SSDI and Medicare
Can I get Medicare?
One of the main concerns for workers who are no longer able to work and who have a severe health condition is medical insurance. Sometimes the availability of medical insurance is more important to the claimant than the actual benefit payments.
The Social Security Administration (SSA) offers medical insurance through two separate programs: Medicare and Medicaid. This blog will specifically address issues related to Medicare benefits and who may qualify for these benefits.
What is Medicare?
Medicare is offered by the United States Federal Government to individuals who are 65 years of age or older. Can you get Medicare if you qualify for Social Security Disability Insurance (SSDI)? Yes, certain disabled claimants will qualify for Medicare including those who are considered disabled (including those who have permanent kidney failure or amyotrophic lateral sclerosis (Lou Gehrigs disease)) and who are receiving Social Security Disability Insurance (SSDI). Claimants who receive Supplemental Security Income (SSI) will not qualify for Medicare, but instead, in most states, will be offered Medicaid at the time of their approval.
According to the Social Security Administration, Medicare is financed by workers payroll taxes and by monthly premiums deducted from Social Security Checks. Qualifying applicants may apply for Medicare through the Social Security Administration (SSA) but the agency which administers this benefit is the Centers for Medicare & Medicaid Services.
What Benefits Does Medicare Offer?
The Social Security Administration has several brochures and packets which explain Medicare and the benefits offered. Contact the Social Security Administration at 1-800-772-1213 for more information or visit their website at www.ssa.gov.
Medicare has four parts:
- Part A is the hospital insurance this type of coverage helps pay for care at a nursing facility or a hospital. Additionally, this benefit may also pay for hospice care or home health care.
- Part B is the medical insurance this benefit will cover the costs for doctors visits and medical supplies.
- Part C is the Medicare Advantage If a claimant receives Parts A and B they can choose to receive their services through a provider organization.
- Prescription Drug Coverage this type of coverage helps to pay for prescription medications.
Medicare will not cover the cost of all medical procedures or long-term medical care.
How does Medicare differ from Medicaid?
If you are receiving Supplemental Security Income (SSI) you will not receive Medicare, but instead, in most states, you will receive Medicaid. This program is state run and provides insurance coverage for doctors and hospital visits for claimants with very limited income and resources. It is possible for qualifying claimants to receive Medicaid even if they are not receiving Supplemental Security Income (SSI).
Keep in mind states have created their own rules for Medicaid eligibility. If you are receiving Supplemental Security Income (SSI) some states will automatically award Medicaid, some states require you to apply separately and other states have created their own eligibility rules for Medicaid and Supplemental Security Income (SSI) recipients may not automatically qualify.
Receiving Social Security Disability Insurance, when will I get Medicare?
This is a confusing question for many claimants who have been awarded Social Security Disability Insurance (SSDI). If you are receiving SSDI you are eligible for Medicare but you will not receive it until 24 months from the date of your disability.
- SSI and Medicaid Benefits (disabilitybenefitshome.com)
- SSDI and expediting Disability Reinstatement (disabilitybenefitshome.com)
- Social Security Disability - What changes do I report? (disabilitybenefitshome.com)
- Disability Lawyer and Disability Advocate - What is an Authorized Representative? (disabilitybenefitshome.com)