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LEGAL ISSUES

What is Medicare?
What is Social Security Disability Insurance (SSDI)?
Who can qualify for the SSDI?
What is the process to establish disability?
What is a Health Care Directive?
Why is it important to have health care directives?
What is a Living Will?

 

What is Medicare?

Medicare is a federal health insurance program administered by the Centers for Medicare and Medicaid Services (CMS). It is available for people age 65 and older and persons eligible for Social Security Disability Insurance (SSDI). For many conditions, there is a two-year wait to become eligible for Medicare. This two-year wait is waived for patients with ALS, who are immediately eligible for Medicare.

Medicare Part A is Hospital insurance. It helps to pay for care in hospitals as an inpatient, skilled nursing facilities, hospice care and some home health care.  Medicare Part B is medical insurance that covers doctors’ services and outpatient services (including some nursing facilities and in-home health care costs). Medicare Part D provides prescription drug coverage.

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What is Social Security Disability Insurance (SSDI)?

SSDI is a payroll tax-funded, federal insurance program of the United States government that is managed by the Social Security Administration. It is designed to provide income supplements to people who cannot work because of a disability, such as ALS. Importantly, eligibility does not depend on income or the resources of the disabled individual seeking SSDI.

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Who can qualify for the SSDI?

A person qualifies for SSDI if all three of the following criteria are met:

  1. They are disabled
    1. Presence of a physical or mental condition that prevents them from working (defined as engaging in any "substantial gainful activity“)
    2. The condition is expected to last at least 12 months or result in death
  2. They are under the age of 65
  3. They have accumulated 20 Social Security credits in the last 10 years prior to the onset of disability

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What is the process to establish disability?

  1. Social Security will determine if you are working, defined as being engaged in “substantial gainful activity,” which means earning more than $1,010 per month as an employee
  2. If you have impairment that Social Security considers “severe.” Social Security will consider impairment(s) severe if they significantly limit the ability to perform basic work activities needed to do most jobs. Examples include: walking, lifting, and speaking.
  3. Social Security will decide if your impairment is a "listed" impairment.  The “list of impairments” is a Social Security list with most of the disabilities that are known to be permanent or terminal. ALS is a “listed impairment,” meaning it meets the requirements for disability.

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What is a Health Care Directive?

A health care directive is a written or oral statement about how you want medical decisions made should you be unable to make them yourself, such as for life-threatening illness, permanent disability, and estate planning. There are three types of advance directives: Living Will, Health Care Surrogate Designation and Anatomical Donation.

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Why is it important to have health care directives?

A health care directive assures that your wishes will be carried out. Without it, the person making decisions on your behalf may not be aware of your wishes. A health care directive, therefore, helps your family insofar as it is easier for them to make difficult decisions when they clearly know your wishes.

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What is a Living Will?

A ‘living will’ is a type of health care directive. It articulates your wishes regarding the EXTENT OF TREATMENT and TYPES OF TREATMENT you will receive if you become incapacitated and are determined to be in a terminal condition and/or to be permanently unconscious.

The “extent of treatment” might include measures to “keep you comfortable” (palliative care), or providing whatever measures are necessary to “keep you alive.”

Types of treatment might include cardiac resuscitation, mechanical ventilation, tube feeding or use of other artificial or invasive nutrition, artificial hydration, blood or blood products, any form of invasive diagnostic testing, antibiotics, etc.

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