Health Insurance Matters: Happy 29th Anniversary

By Harry P. Thal

This month, Social Security celebrates the 29th anniversary of the American’s with Disabilities Act. It was signed into law by George H.W. Bush on July 26, 1990. Disability affects millions of Americans. The definition of disability is different under Social Security than it may be defined by the state or private insurance.

Social Security only pays benefits for full disability which is long term. Partial disability or short-term disability is not covered under this Act. Social Security has a strict definition of disability. Social Security program rules assume that working families have access to other resources to provide support during periods of short-term disabilities, including workers’ compensation, insurance, savings, and investments.

The benefits are not open-ended. A person needs to requalify periodically to show that their condition has not improved, or the disability continues to keep them from working.
Statistics from studies have shown that of today’s 20-year olds, one in four will become disabled before reaching the full Social Security benefit retirement age of 67.

Once a person has been disabled under Social Security for 24 months, they are eligible to enroll in Medicare rather than the traditional enrollment age of 65. Often, the date of the disability can be back-dated to the original time of the illness/injury. The benefits to the disabled worker are the same as for the senior citizen. About 2-3 months before their eligibility date, Social Security will mail them their Medicare ID card. At this time, they will have a 6 month window to enroll in a Medicare Advantage plan or into a Medicare Supplement plan. While normally the Medicare

Supplement plan can deny coverage due to medical pre-existing conditions, if enrolled during this Initial Enrollment Period, it is “guaranteed issue” and most people can get coverage without medical questions. Persons on kidney dialysis are an exception to this “guarantee”, and people with ALS (Lou Gehrig’s Disease) and Kidney Dialysis will not have to wait the 24 months for Medicare to begin.

In Kern County there are several Medicare Advantage HMO plans specifically designed for certain disabilities, such as Diabetes and Cardiovascular disease. These plans are available year-round, and all our Kern Valley doctors, nurse practitioners and physician assistants participate in at least one of these plans. Many of the medications used to treat these ailments are at low or no cost with additional services not available on other Medicare Advantage HMO plans.

Harry P. Thal, MA, is a licensed insurance broker in California (0621106) and 27 other states. His offices are in Kernville. He is a member of the Society of Certified Senior Advisors and Past-President of the Kern Association of Health Underwriters. He may be reached at 760-376-2100, e-mail harrythal@aol.com or visit him on the web at www.harrythal.com.