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SSDI and Health Insurance Coverage: Medicaid/Medicare

For those who qualify for Social Security disability insurance (SSDI), health insurance benefits may be available through the Medicaid or Medicare programs. Eligibility requirements must be met to receive SSDI and health benefits, with which a Social Security disability attorney in Dunn, NC can help.

Eligibility Requirements for SSDI

To qualify for SSDI benefits, an individual must be unable to work for at least a year due to a mental or physical condition, or the condition must be expected to result in death.

Disability benefits through the Social Security Administration (SSA) are based on the length of time the individual paid into Social Security and his or her salary prior to becoming disabled. Sometimes the amount can be reduced if the person also receives other payments, such as Workers’ Compensation.

Eligibility Requirements for Medicaid

Those who qualify for SSDI may qualify for health insurance through Medicaid if they have low income. Because SSDI benefits aren’t dependent on earnings, someone could be disabled and still ineligible for Medicaid.

An example where this may apply is if the SSDI recipient’s benefit amount is significantly high or if a spouse’s salary is higher than the income requirements for Medicaid.

Unlike many Supplemental Security Income (SSI) recipients who automatically may qualify for Medicaid, anyone who receives SSDI will have to prove they have limited assets. Proof of income and assets, along with the approval letter for disability from the SSA, will need to be presented.

Eligibility Requirements for Medicare

For those who qualify for SSDI, health insurance through Medicare is available automatically after two years. If disability payments stop or the person is considered to be disabled no longer, eligibility is not guaranteed.

Unlike Medicaid in which co-pays aren’t required, they are required for many of the services offered through Medicare. This program doesn’t cover all medical costs, including long-term care. However, it’s important to note that some individuals will qualify to receive Medicaid and Medicare.

Those who receive SSDI don’t have to apply for Medicare. They will receive information regarding the program and how to sign up once the two-year mark arrives.

Because it can take months before a decision is made on qualifying for SSDI (resulting in back payments), the two-year waiting period may have been nearly met, or a significant period of time may have gone by when approval for benefits is given. For instance, an individual might have become disabled in February 2012 and applied for disability, which requires a five-month waiting period before SSDI entitlement begins (July 2012).

If it took until February 2013 for the SSA to approve the application, 12 months would have passed from the time the individual became disabled, and seven months would have passed since the entitlement date. So the two-year mark at which Medicare is available would be July 2014. From the time the individual begins receiving SSDI, health insurance may be available in 17 months instead of 24.

Another scenario is when a disability claim is denied, and the claimant appeals the decision. The appeals process can take so long that by the time an individual is approved for SSDI benefits, he or she automatically may qualify at the same time for Medicare.

Keep in mind, there may be exceptions to the two-year waiting period. Recipients of SSDI may receive health insurance through Medicare right away or within the first few months if they have been diagnosed with amyotrophic lateral sclerosis (ALS) or end-stage renal disease (ESRD) with kidney failure.

Medicare is also available to individuals who are 65 and older, so those who are at least this age and receive disability benefits would be entitled to it right away.

Find Help from a Social Security Disability Attorney in Dunn, NC

A Social Security disability attorney in Dunn, NC can assist disabled individuals who wish to apply for SSDI benefits and who wish to discuss SSDI and health insurance coverage.