Medicaid vs. Medicare & How SSDI or SSI Benefits May Apply

Medicaid, Medicare and SSDI are government programs that may help those with disabilities receive healthcare services and pay for basic necessities. Medicaid and Medicare are government healthcare programs that may be available, depending on the individual’s circumstances. Those who receive Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) for their disability could be eligible for one or even both healthcare programs.

Coverage under Medicaid

With Social Security disability, Medicaid is not guaranteed. This type of government health insurance covers low-income people who are blind, disabled or elderly. In some states, Medicaid is automatically given to those who qualify for SSI. This includes the state of North Carolina.

The following are eligibility requirements for Medicaid:

  • recipients must be disabled;
  • Medicaid is necessary in order to work;
  • Recipient is eligible to receive at least one month SSI payment; and
  • gross earned wages aren’t enough to replace Medicaid or SSI.

The following are some of the services that Medicaid covers:

  • long-term care;
  • X-rays and lab work;
  • health clinic services;
  • hospital services;
  • nursing facility services; and
  • dental and vision for children.

Coverage under Medicare

A lot of people wonder if they get Medicare with their Social Security disability. Medicare covers some disabled persons and those who are 65 and older. For instance, anyone who receives SSDI automatically will qualify for Medicare after two years. However, some disabilities (such as end-stage renal failure) provide immediate availability of Medicare.

Coverage depends on whether an individual has Part A or Part B. Part A is hospital insurance, which generally doesn’t have to be paid. It covers things such as hospice, home healthcare and skilled nursing facilities.

Part B is medical insurance, which the recipient must pay. It covers medical equipment, physician services, outpatient care and some types of preventive services.

Talk to an attorney about how disability insurance may affect availability of government health insurance. While some SSDI recipients qualify for Medicare after the two-year period or if their conditions allow for immediate eligibility, if income is low enough and there are limited assets, they also may be entitled to Medicaid, in addition to Medicare and SSDI. 

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