I'm really in need of some solid advice on this one. The wife will be 55 shortly and is at a real crossroads. She had a serious stroke, many years ago, and is totally paralyzed on one side. She has not only raised two children, but maintained her career as an educator/administrator and can now take an early retirement. The issue is that several doctors have been shocked at the fact that, due to here declining health, she isn't currently on full disability. and are offering to help her get approved for social security. Now the details. She can take a standard retirement that pays roughly 50K/yr, and includes absolute top shelf Blue Cross coverage for herself, until Medicare kicks in. She can also take a disability pension from her employer that pays a bit (less than 10%) more that usual, but they do not provide any health care. She could combine this with SSD which would provide an additional 25K year, and eventually(with a 2+ year gap) full medicade coverage.At this point, I am clueless. I am 50 and will be retired to be her full time sidekick. We don't owe a dime to anyone, and have enough retirement savings to start drawing 40K a year, with annual inflation adjustments, forever. Is leaving a great employer health plan, and going to medicare/medicade a big mistake? Will it limit our traveling? Provide a seriously reduced level of care? Greatly increase out of pocket expenses? I really need some real world experience here. Given the level of continuing care, Physical therapy, braces, podiatry, chiropractic, joint replacements (two knees so far) and an implanted infusion pump,etc.... is it worth taking the additional 2K a month in SSD, and leave a health care plan that spends tens to hundreds of thousands per year on her, but costs us a few hundred in co-pays? Would she end up on a state run medicade plan, limiting us to in-state health care?Thanks in advance for any info. you can provide. We never thought we would be in this mess, and now have no idea what is the best option.

Personally, I would hang on to that health insurance option. Due to DH being on dialysis, his employer terminated him. He was able to get on medicare, but I had to buy insurance. It's been a nightmare for me, medically, since we lost that insurance.Hang on to that top shelf health coverage.

That top notch insurance is a gem you really shouldn't give up, especially with her health conditions. If you can make it on the plan that includes the health coverage, that is the way I'd lean. I'm retiring in three weeks (59 years old). My Cobra costs will be $850 per month for the DW and myself with high deductibles. After that, I need to purchase an individual plan, and I will have even higher deductibles. It wouldn't take many serious health issues to cause a very big impact to our income.

Tough call, but I would consider this.1) If she has Cobra rights on her current health plan, you would have to pay the premium on until Medicare kicks in. Normally its available for only 12 months but it can be extended IF you have been approved for Medicare during the first twelve months. Some states have generous approval rates, some not. If it gets approved in the first 12 months you will pay a 25% penalty amount for the coverage until Medicare kicks in.2) If things continue the way they are heading on the ACA, the expensive plan that is currently available will be gone next year when the employer mandates kick in.3) You can go to the exchange for some coverage. Who knows at what cost or or what quality.4) How smooth the social security application process goes depends on how well your wife's disability meets Social Security's stated criteria for disability and how well the case is documented up front in the application. Alot of people think that just because their doctor thinks they are disabled, that say so will do it. No. The disability has to be documented in a precise manner. I would recommend talking to a disability attorney to get some advice as to how hard it will be. Maybe easy, maybe hard, who knows.5) Is the pension that is less non-taxable? SSDI is taxable. 6) Are there any local tax abatements that are only on people with government approved disability. For example, if you have a government recognized disability in my county, you don't pay property taxes. For me, that's a big deal. 7) What is the availability of Medicare supplements/Medicare Advantage in your area? For me, there is one Medicare supplement provider that will write for disability -- the premium is $350 a month-- not all states require offering Medicare supplements to the disabiled. all of the Medicare advantage plans are HMOs with local only coverage. If the coverage is bad in your home state, can you set up a home based elsewhere credibly.8) what is it 10% of? $30k or $80k. 10% of 80K times ten years is alot of money, for a benefit that likely won't be there next year...

Since she is an educator I'm guessing state pension plan? Federal law says social security is reduced since govt pension is there. Also Medicaid won't let you in with cash and owning home. Some of my older co workers are not eligible for Medicare since they are public employees and didn't pay in. I'm in ohio police and fire pension and that is really all I know. My advice is in addition to asking here you seek out a good financial person. One familiar with her pension fund and ssi. Don't forget there may be tax advantages over one than another. Good luck!

Also, plain medicare is usable everywhere. It will not limit your travels. You are responsible for the Medicare copay of 20%, but that is 20% of a seriously reduced amount. If you are able to get a Medigap policy, that covers the 20%. As noted, its likely expensive, but if they are offered to the disabled in SD, it might not be as much as you pay now in copays. She can't be on Medicaid unless you all have exhausted all of your assets. The bigger concern is being on a narrow network exchange plan, where the only non-emergency providers are associated with one hospital. If she is a state employee, I don't know if the Obamacare employer mandate is going to toast that insurance or not.

