What If Your Doctor Only Accepts Medicare And Not Medicaid
Doctors are not required to accept Medicaid payment. Why? It requires more paperwork for them, and Medicaid reimbursements can be less than other forms of insurance. What can you do?
- Remember that there are more than 70 million people on Medicaid. Therefore, many doctors are indeed treating people with Medicaid coverage.
- If you already have a doctor you like, explain to him or her that you recently received Medicaid. They may continue to see you as a patient, even if they are not accepting other new patients on Medicaid. After all, you are an established patient of theirs.
- You may have to put a little effort into finding doctors in your area who accept Medicaid payment. Try searching the physician finder websites in your area, ask your Medicaid contact person, and call individual doctors offices.
- If a doctors office says they dont accept Medicaid, ask for a referral to a practice that does accept new Medicaid patients.
Will I Have To Pay Taxes On The Social Security Disability Benefits I Receive
Probably not, but this depends on the amount of your total income. Most people wont have to pay taxes on their Social Security disability benefits. Couples whose combined incomes exceed $32,000 and individuals with income exceeding $25,000 will pay income tax on a portion of their Social Security disability benefits. The IRS has an odd way of figuring out total income for this rule. The IRS uses adjusted gross income as reported on Form 1040, plus one-half of the total Social Security benefits received for the year, plus non-taxable interest.
Single people with incomes over $34,000 and married people with incomes over $44,000 pay tax on a higher percentage of their Social Security disability benefits.
Heres an odd thing: People whose Social Security benefits are reduced because of the workers compensation offset or offsets for other public disability benefits must count the amount of Social Security benefits not paid when determining taxability of their benefits. But if a child receives benefits on a parents account, those benefits count only for determining if the child must pay taxes on Social Security benefits received.
Tax law is very complex. Please talk to a tax specialist if you have any questions about taxes on your Social Security benefits.
How Can I Discuss My Situation With A Disability Lawyer
If your spouse already receives disability benefits and you believe you may also qualify, the legal team from Berger and Green can help. We can explain how your approval could affect your familys current benefits and look over your application before you file your claim. If the SSA denied your benefits, we can look into why and fight for the monthly payments and back benefits you deserve. Call us at for a free consultation.
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How Are My Health Care Costs Reimbursed If I Have Medicare And Medicaid
When dual eligible beneficiaries have healthcare expenses, Medicare pays first and Medicaid pays last. But this is not the case for things Medicare doesnt cover, like long-term care. If Medicaid is covering a beneficiarys long-term care, Medicare will still be the primary payer for any Medicare-covered services like skilled nursing care or physical therapy.
Although it is less common, if a dual eligible individual has additional coverage then Medicare pays first, Medigap will pay second, and Medicaid is the last payer for their claims .
Do I Have To Take Part B
You are not required to take Part B, and some people choose to delay. Deciding to opt out of Part B at this time is a personal choice and depends on your unique situation. about whether or not you should take Part B when you qualify for Medicare with a disability. Some people who qualify for Medicare under age 65 due to disability but are covered under an employers plan or a spouses employer plan, may opt to delay.2
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When Will My Medicare Begin
In most situations you can receive Medicare disability benefits once you receive Social Security disability income benefits for 24 months. Medicare disability coverage begins the 25th month. The 24-month period begins the month you are entitled to receive Social Security disability benefits. In some cases this could be earlier than the month you receive your first disability benefit check. A person who has ALS and is under age 65 can get Medicare benefits the first month he or she is entitled to SSDI or railroad retirement disability benefits. If you have ESRD , you are eligible for Medicare benefits:
- the first month you start to administer a regular course of dialysis treatment after receiving selfcare training, or
- the fourth month you receive treatment at a dialysis center , or
- the month the transplant is done or the month of hospitalization as an inpatient up to two months before the transplant, if pre-transplant testing has begun.
Health Resources For People With Disabilities
Federal, state, and local government agencies and programs can help with your health needs if you have a disability.
Explore the Disability and Health section of CDC.gov for articles, programs, tips for healthy living and more.
Learn more about assistance and benefits for people with disabilities from the Social Security Administration.
Contact your local city or county government to find out what medical and health services are available locally for people with disabilities.
Your state social service agency can help you locate medical and health programs.
Visit USA.govs Government Benefits page to learn more about government programs and services that can help you and your family.
