Tuesday, April 16, 2024

Do You Get Medicare With Social Security Disability

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Medicare Enrollment For Ssdi Recipients

Do I Get Medicare If I’m Getting Social Security Disability Benefits?

To become eligible for Medicare based on disability, you must first qualify for Social Security Disability Insurance. SSDI pays monthly benefits to people with disabilities who might be limited in their ability to work. If you are injured or have a medical condition that limits your ability to work, you may be eligible for SSDI.

How To I Know If I Get Ssi Or Ssdi

There are couple of ways you will know if you get SSI or SSDI. For example, if you at one point could work, but you can no longer work anymore because of a disability or a serious ailment like cancer, you will most likely get SSDI.

That is because SSDI eligibility is based on the severity of your disability and if you have enough work credits through your own employment.

The way you know if you will get SSI, is that if you have a disability or a serious ailment and with limited or no income and resources.

If you have very little income and resources, plus you get a low monthly payment from SSDI, there is a chance that you can qualify for SSI as well. To which you will be able to receive concurrent disability benefits from the SSA.

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D And Medicare Advantage Costs

The coverage from parts A and B does not include prescription drug costs. Coverage for prescribed medication is known as Medicare Part D.

A person may wish to include Part D as part of their plan, or they may decide to explore available options through Medicare Advantage.

Enrollment in one of these plans is possible, but it must be within a certain time frame.

The cost of premiums can vary depending on the extent or level of cover required and the persons geographical location.

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In Which Statesis Medicaid Enrollment Automatic

The Social Security Administration handles Medicaid enrollmentfor the many states in which Medicaid eligibility is automatic for SSIrecipients. Your state will contact you with information after you receive yourSSI award letter from Social Security. These states are:


North Carolina


Note that SSI recipients in Indiana will be automatically enrolled in Medicaid starting on June 1, 2014. At that point, Indiana switches from being a 209 state to an automatic enrollment state.

Enrolling In Part D With Medicare Disability

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You arent automatically enrolled in Part D. If you want prescription drug coverage, you need to buy a plan during your Initial Enrollment Period, which extends six months after your Medicare effective date. As soon as you get your Medicare ID, you can shop for Part D plans in your area using the Medicare Plan Finder.

If you take daily medications, be sure to enter them into the screening tool. By doing so, youll be able to see how much youll pay for each prescription drug and find the most cost-effective coverage.

If you choose Medicare Advantage, Part D is generally included in your plan.

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How To Enroll In Medicare With A Disability

The first step to getting Medicare coverage if you have a disability is to apply for Social Security Disability benefits. Your disability will need to meet the standards set by the Social Security Administration to qualify for coverage. Generally, this means you are unable to work and that your condition is expected to last for at least a year.

Medicare doesnt determine who is eligible for disability coverage. You dont need to take any further steps if the Social Security Administration has approved your disability application. Youll just need to wait the required 24 months, and you will be automatically enrolled in Medicare.

Once youve been approved for SSDI, youll be automatically enrolled at the start of your 25th month of receiving benefits. Youll receive your Medicare card in the mail during your 22nd month of SSDI benefits. Once youre eligible, youll have coverage from Medicare parts A and B, also known as original Medicare.

  • Medicare Part A . Part A is used to pay for hospital stays and other types of short-term patient care, such as skilled nursing facilities. People generally dont pay a premium for Part A coverage.
  • Medicare Part B .Part B is used to pay for a wide range of medical services, including doctor and specialist appointments, emergency room visits, ambulance services, medical equipment, preventive care, and some medications. Youll normally pay a monthly premium for Part B coverage.

The Basics About Disability Benefits

The SSDI program pays benefits to you and certain if you are insured. This means that you worked long enough and recently enough and paid Social Security taxes on your earnings. The program pays benefits to adults and children with disabilities who have limited income and resources.

While these two programs are different, the medical requirements are the same. If you meet the non-medical requirements, monthly benefits are paid if you have a medical condition expected to last at least one year or result in death.

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Medicare For Disabled Youth

Children under the age of 20 with ESRD can qualify for Medicare if they need regular dialysis treatment and at least one of their parents is eligible for or receives Social Security retirement benefits.