Wife qualfies for SSD, what would you do. | Good Sam Community

34 Replies

agteacher
Explorer
Nov 20, 2013
I would go to SSI.gov and fill out the paperwork for disability. If you have the medical documentation, you can file yourself. My husband went off work last year in July for cancer. He filed for SSDI in July this year. I took copies of the medical paperwork that we had showing dianosis, relapse, treatments, etc to the local office the day after I filed online. The agent at SS said he had never seen such complete documentation and he thought it would be approved with no problem. He called me to say that the approval was the fastest he had ever seen for disability. Took two days. My husband was diagnosed with small cell lung cancer, which is considered a serious illness.

I would try applying for SSDI on your own and if you get turned down, then you can decide what you want to do or if you want to work with an attorney. The attorney will take 25% of whatever backpay amount you are awarded.
Scottiemom
Nomad
Nov 13, 2013
It is Medicare and not Medicaid she would be eligible for if she does indeed receive Social Security Disability. DH's took effect 2 years from the date he was considered disabled according to the application. Once he received Medicare, he was eligible to apply for the supplement and the drug plan. It has been a godsend and is seemless to use no matter where we are. We full time and he has been seen in ER's and doctor's offices in Texas, Arizona and Indiana. He underwent cancer treatment at MD Anderson in Houston with never a hiccup from his Medicare/supplement. For that we are eternally grateful.

I would be leery of keeping a plan that may be here today/gone tomorrow, or replaced by something much more expensive and one that would not be good everywhere you go.

Good luck with your decision.

Dale
wny_pat1
Explorer
Nov 12, 2013
soren wrote:
wny_pat wrote:
rexlion wrote:
In the meantime, if SSD benefits really are reduced by the other pension she can receive, I see little point in applying at this time.
Not at all true. Just where are you dredging up this stuff from???

Actually everything posted so far has been helpful, even if I spent time researching it, only to discover that it doesn't apply. The statement is in fact true. The benefit level could be reduced by another pension, received from a non-qualifying employer. This would also tie into previous posts about "Windfall Reduction". Fortunately, this only applies where an applicant would be in the unusual situation of having two careers, one of which was in a field that did not participate in the SS program, (IE government agencies, some railroad jobs, etc....) and the other working in a situation where SS taxes are deducted.
At this point, everybody involved in our situation, and everything I have found online, indicates that any employer pension benefit has nothing to do with qualifying for SSDI, or the amount of benefits.

Thanks for all the contributions.
Okay, I accept that some state and federal workers who did not pay into Social Security because they pay into a special pension catagory, ie some firefighters, police officers or RR workers, fall into this special catagory, but the average, run of the mill, regular pensions, like my Teamsters Pension are not affect by it.
emzee
Explorer
Nov 10, 2013
soren, I see absolutely no reason she would be turned down at all. I am surprised she needed an attorney. However, I have a neighbor with polio who worked for 25 years and took an early retirement at 55. She was turned down, got a lawyer and voila, got it, no hearing or anything. She didn't have too long to wait for medicare to kick in either. Medicare was based on when she first applied. 24 months is the wait time, (I think I said that already)She kept her current insurance until medicare kicked in. She uses her former insurance (I think her dh was employed through the railroad) as her supplemental.
soren
Explorer
Nov 09, 2013
stsmark, Thanks a million for the info. Had no idea about the online information. She turns 55 in a few weeks, then we hit it hard. The SS attorney claims that as you progress through middle age, there are five year milestones in the eyes of the examiners, (IE over50, over 55, over 60 etc....) where acceptance becomes progressively easier. Who knows, we will see. Thanks again.
stsmark
Explorer
Nov 09, 2013
HI Soren,
A few thoughts, I left work in 2009 due to Primary Progressive MS, at the time of separation I applied for both SSDI and my employers LTD package. SSDI has an online reference that states qualifications for thousands of conditions. It is actually pretty user friendly to navigate. I filled out the online app and provided PDF records of all the listed requirements and was approved in roughly 11 weeks. When I was contacted by the agent to inform of my approval I commented on how quickly it went and she thanked me for providing the all the info she needed to do her job. SSDI was actually faster to approve than the LTD carrier by a few weeks. In my case the LTD carrier offset the benefit less SSDI.

I now have a Medicare part B supplement that allows me to go to any doctor or hospital that accepts Medicare anywhere in the country, it's underwritten by Anthem but these plans do vary state to state I'm in CA.

