Tuesday, October 20, 2009

Do You Get Medicare Or Medicaid From Social Security Disability?

Generally speaking, any individual who is entitled to A) receive Supplemental Security Income (SSI) or B) receive both Social Security disability and SSI disability (concurrent benefits) will be entitled to Medicaid at the month of their entitlement to disability.

In the case of beneficiaries receiving SSI disability only, the date of filing is generally the date of disability entitlement, thus the entitlement date for Medicaid.

Two things to point regarding medicaid.

1) Medicaid is a need based medical insurance program; consequently any individual who receives Medicaid must meet income and resource (asset) limits.

2) If a Social Security disability beneficiary has a low benefit amount, they may still be able to qualify for Medicaid, even if their disability benefit is too high to be concurrently entitled to SSI.

Medicare, like Social Security disability, is based upon an individual’s insured status, not simply income and resources. If an individual is approved for Social Security disability benefits, they will not be eligible to receive Medicare insurance benefits for two years following the first month they became eligible to receive their disability benefits.

Another way of putting it is that an SSD beneficiary will have coverage for medicare after A) the five month waiting period has been served (this five month period applies only to social security disability, not SSI) and B) after the 2 year or 24 month waiting period for medicare has been served.

Some claimants who have been approved for social security disability will have a gap time period in which they have no coverage under medicare, due to these waiting periods. However, because many social security disability claims literally take years to finish (from the disability application to the reconsideration appeal, to the disability hearing, etc), many claimants will have already served these waiting periods by the time they finally receive notification that their disability claim has been approved.

Things to remember regarding medicare:

1) Once an individual is entitled to Medicare part A and B benefits, they are eligible to enroll in part C and D.

2) Medicare offers part C and D premium programs to help with prescriptions and medical expenses that are nor covered by parts A and B.

3) Medicare parts C and D are not free, so there is an additional monthly premium involved.

4) Medicare does offer help with the additional premium cost if an individual meets the income and resource limit for the Medicare part C and D subsidy program.

In conclusion, if you are approved for Social Security disability only with no ongoing SSI disability entitlement and you have health insurance, do not give up your coverage if possible. You will not be eligible for any Medicare for two years after your date of entitlement to Social Security benefits.

Additionally, check with your local Social Services office to see if you might be entitled to Medicaid even if your Social Security benefit is a little too high for SSI benefits.

Return to the Social Security Disability SSI Benefits Blog

Other Posts

Why did I get Denied on my Social Security Disability Request for Reconsideration?
Denial of Disability, Pain, and Medical Records
I was denied the second time for Social Security Disability
Herniated Disc, Social Security Disability SSI - Applying for Disability
Disability Benefits for Mental Illness (bipolar disorder, schizophrenia, depression)

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Blogger lovey said...

Also, another thing to consider in keeping your medical insurance through COBRA, is that after the 18 months, there is a 11-month disability extension where you pay 150% of the "regular" premium. This should take you up to end of the wait period..it's funny though I am short 4 days..everybody is saying I should be a hermit November 27-30th, because nobody is sure whether Medicaid covers those few days until Medicare on Dec. 1st!

I am almost finished in the waiting period, and have used the $711 of my COBRA premiums in the disability extension to meet most of my MI Medicaid spend-down deductible. Having the COBRA insurance has enabled me to have
better health care than Medicaid alone.

It's still put me near bankruptcy, but at least I have survived my conditions because of good access to health care. I might not of, on Medicaid alone.

Oh, and some states, if they find it cost-saving to the state, and you have a serious illness, will pay your COBRA premiums, i.e. California. Insurance companies don't like this arrangement, and have stopped it from being implemented in most states.

3:16 PM  
Blogger Disability Blogger said...

Lovey, thanks for the info.

7:25 AM  

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