Can You Get Medicare/Medicaid Coverage While Receiving Disability Benefits?

by | Published on Sep 4, 2019 | Social Security Disability

Social security disability insurance is a beneficial program that provides financial support for disabled Americans. To qualify for this, the claimant’s medical records should provide clear evidence of the disability that prevents him/her from working and earning a living. Reviewing medical records is a comprehensive process that involves processes such as medical record organization, medical summary preparation and so on. Can a person applying for or approved for SSDI (Social Security Disability Insurance) or SSI benefits receive Medicare / Medicaid along with their monthly social security disability payments?  The answer is ‘yes’ . They will be enrolled automatically in Medicare when they become eligible.

In most cases, the claimant will become eligible for Medicare after he or she has been receiving SSDI benefits for 2 years. Some may qualify for Medicare immediately if they have certain specific qualifying conditions such as End Stage Renal Disease (ESRD) or Amyotropic Lateral Sclerosis (ALS, also known as Lou Gehrig’s disease). To qualify for Medicare, people with the above 2 conditions must meet the following requirements.

  • ESRD – 3 months after a course of regular dialysis begins or after a kidney transplant
  • ALS – Immediately upon collecting SSDI benefits

Typically, you are enrolled in both Part A and Part B – Part A covers hospitalization and emergency services and does not cost you anything whereas Part B charges a modest premium. You can choose to opt out of Part B. SSDI benefits recipients are also eligible for Part C (Medicare Advantage Plans) and Part D (Prescription Drug Coverage).  Medicare Part C and Part D are sold and supervised by private insurers, typically insurers that offer health insurance.

Here are some important considerations.

  • A person qualifying for Medicare based on SSDI eligibility will be covered under Medicare only as long as he/she receives social security disability benefits.
  • If their condition improves to a point when they are no longer considered disabled by the SSA (Social Security Administration)’s definition of complete disability, the Medicare coverage could also stop.
  • Sometimes, you may qualify for both SSI and SSDI (concurrent benefits), and this happens when you are approved for SSDI but receive only a low monthly payment. If you also receive SSI (Supplemental Security Income), you may be eligible to have part of or all of your premiums for Medicare Part B reimbursed. The amount reimbursed would depend on your financial need.

Social security disability applicants qualifying for SSI alone will receive Medicaid benefits, not Medicare benefits. Medicaid is handled at the state level, and there is no 2-year waiting period to qualify. The applicant must meet the income guidelines and other requirements applicable. A needs-based, state- and county- administered program, Medicaid covers a number of doctor visits and prescriptions, and nursing home care under certain conditions each month. SSI recipients could receive Medicare benefits as well, but only when they reach the age of 65. They can file an “uninsured Medicare claim” when they turn 65. The state they reside in would pay the medical premiums for them to be in Medicare. It saves the state the cost of Medicaid coverage.

Disability applicants can consider hiring the services of a social security disability attorney to determine their eligibility for disability benefits and Medicare. Experienced attorneys utilize medical review solutions to find out whether the applicant’s condition meets the SSA’s definition of disability. Among the 63.6 million people who received social security benefits in June 2019, more than 10 million are disabled. As mentioned earlier, some disability recipients may be approved for concurrent benefits and often there is confusion regarding whether they will receive Medicare or Medicaid. In such cases also, an attorney can help applicants contact their local Social Security office.

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