how do they figure?

[sullidog]

I got a letter from social security saying that I know longer qualify for disability benifits because they reviewed my record and my health has improved, I think they are full of crap. They said they are going to stop all of my benifits including medicare, now don't I automatically qualify for medicare since I'm on dialysis? Just because I went full time at work does not give them the right to stop my medicare, yes they may have to stop my SSDI but they have no right to stop my medicare. Wonder who dropped the ball on this one? Is it because the doctor didn't send them anything when my review is up or what? I don't know what to do, I want to handle this tomorrow but my social worker is not in she is only in one day a week that I dialyze, I just don't know what I'm to do now. If I'm stuck without medicare coverage then I'm screwed. I need to know what's going on, how do they determine my health has improved? O guess tomorrow  I will be calling them.
Please keep me over prayer in this.
Thanks and will keep you posted.
Troy

[jeannea]

You definitely have to call and find out what paperwork they are missing. Yes they won't pay you if you work and earn over a certain level. But you should still have Medicare. Good luck!

[MooseMom]

Well, once again I'm going to send you over to the Home Dialysis Central website so that you can ask a certified social worker. 

http://forums.homedialysis.org/forums/17-Beth-Witten-Social-Worker

You'll get a direct answer from Beth.  Or maybe you can look at some of the other posts and find someone else in your situation.  Let us know what you find out because although I know little about Medicare and working  while on dialysis, it does not seem right that anyone with ESRD and on dialysis would lose their Medicare under any circumstances, but I might be well wrong.

[KarenInWA]

sullidog, that is CRAZY!!!!

I work FT and have excellent health insurance. I started dialysis a year ago, and was told it was up to me to sign up for Medicare, since my insurance covered 100%. My insurance started sending me letters after a few months to let me know "hey, you're eligible for Medicare!". I signed up for it shortly before my transplant in November. The first statement was quite large, as they had me paying from my eligibility date of July 1st - Feb 29. I paid it, and haven't seen one bill for anything transplant-related. I had to sign some paperwork saying that I was denying SSDI, as I said I did not need it. I also had to make some calls so that Medicare had all my insurance info so they knew that right now, they are secondary. Medicare will be secondary for me through April (if I remember right) of 2014, and will end for me Nov 2014 as that will then be 3 years since transplant. So yes, you ARE eligible for Medicare as long as you're still ESRD, and you need to fight that every which way you can! Stupid people who work for the government yet don't know their own rules....

KarenInWA

[smcd23]

Sullidog - does the letter address work or does it address medical only? I work for SSA and there are 2 types of reviews that we do. One is a work review (which is what I do so I'm pretty much an expert on that) and if you went back to work FT your monthly benefit check would stop, but the Medicare would continue so long as you keep up with the premiums. The letter says something along the lines of "We have determined that your no longer disabled as of Month/Year" but that's based on work only.

The other type of review we do is a medical review. Which as the name implies, looks at medical records. If your doctor didn't send in the requested records, the medical examiner could have found that you've "improved" because they didn't have up to date records that indicated differently. The letter you get with that sort of review will say you're improved, but it will also contain a paragraph that says you have 10 days to appeal and keep your benefits, so it's really important that you call/file the appeal within 10 days. (The other letter that I send in work reviews gives you 14 days).

The best way for me to figure out what kind review you had would be to ask you what kind of paperwork you filled out. In both reviews we send you some paperwork. When I do a work review I send out a "Work Activity Report" which will list off your employers, ask you about subsidy, an expenses you might have (like medications) in order to go to work etc. The other form is a SSA-454 (I apologize I don't know the title of the form,  just the form number off the top of my head) and that one ONLY asks about doctors and medical stuff. There is another short version of this form that they send out (SSA-453 perhaps?) from the payment center to determine if you need to have a full review done. Do you recall what form they might have sent you?

And I do know that people with ESRD are generally reviewed medically every 12-24 months, because once you get a transplant, you are typically well enough to return to work within 6 months to a year post transplant (providing there are not other conditions preventing you from working).

If you haven't gotten an answer to your question, or have more questions, feel free to ask or send me a PM. I know our rules can be confusing, so I don't mind explaining them.

[EugeneW]

There are a variety of reasons why your benefits could have been terminated (http://www.socialsecuritydisability.tv/blog/how-long-social-security-disability-benefits-last). However, when they say they your condition has improved it generally means that based on your last continuing disability review (where you will have to show that you have been following treatment, have doctor reports, etc.) they have determined that you are now able to go back to work.