Learn About Upcoming Changes to Medicare, the Dec. 7 Deadline and Differences in SSI vs. SSDI

By Janet Shouse

About the Author

Janet Shouse is a parent of a young adult with autism, and she is passionate about inclusion, employment of people with disabilities, medical issues related to developmental disabilities, supports and services, public policy, legislative initiatives, advocacy, and the intersection of faith and disability. She wears many hats at the Vanderbilt Kennedy Center, including one as a disability employment specialist for TennesseeWorks.

Our hope is that this weekly blog will offer information you want to know, so if you have a question you want answered about employment for people with disabilities or other mysteries of the world of work, please email me at janet.shouse@vumc.org.

When I learn something new that I think is important, I usually try to share that information with others. Sometimes I find out that I’m the only who didn’t know that bit of information. For many of you, this may be one of those times—you may already know all this. I have known for a long time that individuals with intellectual and developmental disabilities can be eligible for SSI, which is called Supplemental Security Income, if they meet financial and disability determination guidelines. In many states, including Tennessee, with SSI, comes Medicaid/TennCare.

And I knew that people who acquired their disabilities after having worked for a certain period of time could be eligible for SSDI, which is Social Security Disability Income. After a waiting period, with SSDI, comes Medicare.

What I hadn’t been clear on is that individuals with IDD can have SSI and SSDI, TennCare AND Medicare. These folks are known as “dual eligibles.”

First of all, I will share the information that impacts those individuals with disabilities who have SSDI and Medicare and those who are dual eligibles. Those of you who have Medicare probably received notice about these changes. If not, you should know there will be some changes impacting all Medicare beneficiaries in 2019:

  • Part B monthly premiums for Medicare will increase to $135.50. The current cost is $134. Part B medical insurance covers medically necessary outpatient services and preventive care.
  • Part B outpatient annual deductible increases to $185. The current cost is $183.
  • Part A hospital deductible will increase to $1,364 per qualifying event. The current cost is $1,340.
  • The donut hole, which is a “coverage gap” in the Part D prescription drug benefit, is partially closed in 2019. Once an individual’s full-cost of medications (prior to payment by insurance or insured) reach $3,820, they are in the donut hole. During that period individuals will have to pay 37% of costs for generics or 25% for brand-name drugs. When the individuals’ full drug costs have hit $7,653.75, they come out of the donut hole and catastrophic coverage begins, at which time they will be responsible to pay 5%, or $3.40 for generics and $8.50 for brand name medications (whichever is higher). Before the Affordable Care Act, individuals paid 100% of the costs of drugs while in the donut hole. Here’s a chart that helps explain the donut hole: http://www.tennesseeworks.org/wp-content/uploads/Donut-Hole-2019.pdf.

I recently talked with Alexandra Hulten, the regional program coordinator for the Tennessee State Health Insurance Assistance Program with the Greater Nashville Regional Council-Area Agency on Aging and Disability, and she kindly explained all these changes to me. But she also knows much of this information is confusing, and here is a link that will allow you to learn more about these changes:

https://www.tn.gov/aging/our-programs/state-health-insurance-assistance-program–ship-.html

Or you can call toll free at 1-877-801-0044.

TN SHIP, as it’s called, provides counseling and assistance with Medicare, and it’s free and objective! The information specialists represent you, not insurance companies. They can help with other related health insurance questions as well. In addition to the personal assistance you can get online or over the phone, on the website above, you can find a list of upcoming educational and counseling events in your area.

Each year Medicare offers an open enrollment period that allows people to compare their current Medicare insurance plans with other options, including looking at different plans’ formularies (the list of prescription drugs covered) to see if one plan offers better prices for particular medications than others, which could save someone a significant amount of money. But the deadline for open enrollment is Dec. 7.

I would encourage anyone on Medicare, whether you’re a person 65 or older or an individual with a disability, to think about talking with the folks at the Tennessee SHIP. Plus, Alexandra explained that there are several programs that can assist some individuals with paying for premiums and prescription drugs. But the SHIP folks are much better equipped to provide that information than I am.

In addition to the Medicare changes, the Social Security Administration also announced not too long ago that there will be a 2.8% cost-of-living adjustment for SSI, which means in 2019 SSI limits will rise to $771 for a single individual and $1,157 for a couple.

