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How Many Stage 4 Girls are getting SS disability..

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  • mrsjck
    mrsjck Member Posts: 4
    edited January 2007
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    When Medicare was offered to me, I declined based on the fact that our private insurance was adequate...took Part A as that was free...have been merrily gliding along until reading this thread. Dug out my private insurance booklet and found the clause that states " a member who is eligible for Medicare and for whom Medicare is permitted by federal law to be the primary payer must be covered by both Parts A & B of Medicare and must assign benefits under both Parts to this Plan". I am translating that to mean I HAVE to take Part A & B in order for my private insurance to pay as secondary. So I called Medicare to register for Part B and was told they'd send me the application. Then I called our insurance company and found out that once you are Medicare eligible...they want you to sign up for one of their Seniority Medicare plans...and they just don't happen to have one available for our neck of the woods...and why don't we try in May? Needless to say this is confusing to me...don't know if I should get Part B...don't know what to do about getting a plan to pay for the remainder after Medicare if I do sign up for Part B...don't know what to do about Part D for prescriptions...just yesterday I went to a new doctor for the growths in my nose...turns out I have several large polyps in both nasal passages and now have prednisone and flonase to try to shrink rather than do surgery. Also am waiting for a call from a cardiologist based on the fact that my hospital stay was not for pneumonia...was treated for it...but onc says more than likely it's heart damage/disease caused by radiation and/or adriamycin back in 1999 and wants me to have either echo or muga scans..plus wear an event monitor....so we are holding off on any more chemo until these issues are addressed. The taxol was helping but was too harsh for my system so may start on Xeloda at some point...so, here I am with Harvard Pilgrim insurance...adequate...and a Medicare Part A coverage effective 2/1/07 and nothing else...except a lot of talk about what can happen if I don't have one or the other...I need to speak to a benefits coordinator who would be working for me and not for the government or the private insurance company...any idea where to find one? If I haven't had enough heart disease symptoms and the bone mets isn't painful enough...this mental stress will be the thing that kills me...or at least makes me a less-than-desirable human to be around....just ask my hubby :-)

  • vab
    vab Member Posts: 3
    edited January 2007
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    Jan and Denise -
    I don't know about PA or MA, but in Virginia, we have a program called Senior Services (almost everybody's a senior), which has an insurance advisory program with trained advisers and a detailed computer program to compare private insurance policies, Medicare coverage, etc. They used it for the switch to Medicare Part D drug coverage, and it was very successful. Senior Services is the local name for our Area Agency on Aging. The AAAs are supposed to exist in every state through a federally-funded program. If you can figure out what agency is YOUR Area Agency on Aging, and ask them whether they have a Medicare/insurance advisory program, you may be able to get a benefit comparison for free from someone with no stake in the matter. Also, it seems that Medicare is really trying to discourage people from signing up for Part B, and you should keep in mind that they may not have your best interest at heart -- there, I said it, that's really as nicely as I can put it. I know insurance decisions can feel like playing roulette, but I hope you will check this out. Even if you stay with your current coverage, you will know what's out there. Good luck!
  • florencedonna
    florencedonna Member Posts: 6
    edited January 2007
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    Just to make it more complicated...

    If you get SSDI and Medicare and you are covered by your spouse's insurance through work, and both of you are under 65, then your insurance through your spouse is primary and your medicare is secondary. (I think)

    It gets really really complicated when you have medicare, medicaid and private insurance through a spouse's (?ex spouse's) job, then the medicaid is tertiary I think.

    Donna
  • mrsjck
    mrsjck Member Posts: 4
    edited January 2007
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    Firstly, Donna, one of my daughters lived in Florence and is now in Haydenville and the other is in Amherst....been to Florence and it's quaint and we loved it there....Next, we have made the necessary phone calls, received the forms...applying for Part B as it is the law once eligible; changing insurance plans to include my supplemental due to Medicare and adequate insurance for hubby (retired by under 65) and one college student daughter. Was told by the Insurance Commissions office that my present coverage will pay as usual until the changes are made and in force so it sounds like there is no apparent gap...hope not...went for the echo today and also have a 30 day event monitor...cardiologist tomorrow and oncologist next week...things are happening very fast which is oood...and I have to trust God that all will work out in the insurance department...and let others deal with that for now...my priority is my health....thanks to all of you ladies who have responded...this site is ever more helpful every day!!!

  • florencedonna
    florencedonna Member Posts: 6
    edited January 2007
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    Hello Jan- I do indeed live in the woods in Florence.

