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Social Security Disability and Medicare

Social Security Disability and Medicare

Recently, we discussed advantages to qualifying for concurrent benefits, or the ability to receive Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) at the same time. If you qualify solely for SSI benefits, you are eligible to receive Medicaid coverage, and there is no waiting period to begin receiving coverage. If you qualify for SSDI or SSDI and SSI benefits, you are eligible to receive Medicare coverage, but there is a two-year waiting period. The waiting period is calculated from the date you became eligible for SSDI payments, which is usually the date your disability first began plus the five months that SSDI makes you wait before you begin receiving monthly benefit payments.

What is the purpose behind awarding health insurance to recipients of disability benefits? For many disabled Americans, if they did not receive medical assistance, their medical expenses might threaten or eliminate entirely their monthly disability benefits payments.

In the regular course of life in America, Medicare provides health insurance for citizens age 65 and older. In certain circumstances, however, people under age 65 who are disabled and individuals with End-Stage Renal Disease (ESRD) and Amyotrophic Lateral Sclerosis (ALS) can also qualify for Medicare coverage.

You may be familiar with the different “Parts” of Medicare. Here, we will focus on three of them, Part A, Part B, and Part D. We will also discuss Medicare Supplement Insurance, or Medigap.

Part A provides hospital insurance and some medical and hospital expenses. Most people who qualify for Medicare coverage do not pay for Part A benefits. Part B provides comprehensive medical insurance. Most people who qualify pay monthly for Part B benefits. Together, Parts A and B represent “Original Medicare.”

If you already have medical insurance, you can opt-out of Plan B enrollment, but if you decide to enroll later, it will likely cost you more money. Before you decide to opt-out, make sure the company you work for has at least 100 employees; if it does, your employer’s health insurance will be your primary coverage. If your company does not employ at least 100 people, Medicare will be your primary health insurance coverage, and you will need to enroll in Plan B.

Part D deals with prescription drug costs, and coverage requires payment of a monthly premium. If you choose not to enroll when you become eligible but decide to enroll later, you will have to pay an initial penalty and continue to pay a penalty for as long as you maintain Plan D coverage.

Anyone who qualifies for and is approved to receive SSDI benefits will also be eligible for Medicare insurance coverage, usually after a 24-month waiting period. While you are waiting to receive Medicare coverage, you may be eligible for health insurance coverage through your former employer. The two exceptions to the waiting period are for ESRD and ALS. For ESRD, you are eligible for Medicare coverage either three months after a course of regular dialysis or after a kidney transplant. For ALS, you are eligible for Medicare coverage immediately upon collecting SSDI benefits.

In most states, anyone who is approved for SSI benefits is automatically approved to receive Medicaid coverage. But some states may have lower income or asset limits for their Medicaid programs, so they make their own Medicaid determinations independent of SSI qualifications. Since Medicaid is a needs-based program designed to provide health insurance to the most destitute Americans, the hope is that, in combination, SSI recipients will be able to provide for basic necessities such as food and clothing as well as their health. Medicaid also offers “Extra Help” to assist with drug costs. Extra Help covers the cost of a prescription drug plan, which includes prescription co-pays and monthly premiums.

Many people want to know how Medicare and Marketplace health insurance plans are affected by disability benefits. If you are receiving Medicare coverage because of your SSDI benefits, you cannot enroll in a Marketplace plan to supplement or replace your Medicare coverage. If, however, you were already enrolled in a Marketplace health insurance plan and are waiting for your Medicare coverage to begin because of the two-year waiting period, you may maintain your Marketplace plan. You can also talk to your local human services agency to determine if you are eligible for Medicaid while you wait for Medicare coverage to take effect.

If you did suffer from twelve continuous months of a disability, but you’ve responded to treatment and want to explore the possibility of going back to work for a trial period, speak to your attorney or your local Social Security office first to confirm how many hours you are allowed to work and still retain your SSDI benefits. Even if you do return to substantial gainful activity, you will remain eligible for Medicare for seven years. And it is a good idea to see if your spouse or other dependents qualify for Medicare coverage based on your SSDI benefits.

There are no underlying conditions or illnesses that disqualify you from Medicare. But sometimes that coverage isn’t enough. If that is the case, consider purchasing a Medigap or Medicare Supplement Insurance plan from a private company if you are under age 65, disabled, and qualify for disability benefits. 27 states require Medicare Supplement Insurance companies to sell at least one Medigap policy to Medicare beneficiaries under age 65, including New York. These policies are designed to help pay for things that Original Medicare does not cover, such as deductibles, copayments, and coinsurance.

Medigap presents challenges to people receiving Medicare coverage because of a disability. You will probably pay more for the plan than people over age 65 do, and you may have to settle for a plan that is not as comprehensive. Additionally, if you live in one of the states where a Medicap policy is not a requirement for Medicare Supplement Insurance companies to offer, you might be denied coverage altogether. As a result, premiums for Medigap plans can vary widely across states.

If you have any questions on which benefits you are entitled to, speak with a trusted disability attorney.