All the best to you and your wife.
soren
Explorer
Nov 07, 2013
wgriswold wrote:
soren wrote:

At this point, everybody involved in our situation, and everything I have found online, indicates that any employer pension benefit has nothing to do with qualifying for SSDI, or the amount of benefits.

Not quite right, at least in 2003. My wife worked as a teacher's aide for many years and participated in both PERS( a Calif. pension plan) and Social Security. She paid her share of premiums in both plans. That is important because the rule is:

"The second provision, called the Windfall Elimination Provision (WEP), affects how we calculate your Social Security retirement or disability benefits if you receive a pension from work not covered by Social Security. See our WEP page for more information."

Initially her SS pension was reduced by about half because SS assumed that per employer had picked up the employee part of her PERS pension. When we proved that she had paid it her amount was increased to the full amount. As I understand it, it is fairly common for employers (at least in Calif.) to pick up the PERS employee contribution if lieu of raises for tax reasons.

It sounds like this doesn't apply to you. I mention it to help someone else in my wife's position.

Our state (PA, BTW, South Dakota is where we spend a lot of our summers) is quite the opposite when it comes to responsible pension practices. Not only did she pay every penny of her portion of the contributions (7.5%), but the state is corrupt enough that they failed to remit billions that they were required to. So, to clarify, her pension was fully funded by weekly payroll deductions, and does not fall under any windfall provision. I already have the statement from SS stating her monthly benefit, if approved for SSDI, based on her work history. Even if it did fall under windfall provisions, it would of "timed out" by virtue of having over thirty years of "substantial wages" that had SS taxes deducted.
soren
Explorer
Nov 07, 2013
sayoung wrote:
not trying to bash you but if I understand your original post,you both can retire today in your early 50's with about 90K per year income,or is this a gigantic cut in income?.what are you worrying about a disability pension from the feds for,take the jobs pension,start living. Draw your SSI when ya'll turn 62 and get MC at 65.
Your wife sounds like she deserves to go and do something fun.

Not offended at all. You are correct, 90K isn't a hardship in the least. The issues here are protecting her health care, the likelihood of qualifying for SSDI and the Medicare coverage that comes with it, and planning for the best outcome, while recognizing that there are a lot of potential problems with any final decision.

The point you are missing is that you are not talking about a normal, able bodied person kicking back and waiting until, and if, Medicare becomes a personal reality, a decade from now. Absent the "no exclusions for prior conditions" portion of the ACA, somebody in her situation has zero access to reasonable priced private pay coverage. So, a wrong move now could be a financial disaster in the next decade. Given the current economic and political climate in her district, ANY benefit is far from guaranteed, including retiree health care. So, asking the collective advice of everybody here is very valuable to me.

We literally have dozens of details to clarify from several sources, then need to make a series of decisions that will have a huge impact on the rest of both of our lives. If I make the right ones, it's all good, and we go with your plan and grab a beach chair. OTOH, if the SS battle is a failure, the ACA degrades into an unworkable mess, or the employer says, "sorry, we are broke and retiree heath care isn't something we are willing to pay for any longer" Well, your advice to "kick back and relax" doesn't really work out too well.
sayoung
Explorer
Nov 06, 2013
not trying to bash you but if I understand your original post,you both can retire today in your early 50's with about 90K per year income,or is this a gigantic cut in income?.what are you worrying about a disability pension from the feds for,take the jobs pension,start living. Draw your SSI when ya'll turn 62 and get MC at 65.
Your wife sounds like she deserves to go and do something fun.
wgriswold
Explorer
Nov 06, 2013
soren wrote:

At this point, everybody involved in our situation, and everything I have found online, indicates that any employer pension benefit has nothing to do with qualifying for SSDI, or the amount of benefits.

Not quite right, at least in 2003. My wife worked as a teacher's aide for many years and participated in both PERS( a Calif. pension plan) and Social Security. She paid her share of premiums in both plans. That is important because the rule is:

"The second provision, called the Windfall Elimination Provision (WEP), affects how we calculate your Social Security retirement or disability benefits if you receive a pension from work not covered by Social Security. See our WEP page for more information."

Initially her SS pension was reduced by about half because SS assumed that per employer had picked up the employee part of her PERS pension. When we proved that she had paid it her amount was increased to the full amount. As I understand it, it is fairly common for employers (at least in Calif.) to pick up the PERS employee contribution if lieu of raises for tax reasons.

It sounds like this doesn't apply to you. I mention it to help someone else in my wife's position.

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Wife qualfies for SSD, what would you do.

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