    I am a physician and work in a hospital. Primary and secondary (and tertiary) insurance billing is so complex even providers can be confused.

    Donna
  • Buzz
    Buzz Member Posts: 21
    edited January 2007
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    Medicare Part A is hospitalization coverage. No premiums.
    Medicare Part B is doctor visits, chemo, etc. About $100/mo.
    Medicare Part C is medicare HMO's run by private companies.
    Medicare Part D is Prescription Drug Coverage.

    If you have current medical insurance that covers you for hospital and doctor visits and prescription drugs, and you are nearing becoming eligible for medicare, you need to contact your CURRENT medical insurance provider and ask them if they require medicare to be primary once you are eligible.

    I have had private coverage as a retiree from state government. I have been paying nearly $800 per month since I retired, to cover myself and my spouse. Once I became eligible for medicare, the state retiree coverage became secondary. They told me that I MUST SIGN UP FOR MEDICARE PART A AND B if I want to remain eligible for the state retiree coverage. They also told me that their Rx coverage is better than medicare, so don't enroll in Part D.

    How it works now is everything, hospital, doctor, and Rx goes to medicare first. Whatever they don't pay, the state retiree insurance picks up.

    My medicare premium for Part B is about $98 per month. But my monthly premium for the state retiree insurance went down, from $800 to $575.
  • LuAnnH
    LuAnnH Member Posts: 348
    edited January 2007
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    By the time you pay for the health premiums you have nothing left to live on it looks like! Guess I will work through this disease!

  • Brenda_R
    Brenda_R Member Posts: 52
    edited February 2007
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    I wanted to bump this back up and keep it out where all can see it.

    Maybe they can sticky this thread?
  • tropicmom
    tropicmom Member Posts: 16
    edited February 2007
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    Wow, thanks for this thread. I'm not sure if I'm stage IV yet, waiting for readings of the scans. I'm feeling pretty negative so expecting the worst. But I have been wondering about SSD. Also, those of you who bought short or long term disability through work, I have a question. I haven't had any before b/c I am relativly young, very healthy, and no history of anything. So much for that!! Any way, our re enrollment period is comming up, and of course, now I want to get at least the STD to get me through treatment if I need it. Can I still sign up for this, or will I probably be rejected as a preexisting condition? Should I tell them I have the dx?
    I know my specific coverage will be different from other ins, but any tips, hints, generalizations, would be great.
    thank you, ladies.
  • geeta75
    geeta75 Member Posts: 8
    edited February 2007
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    I just applied for SSD yesterday--I am waiting approval/denial. I hope they dont' deem me "able to work" and therefore ineligible. Though I have days where I can work any job, what job is going to let me stay home on the days I'm feeling crappy? Or take off for doctor's visits, scans, scheduled and unexpected?

    I am hoping I'm approved, as we could use the extra income. And this whole Medicare insurance thing is confusing!! There should be a "medicare for dummies" manual out there!
  • Brenda_R
    Brenda_R Member Posts: 52
    edited February 2007
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    Geeta75, if they deny you, and you are stageIV, be sure to appeal it.

  • geeta75
    geeta75 Member Posts: 8
    edited February 2007
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    I will--thanks for the advice. I have been stage IV since last April--I don't know why I waited so long to apply!

    Have any of you stage 4 ladies been denied, then appealed and were approved? I just want to make sure I know everything in advance~

    Thanks so much!! What a helpful thread!
  • PaulaBeth
    PaulaBeth Member Posts: 6
    edited February 2007
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    Approval with stage IV is automatic. If you're denied, it was a mistake. Also, they will pay you up to 12 months of past payments, so with the six-month waiting period you should get paid for October on. That also means you will be eligible for Medicare two years from last October.

  • brando
    brando Member Posts: 1
    edited February 2007
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    hi karilynn,

    i need to know how you applied for ssi AND how your kids were approved. I am stage 3 with possible liver mets (waiting for doctor to make up her mind) and I have a 15month daughter. Would I qualify and my daughter qualify for ssi? Please let me know how you did it and what i should do....i want to spend as much time as i have left with my family....not working, being away from them!
    thanks
  • Brenda_R
    Brenda_R Member Posts: 52
    edited February 2007
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    Ladies that are on SSD, did you have to go through the "waiting period" and did you get paid backpay for those months or not?
    It seems that some got their SSD checks sooner, and some seem to be indicating they got back pay for those waiting period months.
    Now I'm confused.
  • mrsjck
    mrsjck Member Posts: 4
    edited February 2007
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    If you are referring to disability not connected to income...as in SSDI and not SSI...payment was made for retroactive for a year or so...was approved within a few weeks of applying due to Stage 4 diagnosis....had to have worked for required period of time for eligibility also...didn't tie in exactly with when I stopped working; only when they could legally go back according to Social Security laws. Hope this helps answer your questions.

