JustCare

Tag: People with disabilities

  • People under 65 with Medicare less satisfied than people over 65

    People under 65 with Medicare less satisfied than people over 65

    People under 65 with disabilities are less satisfied with Medicare than adults over 65, reports Kaiser Family Foundation. The reason is likely that people with disabilities need a lot more health care than older adults and face obstacles to care that people who are relatively healthy do not face. Still, people under 65 with Medicare are more satisfied with their health care coverage than people who have Medicaid, employer coverage or coverage through a state health insurance exchange.

    Medicare covers about 66 million people. Nearly eight million (12 percent) of them are under 65 and enrolled in Medicare because of long-term disabilities, including End-Stage Renal Disease and ALS. People with disabilities on Medicare are more likely to be people of color, people with lower incomes and lower education levels; they also tend to be people in worse health than people over 65 in Medicare.

    No matter how you qualify for Medicare, you are supposed to get the same Medicare benefits. But, people under 65 are not guaranteed the right to Medicare supplemental insurance or Medigap–coverage that generally picks up most or almost all of people’s out-of-pocket costs–from a commercial insurer. So, unless people qualify for Medicaid or a Medicare Savings Program, they could have large out-of-pocket costs in Traditional Medicare and in Medicare Advantage. Not surprisingly, people with disabilities on Medicare report greater struggles getting and paying for care as well as less satisfaction with Medicare than people over 65.

    Overall satisfaction with Medicare jumps from 79 percent for people with disabilities to 92 percent for people over 65. Much of the concern among people with disabilities is around their ability to get care from good quality physicians and hospitals. Seven in ten of them reported having a problem with Medicare in the last year, whereas far fewer people over 65 (five in ten) say they experienced a problem with Medicare.

    It’s important to keep in mind that it’s a lot easier for people who do not use the health care system much or at all to be satisfied with their Medicare coverage than people who have complex conditions, as many people with disabilities under 65 do. About half of people with disabilities say they are in fair or poor physical health. Just 19 percent of people over 65 report that they are in fair or poor physical health. In fact, about half of people with Medicare use little or no health care in any given year.

    About 3o percent of people with disabilities say they have fair or poor mental health, as compared with just nine percent of people over 65. Twenty seven percent of them struggled to get mental health treatment they needed but was not covered, as compared with seven percent of people over 65. Eighteen percent said that they could not get medicines they thought they needed, as compared with five percent of people over 65.

    Nearly three in ten people with disabilities report having a hard time getting their Medicare plan to approve critical care, as compared with nine percent of people over 65. While the Kaiser Family Foundation does not distinguish those in Medicare Advantage plans from those in Traditional Medicare, only Medicare Advantage plans require prior approval before getting critical care.

    Twenty-four percent of people with disabilities reported not having their insurance pay for their care that they thought was covered, as compared to eight percent of people over 65. More than one in three people under 65 said they struggled to pay a medical bill as compared to nine percent of older adults.

    People under 65 experienced more difficulty getting care than older adults. They were more likely to skip or delay getting dental care, prescription drugs and medical care because of the cost than people over 65.  People under 65 also reported greater difficulty enrolling and understanding their options relative to people over 65.

    Here’s more from Just Care:

  • Social Security and Medicare benefits for people with disabilities

    Social Security and Medicare benefits for people with disabilities

    About 10 million people qualify for Social Security and Medicare on the basis of a disability.  Here’s what you need to know about Social Security and Medicare benefits for people with disabilities:

    Apply for Social Security Disability Income at your local Social Security office or online. Call Social Security at 1-800-772-1213 to find out where to go. If you qualify for railroad disability annuity income, go to your local Railroad Retirement Board. (To learn more about Social Security disability policy and how it relates to the recent budget deal, click here.)

    Medicare: You automatically qualify for Medicare when you are under 65 once you have been receiving Social Security Disability Income for 24 months or railroad disability annuity checks. And, there is a five-month waiting period before your Medicare benefits kick in. You do not need to do anything to get Medicare Part A and B.  Your Part B premium will be deducted from your Social Security check. You should not turn down Part B unless you have primary insurance coverage through your or your partner’s current job and you confirm that with the employer offering the coverage and Social Security. You want to avoid being without medical coverage or paying a premium penalty for Part B. (And, keep in mind that Medicare covers only about half your health care costs, so you’ll need supplemental coverage. If your income is low, there are several programs that can help.)

    If you have ALS or Lou Gehrig’s disease, you will automatically be enrolled in Medicare the first month you receive Social Security Disability Income or railroad disability annuity income. There is a five-month waiting period after you are determined to be disabled until you begin receiving benefits. Be sure to make clear that you have ALS to avoid the additional 24-month waiting period for Medicare.

    If you have End Stage Renal Disease (ESRD), you should apply for Medicare through your Social Security office, even if you are a railroad worker. Social Security will need supporting documentation about your disease from your doctor and dialysis center. When Medicare begins depends on your treatment.

    • If you are in a self-dialysis training program, Medicare begins on the first day of the month you begin the program. You must begin the program before the third month of your dialysis and you will need support from your doctor that you will complete the training program and do self-dialysis. Otherwise, Medicare begins the first day of fourth month of your dialysis.
    • If you are receiving a kidney transplant, Medicare begins when you begin receiving health care services for the transplant. Medicare coverage begins no sooner than the two months before the month you receive the transplant.
  • Medicare costs high for older adults and people with disabilities

    Medicare costs high for older adults and people with disabilities

    No one should think that Medicare provides more than partial health care coverage.  A new Kaiser Family Foundation report reveals high costs for people with Medicare.  Average out-of-pocket spending was $4,734 in 2010, (the most recent year for which data was available), about 20 percent of the median income of people with Medicare, $23,500. (In 2014, it’s $24,150).

    The ten percent of people with Medicare with the highest costs spent an average of $19,236 in 2010 on premiums, coinsurance and services that Medicare does not cover.  People with costly conditions requiring multiple hospitalizations and long-term care incurred particularly high out-of-pocket costs.

    The oldest Medicare recipients also spent significantly more out-of-pocket on health care. People over 85 spent about three times more out of pocket ($5962) than people between 65 and 74 ($1926).

    Women spent more than men on average in 2010, $5036 and $4363 respectively.  Higher health care spending by women with Medicare is largely attributable to women living longer and needing long-term care, which Medicare for the most part does not pay for.

    Even with Medicare, people who were hospitalized and then admitted to nursing homes had the highest documented out-of-pocket costs, which amounted to $9508. Medicare does not cover most home care or nursing home care. People with Alzheimer’s also had particularly high out-of-pocket health care costs of $8305 on average.

    But the people with the largest health care bills were the people living in long-term care facilities, paying $17,534.  They spent nine times more than people with Medicare living in the community, whose average costs were $1858.

    Here are three tips to plan for long-term care.