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How Do I Know If I Should Be Dual Eligible
Beneficiaries can find out if theyre eligible for Medicaid by contacting their Medicaid office. An Internet search for Medicaid offices in a beneficiarys state should provide the number to call but beneficiaries should make sure they are contacting a government office before sharing any personal information.
The Centers for Medicare and Medicaid Services also maintains a list of state agencies that oversee Medicaid. Beneficiaries can see if they already have Medicaid by contacting 1-800-MEDICARE and asking whether they receive Extra Help with their prescription drug costs .
Will Medicare Offset Workers Compensation Medical Benefits
The Medicare Secondary Payment Act provides that Medicare is the second payer on any medical expenses where an insured has other coverage liable for the expenses. If the medical expense is directly caused by the work injury, its the employers workers comp insurer that is responsible to pay the expense.
Things might get a little more complex if medical benefits are included in a workers compensation settlement, which may end the workers rights to future workers comp benefits. Medicare may request these funds designed for medical expenses be set aside so the worker can use them instead of relying on Medicare to pay medical expenses.
The American Bar Association has advocated for Congress to pass legislation that addresses the uncertainty that can accompany these cases to return an appropriate level of certainty, predictability, and efficiency to the Medicare set aside process.
Injured workers can learn more about how the intersection of workers compensation, Social Security disability, and Medicare rules and regulations affects their case by talking with an attorney. Markhoff & Mittman can navigate you through difficult areas of workers compensation as well as Social Security disability.
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Can You Work While On Disability
The only way an individual qualifies for Disability benefits is if they are able to prove they cannot engage in substantial gainful activity . This means that you make under a certain monetary amount each month, deemed substantial earnings by the Social Security Administration. Therefore, most recipients receive SSDI benefits in place of working. However, the following exceptions make working while on SSDI possible.
Ssdi And Other Disability Benefit Programs
Many people who are on SSDI benefits are also eligible for other disability benefits programs like Medicare or Medi-Cal. Its important to understand how these different programs interact as benefits from one program may impact eligibility for another program.
If you have questions about how programs interact with each other, talk to a benefits planner. You can also use the DB101 Benefits and Work Estimator for estimates on how working may impact your SSDI benefits and other benefits.
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Will I Receive A Notice From The Social Security Administration Explaining My Benefits
Yes. That notice is usually called a Notice of Award. This notice will show the date of entitlement and the amounts of benefits for all months of back benefits. It will show the total amount of benefits to be paid to you. It will show the amount of benefits withheld for direct payment of attorneys fees. It may also give you information about your Medicare eligibility and monthly Medicare premium. It may also give you some information about when to expect a continuing disability review.
Can I Be Enrolled In Medicare And Medicaid At The Same Time
Q: Can I be enrolled in Medicare and Medicaid at the same time?
A: In many cases, yes. Some Americans qualify for both Medicare and Medicaid, and when this happens, it usually means they dont have any out-of-pocket healthcare costs.
Beneficiaries with Medicare and Medicaid are known as dual eligibles and account for about 20 percent of Medicare beneficiaries . Dual eligibles are categorized based on whether they receive partial or full Medicaid benefits.
Full-benefit dual eligibles have comprehensive Medicaid coverage, while partial benefit dual eligibles receive help with Medicares premiums and cost sharing through a Medicare Savings Program .
The federal government oversees Medicare eligibility meaning it is the same in each state. But states set their own eligibility rules for Medicaid and the MSPs and income limits for these programs vary widely.
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Benefit Amount And Colas
Social Security applies a complex formula to your lifetime earnings to arrive at your benefit amount. Whether its for disability or retirement, the benefit is the same. If you draw disability at age 62, you have the option to start taking early retirement however, the retirement benefit will still be reduced. If you start early retirement and then become disabled, Social Security will make up the difference between the reduced and full benefit amount.
In some years, both disability and retirement recipients are given cost of living adjustments, or COLAs, to help their benefits keep pace with inflation.
How Do Ssdi And Social Security Retirement Work Together
SSDI pays out your full retirement benefits until you qualify to draw them under the traditional Social Security retirement scheme. Once you reach full retirement age based on the year you were born, the SSA will automatically start your retirement benefits and cease your SSDI payments.
The SSA allows you to file for retirement benefits as early as age 62, or wait and receive your full benefit amount when you reach full retirement age. Depending on what year you were born, this may vary from 65 to 67 years old. For most people, it does not make sense to file for early retirement benefits at age 62 if you are already receiving SSDI because of a disability. Your disability payments equal your full retirement amount, and those who opt for early retirement receive reduced benefits.
