Medical Insurance while collecting Social Security: Medicare vs. Private Insurance

One of the associated benefits with collecting Social Security Disability benefits is that the disabled individual is eligible to participate in Medicare after receiving Social Security benefits for 24 months. For a large portion of individuals, this is a valuable benefit because many times the disabled individual is not able to afford private health insurance or in some cases have reached the lifetime maximum benefit paid by their plan.

Sometimes however, an individual does have private insurance, whether provided by their spouse’s employment or they are able to afford the premium. In those cases, the question becomes how the private insurance and Medicare work together.

Medicare is divided into four parts: A, B, C and D. Medicare Part A is considered hospital insurance and pays for inpatient care at hospitals and subsequent inpatient stays at skilled nursing facilities. Part B covers doctors’ services and other services and supplies not covered by Part A. Part C allows people with Parts A and B to choose to receive all services from a provider organization under Part C. Finally, Part D is the medication provision.

The essential parts are A, B, and D. Part A is essentially free for everyone and was paid for through taxes. Enrollment is automatic and participation does not require a monthly premium. Part B also has automatic enrollment, and there is a monthly premium. Most disabled individuals have the premiums deducted directly from their monthly benefit check. While enrollment is automatic, individuals can opt out of the program by completing the necessary paperwork. Part D requires an individual wishing to participate in the plan to enroll during the enrollment plan and pay a monthly premium. Social Security will not automatically enroll an individual in Part D.

For those with private insurance plans, it is important to determine how your plan fits with Medicare coverage. No single plan covers all kinds of health services and sometimes gaps left by one can be filled with the other. For instance, most private plans do not cover nursing home stays, but Medicare will cover inpatient treatment at a skilled nursing facility if it follows an inpatient hospital stay. It is important for an individual with both Medicare and private insurance to notify Medicare of the private insurance and ask the private insurer what types of services are included with the plan.


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