Thursday, September 2, 2010

Bridge the SSDI Coverage Gap to Medicare with High Risk Pools

Many folks are surprised when they learn that there is a significant waiting period for Medicare benefits from the disability onset date of an SSDI award. Unlocking insurance benefits is a powerful incentive to apply for disability, and many folks find themselves with SSDI and no insurance. Medicaid can provide options for some (especially in spend-down scenarios or those with children), but there is a brand new program that is specifically designed for folks affected in this way. They are called High Risk Pools and are a designed to allowable the purchase of affordable coverage until Health Reform is implemented.

Georgia opted not to have state involvement in administering this program, but there are still funds available for people in Georgia, and the Federal Government (via HHS) will distribute them. The purpose of high risk pools is to provide affordable health benefits coverage for those individuals rendered otherwise uninsurable by pre-existing conditions. $5 Billion has been allocated by the Federal Government for this endeavor, $117 million of which is earmarked for Georgia. The non-partisan Congressional Business Office has given guidance that these funds will probably not completely bridge the gap to 2014 when the Health Reform Laws are implemented, but for those who need coverage ASAP, and have a Medicare "light at the end of the tunnel" waiting for them, this is a worthy option to consider.

All that is required is that an individual:
  • Be a citizen or national of the United States or lawfully present in the United States;
  • Not have been covered under creditable coverage (as defined in Section 2701(c)(1) of the Public Health Service Act) for the previous 6 months before applying for coverage; and
  • Have a pre-existing condition, as determined in a manner consistent with guidance issued by the Secretary.
As of this writing, this program is only recently available, but if you are without coverage, it is worth exploring. Visit here to view the Health and Human Services Fact Sheet.

For information about disability and health benefits law, contact Thomas O'Brien.

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