Can a disabled Teacher qualify for Medicare (Health Insurance) before age 65?

Probably not, turning 65 is one way to qualify for Medicare and so is getting SSDI – Social Security Disability for two years and then getting Medicare. Medicare Interactive.org

Social Security pays benefits to people who cannot work because they have a medical condition that is expected to last at least one year or result in death. (ssa.gov) However, as a teacher and a member of CalSTRS you don’t pay into Social Security so you probably wouldn’t get SSDI. Check with CalSTRS, Medicare or Attorney’s.

You might qualify under your spouse’s Social Security benefits???  Auxilary Benefits as a spouse of an insured worker – Nolo Excerpt

CalSTRS Publications & Medicare & Social Security

The CalSTRS Disability Benefits Guide states that you may qualify for long-term disability benefits if you have a medical condition that will prevent you from working for at least a year. STRS Member Handbook Your CalSTRS retirement benefit or Medicare benefit will not be reduced because of these provisions in Social Security law Nolo’s Guide to Social Security Disability

Social Security, CalSTRS and You

Our Webpage on Social Security Disability

California State Disability

 

FAQ’s from Consolidated Pages
 

My wife is a paraplegic and was on SoonerCare, she has Medicare disability and Medicaid disability, she got a form from social security saying do you want Part B Dr. Visits coverage as of February 1st, she returned the form and told them no, but someway she got put in some company for part D Prescriptions, she didn’t sign with any company and didn’t want plan D coverage, so now Sooner Care tells her she has no drug coverage with them, and Sooner care is so much better than private coverage,

how could she have been put on a private insurers plan for D coverage when she knew nothing about it?

She has not been able to even find out which company she fraudulently got enrolled in.

How can something like this happen and what can she do to correct this and get her drug coverage back from Sooner Care?

 

**************************

My wife just was informed that she will be on permanent disability from CalStrs. She has Young Onset Parkinson’s.  She is 54 years old. Her payments will start on Sept 15th.  She worked for close to 10 years in something outside of teaching so she must have close to the 40 quarters and also she paid into Medicare in each of her checks as a teacher.

Is she eligible for Medicare?

 

***This is all quite complex… Here’s the page on Social Security’s website about how many quarters you actually need.  Check our webpage on Social Security Disability and we’ve linked to attorney’s that can help you sort through this confusion. Please also visit your local CalSTRS office. Here’s their office locator.

If you are not getting employer paid medical coverage and want to check out the individual & family market, including ObamaCare Subsidies, click here.

Try this Medicare eligibility calculator.

It is difficult to figure all this out. We have heard that she will be eligible for Medicare after two years of being “officially disabled.” We have heard that she would be eligible for Medicare if she was eligible for Social Security disability.

***Yes, that is correct, if one qualifies for Social Security Disability.

Social Security Disability Benefits Publication # 10029

Our Webpage on Social Security Disability – I don’t see that you have anything to lose by applying. If you do get benefits, they would offset what you are getting from STRS per page 7 of the STRS manual.

The Question in your situation, is can she get both Medicare and CalSTRS disability?

***Appears to be yes, as there is an offset – reduction see citation above. What medical coverage does she have now?

She went on Medical leave on Feb 1st.

We want to stick with the CalStrs disability payments since they are larger.

***That’s fine, it’s just an offset.

 

What is the three pronged test for Disability Eligibility?

 

To meet the definition of disabled as established for CalSTRS in the California Education Code, you must have a medically determined physical or mental impairment that is permanent or expected to last at least 12 continuous months. The impairment must prevent you from performing:

  1. Your usual duties with or without reasonable accommodation from your employer.
  2. Duties of a comparable level to your usual duties, which you are qualified for or can become qualified for in a reasonable period of time with education, training or experience.
  3. Employment at a comparable level at which you can earn at least 66 2/3 percent of your final compensation.  Cal STRS Disability Benefits * Calstrs.com *

This looks to me, and of course please go ahead and check with competent legal counsel to be a 3 prong test.  See the Miller 3 prong Test for Obscenity.  That is to be disabled you must meet all 3 of the above requirements.  That is, if you can make more than you earned before, but voluntarily elect not to, then your not disabled.

Links & Resources

California Education Code   Disability Retirement [24100 – 24119]

 * 24103.    (a) The member shall provide medical documentation substantiating the impairment qualifying the member for the disability retirement under this part.

Duarte v Cal STRS

calstrs.com/disability-benefits

calstrs.com/disability_guide  2019

calstrs.com/your_disability_benefits  from member handbook 2012

calstrs.com/intro-to-calstrs-disability-benefits

 

  1. I’m sure I’m disabled and can’t go back to work! How do I show? know if my problems are enough to convince the “board” that I can’t go back to work?

How does one live on 2/3 rds of their prior income
or a max of $31,500 earned + the Disability Benefit?

 

You can earn income after you begin receiving a disability Coverage B benefit. You can teach under certain employer conditions, but you are not allowed to earn CalSTRS service credit or contribute to CalSTRS while receiving a disability retirement benefit. Your earnings from all types of employment, including self-employment, are subject to an earnings limit, unless you are participating in an approved CalSTRS rehabilitation plan.