While I was talking with Alexandra about these Medicare changes, I kept quizzing her about how someone becomes a dual eligible. She kindly connected me to a friend in a local Social Security Administration office, who then shared my questions with folks in the Atlanta SSA office.

These were my questions, and the answers are in bold:

  1. What are the ways that a child or an adult with an intellectual or developmental disability who has never worked receive Medicare? (I know children and adults with IDD who receive SSI receive Medicaid/TennCare, but I am unclear on the Medicare issue.)

Medicare is a federal health insurance program for people age 65 or older, and for people who have been getting Social Security disability benefits for at least two years. Adults disabled since childhood (this is referred to as a Disabled Adult Child benefit because it is paid on a parent’s Social Security record) may qualify for Medicare after receiving disability benefits on the Social Security record of one of his or her parents for at least two years. For more information, see https://www.ssa.gov/pubs/EN-05-10026.pdf

  1. What are the ways that a child or an adult with IDD who has never worked can receive SSDI?

The Social Security Disability Insurance (SSDI) program pays benefits to adults who have a disability that began before they became 22 years old. For a disabled adult to become entitled, one of his or her parents must be receiving Social Security retirement or disability benefits or must have died and have worked enough to qualify for Social Security. These benefits are also payable to an adult if he or she is disabled at age 18, and if they received dependent’s benefits on a parent’s Social Security earnings record prior to age 18.  SSDI disabled adult “child” benefits continue as long as the individual remains disabled. Marriage of the disabled adult “child” may affect eligibility for this benefit. The Disabled Adult Child doesn’t need to have worked to get these benefits.

  1. Can an individual receive both SSI and SSDI?

Yes. SSI is a needs-based program, so as long as the SSDI benefit is below the SSI income limit, a person can receive both benefits assuming they also meet all of the other eligibility requirements.

  1. Do SSDI payments vary? If so, what is the variation based on? (I know SSI levels can vary if a person is living with their family vs. living on his/her own and or working.)

SSDI payments are based on the parent’s monthly Social Security benefit.  A Disabled Adult Child may be eligible for a monthly benefit of up to 50 percent of the parent’s monthly benefit. This percentage can go up to 75 percent if the disabled adult child is receiving benefits on a deceased parent’s record. However, there is a limit to the amount paid per family. If the sum of benefits payable is greater than the family limit, then benefits to each family member may be reduced proportionately.

  1. And one rather weird question…. If a person receives Supplemental Nutrition Assistance Program benefits, also known as food stamps, does that reduce the SSI or SSDI amount he/she receives? (Many individuals with disabilities qualify and use SNAP benefits.)

SNAP benefits do not reduce SSDI or SSI benefits. 

Additional information on Social Security Disability, SSI benefits and Medicare is available at the SSA website.We will make these hyperlinks.: www.socialsecurity.gov and specifically at these links:

https://www.ssa.gov/benefits/disability/

https://www.ssa.gov/benefits/ssi/

https://www.ssa.gov/benefits/medicare/

If you need additional information about programs and services for people with disabilities or older Tennesseans, your local Area Agency on Aging and Disability can help. There are nine in Tennessee. These agencies plan and provide programs and services for older adults, as well as those with disabilities.

The Greater Nashville Regional Council serves Cheatham, Davidson, Dickson, Houston, Humphreys, Montgomery, Robertson, Rutherford, Stewart, Sumner, Trousdale, Williamson, and Wilson Counties. GNRC’s major programs include the Area Agency on Aging and Disability, Nashville Area Metropolitan Planning Organization (transportation planning), the Mid-Cumberland Area Development Corp. (small business assistance and lending), and the Middle Tennessee Tourism Council, among others. For more information visit GNRC.org.

To find your local AAAD outside of the greater Nashville region, check here:https://www.tn.gov/aging/resource-maps/tennessee-area-agencies-on-aging-and-disability.html

Thanks to Alexandra for her patient explanations of this highly technical information and for connecting me with someone in Social Security who could help get my questions answered!

Ordinarily, I close with a statement saying that if you have questions, please email me at janet.shouse@vumc.org, but for this blog post, I’m almost afraid to do that. But I will. If you do have questions, I will try to find answers. Thanks for reading!