Discussions about Social Security disability benefits through the Supplemental Security Income and Social Security Disability Insurance programs usually focus on monthly cash payments, which are essential for anyone unable to work because of a disability. Equally crucial is the ability to afford the medical care and treatment needed for treatment. Medical benefits through Medicare and Medicaid are available for people with disabilities, but you need to understand how the programs work to get the most from them.
Medicare and SSDI benefits
Although Medicare is usually considered a health insurance program for people 65 and older, it is also available to younger people who qualify for SSDI benefits. If you have a medically determinable physical or mental impairment that prevents you from doing substantial gainful activity and has lasted or is expected to last for a continuous period of 12 months or longer or to result in death, you can qualify for SSDI benefits.
Of course, before you can qualify for SSDI benefits, you must be eligible for the program. A disability that meets the definition used by the Social Security Administration is only part of the qualifying criteria. You also must have worked long enough and paid Social Security taxes on the money you earned to qualify for disability through SSDI.
Medicare has two parts: Part A hospital insurance and Part B medical insurance. Everyone qualifying for SSDI benefits receives Part A Medicare coverage. You must pay a premium if you elect to add Part B benefits to your Medicare.
There is a 24-month waiting period before Medicare eligibility begins. The waiting period represents 24 monthly SSDI benefit payments. The waiting period does not apply to people who qualify for disability benefits through SSDI because of end-stage renal disease or Lou Gehrig’s disease.
SSI benefits and Medicaid
Medicaid is a health insurance program jointly funded by states and the federal government. Most states provide Medicaid coverage to anyone qualifying for SSI benefits. Some states require a separate application for Medicaid coverage or have their own eligibility rules.
If you live in a state where Medicaid eligibility is not automatically granted with SSI benefits, the Social Security Administration directs you to the agency in your state that you must apply to for coverage. Your Medicaid insurance coverage begins the month that you become eligible for SSI cash payments.
You do not pay a premium for Medicaid coverage, which differs from the Medicare program. Another difference between the two programs is that Medicaid covers services that Medicare does not, including nursing home care.
Can you be eligible for Medicare and Medicaid at the same time?
Some people who worked long enough to qualify for SSDI benefits may also be eligible for disability benefits through SSI. If they worked at low-paying jobs or became disabled early in their careers, their monthly SSDI benefits may be low enough to allow them to also qualify for SSI benefits. Qualifying for disability benefits simultaneously through both programs is called concurrent benefits.
If you are eligible for concurrent benefits, you may also have dual eligibility for Medicare and Medicaid. During the 24-month waiting period before becoming eligible for Medicare, Medicaid is your primary health insurance coverage. Once you become eligible for Medicare, it becomes your primary payer, with Medicaid as the secondary payer.
When you qualify for concurrent benefits, it eliminates concerns about paying for medical care during the 24-month waiting period if you meet the eligibility rules of your state to be covered by Medicaid. At the end of the waiting period, the fact that you then have dual eligibility means that services you might otherwise pay for with only Medicare insurance may be paid through Medicaid.
A consultation with a disability lawyer answers your questions and addresses concerns about disability benefits, including health insurance coverage through Medicare and Medicaid. Disability benefits lawyers provide skilled and knowledgeable representation to appeal benefit denials and other adverse decisions preventing you from getting the disability benefits you deserve and need.
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