CalSTRS retirement benefits will be reduced dollar for dollar by the total amount of earnings from all employment in excess of the 12-month calendar year limit. You will be required to provide CalSTRS with an annual report of your gross earnings from all employment. The Employment Development Department and your employer will verify your reported earnings.

The 2019 calendar year earnings limit is $31,500. The limit is determined early each calendar year. This amount is different from the service retirement earnings limit.  Member Handbook Page 110 *

Links & Resources

Why you need and how to get disability insurance – Nerd Wallet

 

Check out the Disability Needs Calculators below. 

You’ll find that there is a limit to how much you can get while disabled.

The Insurance Companies don’t what you home, if you can work.   It’s adverse selection – moral hazard  to sell you too high a benefit.

If you’re disabled, you don’t have to drive to work, buy lunches out, nice clothes, etc.

You generally don’t need the same level of income when you are disabled as you did when you were working. In fact, you can typically only purchase disability insurance for about 60% of your predisability income.

Consider the following reductions in spending that you could make if you became disabled:

  • Commuting expenses. If you drive to work, you can probably assume it costs you $0.50 per mile.
  • Workday lunches and breaks. If you eat out every day and buy the occasional latte, you could easily save $10 to $30 per day when you are not working.
  • Work clothes. Being unable to go to work can save thousands of dollars per year in clothing expenses.
  • Discontinued activities. It’s sad, but life on disability may not include the vacations you’re used to. On the bright side, you’ll have fewer expenses. You may even generate income from selling those jet skis, ATVs, and other toys.
  • Downsizing. Most of us can make cuts in our budget if we have to. Moving to a smaller, perhaps one-story house may even be a good idea.  Motley Fool.com

 

It’s difficult to live on the disability pension and an earnings limit of $31,500. I’ll be on Medicare soon. Would that pay for my mental health needs?

 

Nolo's Guide to Social Security Disability

Nolo's Guide to Social Security Disability  

We do have a reference copy in our office

Medicare and You 2021 (PDF)  #10050  
Everything you want to know 

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19 comments on “California Teachers & Social Security Disability

  1. I am temporarily disabled because I have

    Crps https://www.mayoclinic.org/diseases-conditions/complex-regional-pain-syndrome/symptoms-causes/syc-20371151
    Complex regional pain syndrome (CRPS) is a form of chronic pain that usually affects an arm or a leg. CRPS typically develops after an injury, a surgery, a stroke or a heart attack. The pain is out of proportion to the severity of the initial injury.
    Complex regional pain syndrome is uncommon, and its cause isn’t clearly understood. Treatment is most effective when started early. In such cases, improvement and even remission are possible.

    on my dominant hand/arm.

    I’m a teacher.

    Can I get state disability payment?

    • Did you have SDI deducted from your pay check?
      What district do you work for?
      Check our webpage on SDI

      SDI Eligibility Requirements

      In order to be eligible for DI benefits, you must:

      Be unable to do your regular or customary work for at least eight days.
      Be employed or actively looking for work at the time your disability begins.
      Have lost wages because of your disability.
      Have earned at least $300 from which State Disability Insurance (SDI) deductions were withheld during your base period. For additional information visit, Calculating Benefit Payment Amounts.
      Be under the care and treatment of a licensed physician/practitioner or accredited religious practitioner within the first eight days of your disability. The date your claim begins can be adjusted if it does not meet this requirement. You must remain under care and treatment to continue receiving benefits.
      Complete and submit your claim form (DE 2501) no earlier than nine days after your first day of disability begins but no later than 49 days after your disability begins or you may lose benefits.
      Have your physician/practitioner complete the medical certification portion of your disability claim.
      A nurse practitioner may certify to a disability within his/her scope of practice; however, he/she must perform a physical examination and collaborate with a physician or surgeon.
      A licensed midwife, nurse-midwife, or nurse practitioner may complete the medical certification for disabilities related to normal pregnancy or childbirth.
      If you are under the care of a religious practitioner, request a Claim for Disability Insurance Benefits-Religious Practitioner’s Certificate (DE 2502), from an SDI office. Certification by a religious practitioner is acceptable only if the practitioner has been accredited by the Employment Development Department.https://edd.ca.gov/Disability/Am_I_Eligible_for_DI_Benefits.htm

  2. My spouse has cancer. G-d forbid, when she passes away can I draw disability from her retirement?

    I have been on disability since 2011.

    Am I allowed to receive her Strs retirement?

  3. I was a teacher I applied for SSDI through Allsup. https://www.allsup.com/ Disability Services

    I was approved as 100 percent disabled but was only awarded Medicare ( which I do not want! Because I had Tricare military benefits which are great but would then become secondary to medicare ).

    Can I refuse Medicare?

  4. I have 10 years of service and am receiving Ca lStrs Disability.

    I worked 20 years prior to teaching

    Can I also collect state disability?

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