Receiving Medicare and Medicaid with Disability Benefits

Oftentimes, the complications that come with a disability can be overwhelming, and many require help from family, friends and a disability representative with the application process for benefits. Qualifying for Social Security Disability Insurance (SSDI) or Supplemental Security Insurance (SSI) benefits is a deciding factor in determining if you will receive Medicare or Medicaid coverage. This can be a stressful process, but simply put, it is most often as follows: if you receive SSDI, you get Medicare, and if you receive SSI payments, you get Medicaid.

Each have different policies for those receiving disability benefits. In this article, we break them each down so you can determine which (or both, if applicable) that you are potentially eligible for:

Medicare Eligibility

For Medicare, there is a 2 year waiting period after your SSDI entitlement date before your Medicare coverage begins. This is a measure that has been in effect since Medicare's rules were adjusted to award coverage to those with disability benefits. In some situations, the SSA awards retroactive benefits, which can be awarded for up to 12 months prior to the date you submitted your application for disability. Either way, you must be eligible for disability benefits for at least 24 months before receiving Medicare.

There are exceptions to this rule, which include permanent kidney failure (with maintenance dialysis or a kidney transplant), amyotrophic lateral sclerosis (ALS) or Lou Gehrig’s disease. Having one of these conditions will eliminate your waiting period considerably, and make you automatically eligible.

You also may have heard that there are multiple “parts” to Medicare. These parts are as follows:

• Part A is free hospital insurance that pays for “inpatient care in a hospital or skilled nursing facility,” as well as hospices and selective home health care

• Part B is an optional medical insurance that requires a monthly premium and helps pay for doctor and outpatient care

  Part D is prescription drug coverage that helps pay for prescribed medication (this also requires a monthly premium payment)

Medicaid Eligibility

For Medicaid specifically, as it is federally funded but state-administered, the eligibility requirements differ from state to state. Some states, such as Florida and Georgia, have automatic Medicaid eligibility if you are receiving Supplemental Security Income (SSI) benefits. Other states, like Virginia and Ohio, have individual credentials and criteria for SSI, as well as Medicaid.

Medicaid provides hospital and medical coverage for people with low income and limited resources, hence why you need to be receiving SSI payments in order to be eligible. Is that the only way you can become eligible for Medicaid? Not at all! There are annual federal funds that are appropriated according to the current standard-of-living, which are used to determine if you are approved (as well as other factors).

Be aware that, if you are eligible for SSI payments, you automatically receive Medicaid at no cost to you. For more details about this, it is wise to contact your local state or county human services department to learn about the programs that may apply to you.

Key Takeaway

You may qualify for just SSDI, SSI or both — it’s difficult to discern without a full overview of your living situation, whether you’re married, your medical records, as well as a slew of other requirements. It’s important to consult with a trained disability professional in order to fully understand your rights to medical care alongside your disability benefits.