PA Specialist Corner: The Impact to Social Security Benefits When Parents Retire (Part 2)
The last PA Specialist Corner blog post, Planning for the Future and Social Security Benefits (Part 1), discussed changes to Social Security benefits when the parent of a person with disabilities retires. There are also changes to health insurance that follow this shift in benefits.
In the scenario above, after receiving Social Security Disability Insurance (SSDI) benefits for 24 months, the person with disabilities will become eligible for Medicare. Individuals should expect to receive information in the mail several months before their coverage starts.
Medicare Comes with Choices
Individuals with disabilities:
Will initially be enrolled in Original Medicare, which includes Part A (Hospital Insurance) and Part B (Medical Insurance).
Can choose to enroll in a Medicare Advantage plan (also known as Part C) instead. This choice replaces Original Medicare Part A and B with a package plan.
Most Medicare Advantage plans offer extra benefits that Original Medicare does not cover, like drug coverage, vision, hearing, or dental, but plans will likely have restrictions as well, like only using doctors who are in the plan’s network.
To compare options, visit the Medicare website: www.medicare.gov/basics/get-started-with-medicare/get-more-coverage/your-coverage-options/compare-original-medicare-medicare-advantage
If an individual decides to keep Original Medicare, they will need to choose a Part D (Drug coverage) plan to cover medications.
What Happens to Medicaid Coverage When Medicare Starts?
It is important to report new Medicare coverage to the Department of Human Services (DHS). Individuals can do this through their online ONE account, or by contacting the office that handles their Medicaid renewals. The office will note the change and check the individual’s eligibility for Medicaid. The individual may be asked for proof or additional information, so it’s important to check your mail after reporting any change.
Many people with disabilities, especially those who are enrolled in long-term developmental disabilities (DD) services, will be eligible for both Medicare and Medicaid. People who are eligible for both Medicare and Medicaid:
Can access programs that cover out-of-pocket Medicare costs, like co-pays and premiums
Are automatically enrolled in a program called Extra Help to cover costs of prescription drugs
Because of these programs, people who are dually eligible do not need to purchase supplemental Medicare policies (also known as Medigap plans).
So Many Choices!
Individuals can discuss these choices with their DHS worker when they report their new Medicare coverage, and the DHS worker will help provide guidance. Ask the DHS worker to help find “zero-dollar” options, so health insurance will continue to be free.
A popular option is to choose a Medicare Advantage plan that aligns with the Oregon Health Plan (OHP) Medicaid provider that an individual is enrolled with. For example, Health Share, the Coordinated Care Organization (CCO) for many OHP recipients in the Portland Metro area, provides coverage through various health plans like Providence, Kaiser, Care Oregon, and OHSU. Many of these health plans also offer zero-dollar Medicare Advantage plans.
Another way to get answers to questions about Medicare is to contact SHIBA (shiba.oregon.gov). They offer free advice and publish a Medicare Guide each year.
Pay attention to any mail you get, especially during the Medicare enrollment period at the end of each year, to make sure you continue to be enrolled in a plan that meets your needs without cost to the individual with a disability. Ask your Personal Agent (PA) or your provider if you need help.
- Christine X., PA Specialist, Community Pathways
Do you have a question for our PA Specialists?
Send any questions you might have about disability services, including Community Pathways’ brokerage support services, to info@communitypath.org.
Our PA Specialists will try their best to respond to the questions we get by sharing helpful information and resources in an upcoming blog post. Thank you!