Imagine that, at age 60, you suffer a back injury leading to a disability. You are approved for SSDI benefits and you begin drawing an amount equal to your full retirement amount. When you reach age 62, nothing changes you continue to draw your full SSDI amount. Once you reach your full retirement age, the SSA swaps you from SSDI to traditional retirement benefits. However, this occurs automatically so you will not see a break in your benefits and do not need to do anything to ensure this happens.
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Dual Special Needs Insurance
Even better, some insurance companies offer Medicare insurance packages specifically designed to work with your Medicaid dual-eligible status.
How so? If you have certain chronic health conditions , you may be better served by one of the dual special needs Medicare insurance plans that have extra benefits to address those specific conditions.
When Does Social Security Pay More Than Disability
The reverse of the above situation is if you are between your FRA and age 70. After you reach your FRA, your Social Security benefit amount increases by 0.8% for every month you hold off on electing. This continues until you reach 70, at which point your benefit reaches its maximum. In this situation, your monthly Social Security benefit would be larger than your monthly Disability benefit.
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When Disability Benefits Will Stop
There are three separate occasions when Social Security disability benefits stop. The benefits will stop:
When you are no longer disabled. If your condition changes such that your disability is no longer considered to be severe or debilitating enough to preclude you from working, your benefits will end. For instance, if you qualified for disability for cancer but you have completely recovered, expect your benefits to stop.
When you reach retirement age. When you reach the age of 65, your Social Security disability benefits stop and you automatically begin receiving Social Security retirement benefits instead. The specific amount of money you receive each month generally remains the same.
When you being to earn too much money. There are limits on the amount of income you can earn when receiving SSDI payments or SSI .
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What If We Do Not Qualify For Ssdi
Both spouses can get approved for SSI as long as they are disabled and the household income meets Social Security requirements.
SSI is a need-based program. Only those with extremely low incomes and few assets are eligible for benefits. Unlike SSDI, which looks at only an individuals earned income, SSI considers almost any income that comes into your household. This would include your spouses SSDI or SSI payments. If both spouses are on SSI each will get a reduced amount because there is an SSI limit for spouses living together.
Depending on your situation, you could even lose your current SSI benefits if your spouse gets SSDI. The additional income could push you over the cut off for SSI.
If your spouse qualifies for SSDI but you lack the necessary work historybut you meet the other program qualificationsit may be possible to get approval for SSI if you meet the income and resources guidelines. Our attorneys can determine if you qualify in this situation.
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Speeding Up An Ssdi Application
Your application for SSDI is likely to move more quickly if you select one doctor as the lead contact for your case. It’s best to go with one who:
- Has experience with disability cases
- Responds promptly to requests for information
- Is familiar with your overall health situation
It’s also a good idea to keep a detailed log of your everyday activities and experiences.
For example, document any difficulties you have with mobility or side-effects you are experiencing from medications. This will help when you have your interview with a Social Security representative. The interview may take place on the phone or in person at your local Social Security office.
The SSA website provides an easy-to-use Disability Starter Kit that includes FAQs, a checklist, and a worksheet to help you get ready for your interview. You can save time during your interview if you fill out the needed applications online before your appointment.
According to the SSA, most applications are processed within three to five months.
Getting And Keeping Dac Medi
Any individual described above who qualifies should be able to get Medi-Cal either as a continuing benefit when she loses SSI or, if later, as a new applicant under the Medi-Cal DAC Program. The state periodically sends counties lists of Title II DAC recipients whose SSI/SSP has been or is being terminated. The counties are required to contact the recipients to see if they need assistance in completing the forms required for the application process. Eligible individuals should remain eligible as long as they meet all the other SSI eligibility rules. DAC Program Page 84 Non Magi Medi-Cal 3.71
Eligibility Group Requirements*: An individual who was receiving Supplemental Security Income benefits and who meets the following:
Is at least 18 years of age Has blindness or a disability which began before the age of 22 Has been receiving Supplemental Security Income based on blindness or disability and Has lost Supplemental Security Income due to the receipt of Social Security benefits on a parents record due to the retirement, death or disability of a parent.
Resources & Links
When a person receives SSI and one of their parents retires, becomes disabled, or dies, the person switches from receiving SSI to receiving SSDI. Sometimes a person can receive both SSDI and SSI.
- Our webpage on Special Needs Trusts
DAC #Retirement Survivor Benefits
Who can get survivors benefits based on a spouses or parents work records?
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