  • KariLynn
    KariLynn Member Posts: 41
    edited February 2007
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    I get SSD not SSI. Applied on line then had a phone interview - was painless. I waited the six month period before getting checks - no back pay. I applied aslmost as soon as I knew stage 4 so there was no going back.

  • geeta75
    geeta75 Member Posts: 8
    edited February 2007
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    Brando--

    SSI is almost like public aid, income based. So you would have to fall below a certain income mark, as a household, to qualify. SSD is the disability portion that does not require you to be at a certain "poverty level."

    If you are stage IV (and I'm saying a little prayer now that your liver is NED), then you can apply for SSD. (You can do it now, too, but you'll have to prove you are unable to work--from what I am hearing on this thread, stage IV is almost an automatic approval). Once you are awarded SSD, you will then apply for your children. You can't do it before, from what I've been told, and it isn't automatic, so you'll have to request the application one you are approved--And it is also my understanding that your children ARE automatically eligible if under the age of 18, you just have to send in the app for them.

    The easiest thing to do is go to the SSA website--www.ssa.gov, and there will be a number you can call to start the app process. They are super helpful and will answer any questions you have.

    Good luck!
  • Fllorik
    Fllorik Member Posts: 381
    edited February 2007
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    I receive SSDI but am wondering is it reviewed every year? So if I become NED, can it be stopped?

  • denny123
    denny123 Member Posts: 1,445
    edited February 2007
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    I was told that my review would be every 7 years. I became eligible once I had a bi-lat mast with bi-lat node dissection. At that time I was only reported to be Stage 2, but was eligible for SSD.

    When I learned a year later that I had been Stage 4 from the get-go, I called to make sure that I could continue to receive SSD, and was reassured that it would continue forever.
  • Buzz
    Buzz Member Posts: 21
    edited February 2007
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    FloriK,

    The award letter you got saying you were approved for SSDI would say when they are going to review you. Usually it's 3 or 7 years, depending on your diagnosis. They do not cut you off if you are NED, because you still have a terminal diagnosis. You can go to this link to read about the review process. http://www.ssa.gov/dibplan/dwork1.htm
  • Fllorik
    Fllorik Member Posts: 381
    edited February 2007
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    Thank you. I looked at my award letter and it's 7 years. SSDI is a bittersweet ordeal. I am glad I get it but wish I didn't need it. Sort like this club we all belong to.

  • Buzz
    Buzz Member Posts: 21
    edited February 2007
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    Quote:

    I am glad I get it but wish I didn't need it. Sort like this club we all belong to.


    That is exactly how I feel, too.
  • Brenda_R
    Brenda_R Member Posts: 52
    edited February 2007
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    Bumping this up

  • Brenda_R
    Brenda_R Member Posts: 52
    edited February 2007
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    bumping this to the front

  • jjb1984
    jjb1984 Member Posts: 6
    edited February 2007
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    Does anyone know if your employer is contacted during the application process? No one at my job knows my true diagnosis and if I can leave because I'm getting SSD, I don't necessarily want them to know the real reason I'm leaving.
    Julie
  • Buzz
    Buzz Member Posts: 21
    edited February 2007
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    I don't believe anyone contacted anyone at my work when my application was being reviewed. Except for medical records to confirm my diagnosis, no other releases were asked for. They didn't even ask me where I worked.

  • LuAnnH
    LuAnnH Member Posts: 348
    edited February 2007
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    Julie, do you have LTD with your work? That can help give you a little more than SSD if you have it.

    LuAnn
  • jjb1984
    jjb1984 Member Posts: 6
    edited February 2007
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    LuAnn
    My hubby and I both have outside disability policies, which we took out when we were just married. That, plus SSD, plus what my son would get from SS is probably more than I'm making now! It's just having to check that "terminal disease" box on the application form...I've probably looked at it at least 10 times and just exited out...how do you get over having to check yes?
    Julie
  • KariLynn
    KariLynn Member Posts: 41
    edited February 2007
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    Checking a box does not change how you are doing, get the monetary help you need. It will give you more time to take care of yourself.