Insurance & Billing

THANK YOU for sharing!

Hi Marty! Your question is very interesting.

Medicare eligibility due to disability is usually connected to SSDI, not SSI. In most cases, once a person is approved for SSDI, there is a 24-month waiting period before Medicare coverage can begin.

Because every situation is different, the best next step would be for the patient to contact the Social Security Administration directly to confirm whether he may qualify for SSDI. My understanding is that the 40-quarter requirement is mainly related to retirement benefits, and SSA may apply different work-credit rules for disability benefits, especially for younger individuals who have not had enough time to build a long work history.

It may also be helpful for the patient to ask SSA to explain the possible benefits, limitations, and long-term impact before making a final decision. If disability benefits are approved at a young age, it may have future implications for earnings and benefits, so it is important that he receives guidance directly from SSA.

My suggestion is for the patient to call SSA, confirm his eligibility, ask about the pros and cons, and then decide whether moving forward with the SSDI application is the best option for his situation.

I truly hope this info helps you guide your patient toward the next steps that are best for her/his/their situation. Have a great day!

If someone is receiving SSI/SSDI under the age of 65 they will be eligible for medicare after 2 years. I would find out why the procedure is not covered and go from there.

I believe after 2 years they become eligible for Medicare. What’s their diagnosis and what is the procedure?

Good information to know. Thank you Dalia.

Good information. I have an investigative journalism piece on WISeR that will likely be published later this month and will share.

This is great information. Thank you Dalia.

Hi Natasha,
The only Independent Advocate that I know that is billing Medicare is Terry McLellan — Sunnavhca. She is located in TX. I'm sure she will be happy to have a conversation with you. Here's her email: terry@sunnavhca.com
Let her know I referred you.
Tammy

Hi, Rachel!
Do you mean you are trying to become an advocate who accepts Medicare?

if so, there are a number of agencies around the country that accept Medicare. It is my understanding that an RN must work under a licensed supervising clinician, and the setup is long, indepth and complex. I know of one RN advocate who is deep into the process and actually building a training program she intends to offer once she has reached sort of 'a good endpoint' with the process.

I hope other nurses might respond here to provide more information, although if this question is about accepting Medicare as reimbursement, it's likely in the wrong conversation space, and I can move it for you.

If you would like the list of agencies that we at GNA are aware of and have had at least some contact with/knowledge of, feel free to ask. I'll gladly share it here.

Thanks for sharing, karen! Id love to see you start a conversation about long term care claims, knowing that's a niche you know well.

Thank you! this post is HUGELY helpful!

Such a great scenario to give that allows clients to more easily understand the benefit of advocates!

LOVE this!

Great job, Jeff!