Curious about disability and Medicare

[kimmie0409]

I filed for disability over a year ago and was denied.
I have an atty now and Ssi/disability says that
Basically my claim will b denied until I start dialysis .
Has any body else had this problem ? Also I was
Wondering if I get transplanted do I get Medicare ?
If so when would I get it? I'm only 37...

[cattlekid]

Hello Kimmie,

If you have worked the minimum number of quarters to qualify for Social Security, you will qualify for Medicare due to ESRD regardless of age or disability status.  I was 41 when I went into ESRD and was working full time.

If you start dialysis in-center, you will have to wait three months to be eligible for Medicare.  So if you started dialysis today (March 9), you would be eligible for Medicare starting June 1st.  However, if you start right away with home-based dialysis (PD or home hemo), your Medicare coverage will start right away. 

If you are working and have employer-based group health insurance, your employer insurance will be primary payer for the first 30 months that you are on dialysis and Medicare will pick up the remainder.  After 30 months, Medicare will be primary and your employer insurance will become secondary.

When you get a transplant, Medicare will remain in force for 36 months post-transplant.  For example, I received my transplant while I was still in the 30 month coordination period.  My employer insurance paid for my transplant and when the 30 month period ended, Medicare became primary.  I now have to keep paying the Medicare Part B premium until April of 2016, at which point I will no longer be eligible for Medicare and I will only have my employer insurance.

There is a very helpful book that you can get from the Social Security office called "Medicare Coverage of Kidney Dialysis and Kidney Transplant Services".  If you call 1-800-MEDICARE, they can send you a copy.  I highly recommend it. 

Also, once you are ready to start dialysis, the social worker at your dialysis center will definitely go over all of this with you and make sure that you have Medicare and work on getting you insurance to cover the remainder Medicare won't pay, even if you aren't employed.  In my opinion, this is the one thing the dialysis social workers are good at, even if (at least in my experience) they aren't good at much else.

[kimmie0409]

Thanks for the info. I'm HOPING for transplant
Before dialysis . Hopefully my candidate is a
Match:) will not find out for sure until mid april .
I see my neph this Thursday . I have not worked
In year and half. Hubby has worked for his company
For 20 years and has great insurance. For now...
But I worked full time as a medical billing specialist
I'm so weak now and have other issues like
Diabetes and hypertension . So I can't go back
To work right now. Hopefully, if and when I get
My new kidney I can go back to work . Thanks
Again for the info.

Kim

[Sydnee]

Are you in ESRD or just stage 4 kidney failure? If you are ESRD they should not be able to deny your claim (per SSA's own website)
Cattlekid gave great info. Thought it is if you or your spouse worked enough. 

[kimmie0409]

My GFR is now 16. So my neph says be prepared
Any time now . I'm hoping I have a living donor
And do transplant . Will I get Ssi if I have a transplant ?