How does disability affect medicare enrollment

[ValeRosso]

Have a client who is 62, and now going on disability through his work (large employer) and potentially will be on disability until he is retired at 65. His wife is on his group coverage and she T65 in 3 months. I was under the impression long term disability is through the govt, and short term is through employer, but she said he is getting long term through work apparently.

Does him going on disability change anything as far as the creditable coverage aspect? I told him to talk to his HR and find out how that works and if they will still have creditable coverage until he retires, even if disabled.

Anyone have input on this?

 

[Tahoe Ray]

Have a client who is 62, and now going on disability through his work (large employer) and potentially will be on disability until he is retired at 65. His wife is on his group coverage and she T65 in 3 months. I was under the impression long term disability is through the govt, and short term is through employer, but she said he is getting long term through work apparently.

Does him going on disability change anything as far as the creditable coverage aspect? I told him to talk to his HR and find out how that works and if they will still have creditable coverage until he retires, even if disabled.

Anyone have input on this?

My only input is that any meaningful long-term disability is mainly through employers or purchased individually. It is very common.

Qualifying for SSDI (government) is very, very difficult and doesn't cover the majority of circumstances of why people are unable to work/do their actual job.

Every agent should have a disability policy on themselves and mention it to any client who is still working.

I'll let a medicare agent comment on the rest.

 

[somarco]

Qualifying for SSDI (government) is very, very difficult and doesn't cover the majority of circumstances of why people are unable to work/do their actual job.

To meet our definition of disability, you must not be able to engage in any substantial gainful activity (SGA) because of a medically determinable physical or mental impairment(s) that is either:

Expected to result in death.

Has lasted or is expected to last for a continuous period of at least 12 months.

We use the term “substantial gainful activity” to describe a level of work activity and earnings.

Work is “substantial” if it involves doing significant physical or mental activities or a combination of both. For work activity to be substantial, it does not need to be performed on a full-time basis. Work activity performed on a part-time basis may also be SGA.

“Gainful” work activity may include:

Work performed for pay or profit.
Work of a nature generally performed for pay or profit.
Work intended for profit, whether or not a profit is realized.

How Do We Define Disability? | The Red Book | SSA

This is the text of the English version of the Red Book.

www.ssa.gov

I was taught, if you could sit on a street corner selling pencils, you were not disabled according to SSDI rules.

 

[Tahoe Ray]

To meet our definition of disability, you must not be able to engage in any substantial gainful activity (SGA) because of a medically determinable physical or mental impairment(s) that is either:

Expected to result in death.

Has lasted or is expected to last for a continuous period of at least 12 months.

We use the term “substantial gainful activity” to describe a level of work activity and earnings.

Work is “substantial” if it involves doing significant physical or mental activities or a combination of both. For work activity to be substantial, it does not need to be performed on a full-time basis. Work activity performed on a part-time basis may also be SGA.

“Gainful” work activity may include:

Work performed for pay or profit.
Work of a nature generally performed for pay or profit.
Work intended for profit, whether or not a profit is realized.

How Do We Define Disability? | The Red Book | SSA

This is the text of the English version of the Red Book.

www.ssa.gov

I was taught, if you could sit on a street corner selling pencils, you were not disabled according to SSDI rules.

Looks about right...

 

[Travis Price]

He's not going through SSDI YET.

His LTD carrier will force him to apply eventually. At age 60, he's more often to be approved than denied.

29 months after he is approved for SSDI, he'll be eligible for Medicare.

With LTD, he should still have his employer plan. However, they'll term him after a year and he'll lose insurance.

It could screw up the 63 day bit, but it won't be a huge deal. He will likely need to go through wife's eghp OR ACA if he can.

 

[Travis Price]

I was taught, if you could sit on a street corner selling pencils, you were not disabled according to SSDI rules

That's not exactly true. Under 49? Probably true. 50-54 50/50 shot, 55+ more likely than not.

It really boils down to his last 15 years of work history. More skilled and more physically capable, less likely to be approved.

Less physically capable and less skilled work, more likely to be approved.

Under 49, it's like 30% approval.

 

[Tahoe Ray]

He's not going through SSDI YET.

His LTD carrier will force him to apply eventually. At age 60, he's more often to be approved than denied.

29 months after he is approved for SSDI, he'll be eligible for Medicare.

With LTD, he should still have his employer plan. However, they'll term him after a year and he'll lose insurance.

It could screw up the 63 day bit, but it won't be a huge deal. He will likely need to go through wife's eghp OR ACA if he can.

Not all LTD has social offset (where you're required to file SSDI).

 

[somarco]

One other thing . . . when SSDI is approved it is retroactive to when you were initially eligible. That has a way of screwing up a lot of things.

 

[Travis Price]

Not all LTD has social offset (where you're required to file SSDI).

Not all, but my experience is most of the larger companies do... especially in group plans.

 

[Lloyds of Lubbock]

"Every agent should have a disability policy on themselves and mention it to any client who is still working."
Great advice!