Medicare & Long-Term Disability

Medicare is a government-run medical insurance provider for nearly 40 million Americans who are over the age of 65, under 65 who have certain disabilities and any citizen with end-stage renal disease. (Source 2) More than 9 million Medicare participants will need care for a long-term disability or chronic illness in 2010. That number is expected to reach 12 million by 2020. (Source 1)

Long-Term Care

• Medicare puts restrictions on long-term disability care

  Long-term care involves providing the disabled patient with the support services needed for daily living activities, such as dressing, bathing and eating. When performed by non-professionals, it is called "custodial care." Medicare does not cover these types of expenses unless it is deemed "medically necessary," the care is performed by professionals and the patient is a resident in a nursing facility. (Source 1)

Facilities

• Medicare covers SNFs that provide continual medical care and monitoring

  Non-hospital based skilled nursing facilities (SNFs) are for people whose illness or disability requires a relatively high level of medical care and monitoring. Intermediate care facilities (ICFs) are for those who have long-term requirements for medical attention, but have conditions that are not as acute as patients requiring an SNF or hospital. Custodial care facilities (CCFs), also called "rest homes," provide less extensive medical care and are for those who do not require extensive medical care and intervention. Medicare typically covers SNF charges, but not ICF or CCF charges. (Source 3)

Types of Medicare

• Medicare has 4 types of coverage: Part A covers hospital costs; Part B covers doctor visits and out patient services; Part C (also called Medicare Advantage) is provided through HMOs and PPOs by Medicare-approved private insurance providers and Part D covers prescription medication. Part A is usually free, however all other parts have a monthly premium charges that are usually paid by the patient. (Source 6)

Disability Insurance and Medicare

• Medicare pays the heathcare provider directly

  Disability insurance can be provided by the federal government through the Social Security Administration (SSDI) or by private insurance companies. Unlike Medicare, disability insurance payments go directly to the patient, not the healthcare provider. It insures loss of income, not medical care. It is therefore possible to receive benefits from both SSDI and Medicare simultaneously. The dollar amount of benefits for SSDI is determined by the patient's income and work history, unlike Medicare that pays for all covered expenses, regardless of work history. (Source 4)

Joining Medicare

• Medicare has optional plans to best meet the patient's needs

  For a person who qualifies for Medicare due to a disability, coverage under Medicare Part B (doctor visits and outpatient care coverage) will begin automatically during the 3-month period before, to the 3-month period after, the 25th month of receiving Social Security disability payments. The patient has the option of joining Medicare Part D (prescription medication coverage) or a Medicare Advantage Plan during the same 6-month period. (Source 4, page 19)

Changing Medicare Plans

• Medicare Part D covers perscription medications

  People on long-term disability with Medicare can make changes to their Medicare plan each year between November 15 and December 31 or between January 1 and March 31 only. However, Medicare Part D can only be added or dropped during the November-December period. (Source 4, page 21)

Other Resources

• Those with long-term disabilities who have limited incomes and resources might be eligible for Medicaid as well. Qualifying criteria for Medicaid varies from state to state. Medicaid will often pay for long-term care that Medicare will not. (Source 4, page 32)