Social Security Disability Insurance (SSDI) provides access to Medicare benefits after individuals have been eligible to receive SSDI payments for two years. People receiving Supplemental Security Income (SSI) usually receive healthcare coverage through Medicaid. Here, we discuss Medicaid and whether it is available to SSDI beneficiaries in certain circumstances.
Medicaid is healthcare coverage designed for low-income and needy people that is jointly funded at the federal and state levels, but the Center for Medicare and Medicaid Services oversees administration of the program. Medicaid also provides coverage for the aged, the blind, children, the disabled, and others who are eligible to receive income maintenance payments from the federal government.
In 35 states and the District of Columbia, you are automatically eligible for Medicaid if you qualify for SSI benefits. In Connecticut, Hawaii, Illinois, Minnesota, Missouri, New Hampshire, North Dakota, Oklahoma, and Virginia, however, you have to file a separate application just for Medicaid.
You can only qualify for Medicaid if you meet your state’s definition of low-income. Although Medicaid eligibility rules vary from state to state, many states use the federal poverty level as the income threshold. In 2020, the federal poverty level was $12,760 for a household of one person.
For most categories that determine Medicaid eligibility, the program has strict income thresholds, and Medicaid determines a household’s income through a tax-based measure of income that is called modified adjusted gross income (MAGI). For MAGI purposes, Social Security retirement, disability, and survivors’ benefits count as income.
As you can imagine, instances arise where SSDI recipients make too much money to qualify for Medicaid but also have not been receiving SSDI benefits for long enough to qualify for Medicare. To avoid going without health insurance, buy-in and spend-down programs exist in some states to help “over-income” individuals qualify for Medicaid coverage while they wait for Medicare.
Buy-in programs allow low-income individuals get Medicaid coverage for an affordable premium. In general, they are limited to disabled low-income individuals who are still working, but the “work” requirement is interpreted loosely and can be as little as one or two hours each month.
Spend-down programs allow people to qualify for Medicaid when they, their spouses, or their children have high medical expenses. These expenses can be ongoing or past-due. If you think that you might qualify, you should contact your state’s Medicaid agency.