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ToniSays: Social Security Disability’s Medicare enrolling rules

Toni King
Toni King
Toni King Says
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In her weekly ToniSays columns, Toni King answers your questions about navigating the Medicare and Social Security systems.

Toni: My husband has met his 24th month of being on Social Security Disability which qualifies him for Medicare. His disability is because of a severe case of Parkinson’s. On March 1st his Medicare Parts A and B will begin, but he is only 64.  He will turn 65 this September and I am not sure what he should do.

With Paul’s serious Parkinson’s issues affecting his health, I am concerned with which Medicare option is for him to enroll in. Should he enroll in a Medicare Advantage plan or a Medicare Supplement?  

I am very concerned about whether he will enter the Medicare Prescription drug donut hole because his Parkinson’s medications are rather expensive.  Please advise what we need to do to find what Paul’s best Medicare option should be? Thanks, Cynthia from Cypress area

Cynthia: Learning how to enroll in the right Medicare and Part D prescription drug plan when someone has a serious health condition can be extremely complicated.  Your current specialists and prescriptions are what the Toni Says® Medicare team focuses on. 

What those on Social Security Disability need to understand is that there are 2 Medicare enrollment windows.

Below are Medicare’s 2 Enrollment times for those on Social Security Disability:  

1) Enrolling in Medicare under 65: When one’s Social Security Disability 24th month happens, and you are enrolled in Medicare to begin on the 1st day of the 25th month such as your husband Paul’s Medicare, even though he has not yet turned 65. In Texas, when one is under 65 and eligible for Medicare, there is only one Medicare Supplement plan which you are eligible for with most Medicare Supplement Insurance companies and that plan is Plan A.  Medicare Supplement Plan A works directly with Original Medicare and has more out of pocket than Medicare Supplement Plans F or G.  Different states have different Medicare Supplement plans available to those under 65.  

When one is under 65 and enrolling in Medicare for the first time, a Toni Says® Medicare team member will advise the new Medicare client to discuss which Medicare Advantage plan their medical professionals and facilities accept that can help to pick up their Medicare costs. 

Medicare Advantage plans help to cover the Medicare costs that Medicare does not pay for.  The Advantage plan will have deductibles, copays or maximum out of pocket costs that the Medicare enrollee will have to pay.  When under 65, this may be an option to consider since Original Medicare has out of pocket. Always verify that your healthcare professionals or facilities will accept and bill the Medicare Advantage plan that has been picked.

2) Turning 65 and on Social Security Disability:  Cynthia, I have good news for you because when Paul turns 65 in September, he will have a second Medicare Supplement enrollment period which is called Medigap/Medicare Supplement Open Enrollment period.  He will not have to answer any health questions because he has turned 65, the same as anyone who is just turning 65 and has received both Medicare Parts A and B. Those on Social Security Disability will qualify in Texas during a 6-month period that begins the month one turns 65 for Medicare Supplement Plans A-N. 

Exploring the Medicare Part D prescription drug donut hole and what prescription drug plan fits Paul’s needs is discovered during a Toni Says® Medicare consultation. We always check prescriptions with medicare.gov for which Medicare Part D plan best fits his needs.

Toni King, the author of the “new” Medicare Survival Guide® Advanced edition, is available at www.tonisays.com. Have any Medicare or Social Security questions, please feel free to reach out to Toni at 832-519-8664 or email info@tonisays.com.

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