Medicare eligible due to disability

[Anonymous]

My son was determined SSDI eligible last year, but although now he can work very little he does hope to eventually work more or less fulltime. He just became Medicare-eligible and has a BCBS marketplace plan. The plan works very well for him. His medications include two drugs which together total $11,000/month. One of them is currently around $8000. He has a high deductible plan and patient assistance for the high priced drug, so the patient assistance plan pays for his first fill in January which satisfies his deductible.

According to the Medicare information, he could be penalized down the road if he doesn't chose part B and D when he becomes eligible. Since he is currently insured, it looks like he doesn't have to choose right now, but we don't know if the marketplace plan will allow him to renew it for 2025.

Is it correct that as long as BCBS does allow him to stay on the plan he is safe from penalties in the future if eventually he does have to take part B and Part D? (no way would Medicare Advantage make sense, and from what I have read doctors agree that traditional Medicare is the best bet to avoid insurance companies deciding your medical care)

[Anonymous]

You may want to contact the state health insurance program (ship) for your state, as you will get better advice there. Or a lawyer from the special needs alliance directory.

[Anonymous]

I agree with contacting your SHIP, and also contacting the Social Security office to ask. But I think the answer to your question is that your son would face the Part B penalty, because the exception to that penalty is tied to still being employed and having employer coverage. I could be wrong, but I think that’s the issue.
The Part D penalty exemption is tied to having creditable coverage, which I would guess your son has through the BCBS plan, but you should call and ask BCBS that question (they should be able to tell you, and provide to you a document that affirms the plan counts as creditable coverage — often you get a letter at some point each year that says this, so you might already have it).
Good luck.
Also, in thinking about whether Medicare makes sense, check the laws in his state regarding access to Medicare supplement, or Medigap, plans. Different states have different rules for those eligible for Medicare due to disability. Also, in thinking about a Medicare Advantage plan, remember that they are required to have an out-of-pocket maximum, which might work in your son’s favor. Also, with the changes to Part D coverage resulting from the Inflation Reduction Act, his costs might not be terrible, though you would need to check formularies carefully.
Good luck.

[Anonymous]

don't trust what the SSA office tells you. If you can find an answer in the POMS (their manual) or regulations that's one thing, but if you mess up and relied on them, it's your work against theirs and you will lose.