna advertise in my area and those companies also have Medigap plans in most parts of the country.
Plan D is the drug plan. If you buy a traditional Medigap plan, you need a separate Plan D plan as well. If you buy an Advantage plan, like the one I have from our local Blue Shield company, Plan D is built in.
My husband has the original type of Medigap plus separate Plan D. I have an Advantage Plan with Plan D built in. Jane doesn't like Advantage Plans, and depending on where she lives that might be reasonable. My experience is that my Advantage plan has never refused me coverage for anything substantial.
In the area where I live the Advantage Plan was offered by the company I had my private Health Insurance with before I turned 65. I asked some hard questions before I took it, but decided that I liked it enough to put up with a few co-payments in the front and a smaller premium. I specifically asked what the difference was at the back end where the really expensive charges were. I was told there were no differences in coverage once you were in the hospital.
It really isn't all that confusing. Once he is no longer covered by private insurance he needs Part A and Part B from Medicare. I had to do that for my husband as well once we retired. At that point, no matter what his existing conditions are the Medigap companies are required to accept him. You will want either a Medigap plan plus Part D or an Advantage plan which includes Part D from a private company. Arrange it so that the private insurance plan start on the day after your company insurance stops. Again, very easy to do over the phone or in person. You can get Part B started a month earlier just to make sure that their are no slip ups.
Easy for you to say , not confusing.....but like Greek to me...no seriously , thanks for your input. You actually made it very clear. So is the term Advantage plan .. just a supplemental plan with the drug coverage rolled in?
Before my husband got approved for Disability I was so hoping he would get Medicare. I foolishly thought that would really help me, in that I could reduce our insurance costs and I would be able to stay home sooner to provide care. Only when I started to make phone calls did I learn that additional coverage , if available , would be sky high because he was under 65...There is no way I could let him go without coverage for medications It sounds that for now I am find. I need to keep this information available for later to avoid making major and costly mistakes. Thanks ....
Yes, basically the Advantage plans are supplementary plans with the drug benefit rolled in. There are some differences. I have a PPO plan. That means I can go to any of the doctors within the system (which is just about everyone around here, without a permission slip from my family doctor. There are HMO versions. Personally I'd avoid the HMO version although they are even cheaper. With the Advantage plan, it is the PRIMARY insurer, not Medicare, but it basically is Medicare rules, except I get better vision insurance through the Advantage plan. I have a $15 co-pay for almost all doctor visits. The Emergency room cost me $50. I saw the bill. I paid $50. The insurance company paid over $6000.
The other kind of supplement works this way: Medicare is primary. It decides what is covered. It pays 80% of the bill according to its own rules. The Supplement pays the 20% but only if Medicare paid first. Generally everything gets covered 100%. The only drugs that are covered are drugs in the hospital. The drug benefit which you buy separately, has still a third set of rules.
Anita41, I don't mean to sound against Starling, but it matters not where you live when it comes to Medicare. Stay with the Original Medcare plan that you now have. Get the Medigap Plan F and Plan D Rx plan when the time comes. Stay away from the Humana or so called Advantage Plans. With the Advantage plans they are contracted by Medicare, you still have the Medicare Part A but the Advantage plans control the care. Please keep the Orignial Medicare, on down the road you will be glad you did.
Anita41, just get the Medicare part B when the time comes for you to quite work, as I said you will have a special open enrollment then for him. Yes you are correct on the questions you asked me above. When you were advised that you had Medicare for him, that meant Original Medicare so that is what you have if you have not elected anything different. Stay with that, when the time comes get the Part B. Then get the Plan F medigap, either AARP, Blue Cross Or Mutual Of Omaha are good ones, they are companies that cross over the claim with Medicare, meaning that Medicare submits to them for you after they pay and you will have no other paper work. You will not have to certain Doctors in a network or anything like that. It is the best you can get. If the time ever comes that your hubby had to go to the Hospital and then to a NH for skilled care you will be covered for up to 100 days as long as he is needed skilled care. Of course you would not be if he did not need skilled care. I am not positive but I do not think the Advantage plans even offer that.
Like I said, can't stress enough, stay with the ORIGINAL MEDICARE
Jane, just getting a chance to read posts again. Thank you for all your help. I do realize that you are giving just information , not legal advice,but you have been a real god send to me . Last year when I first started making calls about legal,SSDI and medicare. etc. I did not find it easy to get answers. I won't belabor the point but I live in a small city . No AA near by , no agency on aging near by. Everytime I needed to call someone I was calling a national number with long waits. When I finally got the name and number of someone in my state that was supposed to be the medicare consumer advocate, she didn't return my several calls. I ended up having to research alot on my own and then coming here to confirm . I could go on and on , but let me just say ... Thanks.....
I was told a little secret and I'm going to pass it on here. You can save the attorney's fees. It worked for me and it might work for you. There are many people that get turned down for SS Disability the first time and sometimes several more times before they get approved. Immediately after application, write a letter to your US Congressman. Keep it to one page. Explain the disability and your need for rapid relief in the form of SSD. Be brief but thorough. Stick to the facts involving the financial situation and the inability to work anymore. I hand carried my letter to their office and spent a few minutes with the receptionist or anyone that they will get to speak with you. They have people that monitor these applications and stay in touch with the SS powers that be. My husband's went through within about 3 months and he was approved the very first time. We even got updates from the Congressman's office letting us know that they were hard at work on the case and when to expect approval.
Hopefully, this will work for those of you that are about to apply. Good luck and hope it works as well for you as it did for us.
We tend to forget about our congressmen. When the local post office decided to not deliver mail to our community for several days and to hold our mail hostage in the delivery person's truck, so we couldn't pick it up, one of our residents called our congressman and faxed a short letter with a description of what was going on to the office as requested.
We had a complete mail delivery of all the missing mail the next day by a supervisor and were on a new route the day after. We never had another problem with that post office.
Those offices are there to help us when we are having trouble with a federal agency.
Yes, my DH has Social Security Disibility income, Long term disability from his last employer, and a private disability income from a policy we took out many years ago. No problems getting any of them, but I did get a lot of great advice from various web sources.
Val, the first requirement for SSDI is working recent enough and long enough (subject to Soc Sec deductions) as described on http://www.ssa.gov/pubs/10029.html#part2