It is not uncommon for many Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) applicants to need medical care more than they need the monthly cash
assistance of disability payments. Medical costs have skyrocketed and finding affordable healthcare is challenging, even for employees who are able to work and receive insurance through their employer.
But what if you are unable to work? What are your options for insurance and medical care? The Federal Government offers two medical insurance programs to qualifying applicants- Medicare and Medicaid.
What is Medicare and can I get it?
According to the Social Security Administration (SSA), “Medicare is our country’s health insurance program for people age 65 or older. Certain people younger than age 65 can qualify for Medicare, too, including those who have disabilities and those who have permanent kidney failure. The program helps with the cost of health care, but it does not cover all medical expenses or the cost of most long-term care.”
So can SSDI or SSI applicants get Medicare if they are approved for disability benefits? SSDI recipients can, but they will have to wait 24 months from the date of their disability. SSI recipients will not, however, receive Medicare, but they will receive Medicaid, in most states, at the time of their approval.
What happens if you are denied SSDI benefits and you are under the age of 65? Do you qualify for Medicare? Unfortunately, the answer is no. There may be other private insurance options or you can attempt to pay cash for medical care, but Medicare is not an option.
What is Medicaid and can I get it?
Medicaid was created under Title XIX of the Social Security Act in 1963. Its main objective is to help low-income families and children have access to affordable health care. Many states also provide Medicaid to low-income pregnant women and children under the age of one.
States administer their own Medicaid programs, although the funding comes from state and federal government programs. Eligibility guidelines are also determined by the state.
Supplemental Security Income (SSI) recipients may, in many states, get Medicaid automatically when they are awarded SSI benefits. Some states require SSI recipients to file a separate Medicaid application form, and the remaining states do not automatically award Medicaid to SSI recipients unless they meet other criteria.
What if I am denied SSI or SSDI, am I still eligible for Medicare or Medicaid?
As mentioned above, SSDI applicants who are denied SSDI benefits will not be awarded Medicare because they are not 65 years or older nor disabled. SSI applicants who are denied SSI benefits may still qualify for Medicaid but it will depend on the requirements determined by their state.
What are my options if I cannot get Medicaid or Medicare?
On our disability forum many disability claimants ask, “How do I get medical care if I cannot afford insurance?” This is probably one of the toughest questions to answer because there is not a good answer.
Some doctors will take cash payments for basic medical services, but if a claimant is out of work they may not have any money. Without good medical care it is tough to prove a claimant is disabled. Unfortunately, the system is broken.