If your child is over the age of 20, they qualify for Medicare after receiving SSDI benefits for at least 24 months. In the case that your child was disabled before turning 22, is unmarried, and one parent receives Social Security retirement benefits, no work history is required for SSDI.

Children 19 years of age or older who dont qualify for Medicare may qualify for Medicaid. Lastly, children under the age of 18 who dont qualify for Medicare could qualify for a state Childrens Health Insurance Program if their family has a lower income.

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How Medicare Works with Social Security Disability

1. People are eligible for Medicare for different reasons.

Some are eligible when they turn 65. People under 65 are eligible if they have received Social Security Disability Insurance or certain Railroad Retirement Board disability benefits for at least 24 months. If they have amyotrophic lateral sclerosis , theres no waiting period for Medicare. Some people with End Stage Renal Disease may be eligible for Medicare. Its important to know the different ways that people qualify for Medicare so you can help current and former employees and their dependents anticipate their eligibility for Medicare so they can make timely and appropriate decisions about their enrollment.

2. Some people get Medicare Part A and Part B automatically and some people need to sign up for them.

People living in the United States and U.S. Territories who are already collecting Social Securityeither disability or retirementare automatically enrolled into Part A and Part B when theyre first eligible. These people will get a packet of information a few months before they turn 65 or receive their 25th month of Social Security Disability or Railroad Retirement Board benefits. At that time, they can choose to keep or decline Part B, but cant decline Part A unless they withdraw their original application for Social Security and pay back all Social Security cash benefits.

3. Enrolling in Medicare can only happen at certain times.

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How Much Does Medicare Cost On Disability

If you qualify for SSDI, you’ll typically qualify for premium-free Medicare Part A based on your work record. Part B requires a monthly premium , automatically deducted from your Social Security check. You can technically opt out of Part B if you dont want to pay the premiums. Just know that without Part B, youll forego extensive medical coverage. Its usually not a good idea to opt out of Part B unless you have other health insurancelike from an employer.

Who Pays For Disability Insurance Benefits

Workers and employers pay for the DI program with part of their Social Security taxes. Workers and employers each pay a Social Security tax that is 6.2 percent of workers’ earnings up to a cap of $127,200 in 2017. The cap is adjusted each year to keep pace with average wages. Of the 6.2 percent, 5.015 percent goes to pay for Social Security retirement and survivor benefits and 1.185 percent pays for disability insurance. The combined tax paid by workers and employers for disability insurance is 2.37 percent of wages, while the combined tax for retirement and survivor benefits is 10.03 percent, for a total of 12.4 percent.

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Most People Who Are Approved For Disability Benefits Through The Social Security Administration Get Medicare Or Medicaid Eventually

By Bethany K. Laurence, Attorney

Generally, if you are approved for Social Security disabilityinsurance benefits, you will receive Medicare, and if you are approvedfor Supplemental Security Income , you will receive Medicaid. However, thisisn’t true in all states. Medicaid is operated by the states,and the states are allowed to set eligibility criteria that are different thanSSI’s criteria. As a result, whether getting approved for SSI gets you Medicaiddepends on your state, as we’ll discuss below.

The Severity Of Your Disability

Social Security Disability Insurance Work Programs

Not all disabilities qualify for SSDI or Medicare. To receive your insurance benefit, your disability must be severe enough to hinder you from performing substantial gainful activity for at least 12 months. Substantial gainful activity includes any physical or mental task that you are required to perform for your job.

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Number Of Credits Needed For Disability Benefits

To be eligible for disability benefits, you must meet a recent work test and a duration work test.

The number of credits necessary to meet the recent work test depends on your age. The rules are as follows:

  • Before age 24 You may qualify if you have 6 credits earned in the 3-year period ending when your disability starts.
  • Age 24 to 31 In general, you may qualify if you have credit for working half the time between age 21 and the time you become disabled. As a general example, if you become disabled at age 27, you would need 3 years of work out of the past 6 years .
  • Age 31 or older In general, you must have at least 20 credits in the 10-year period immediately before you become disabled.

The following table shows how many years of work credits you need to meet the duration of work test based on your age when your disability began. For the duration of work test, your work does not have to fall within a certain period. The table only provides an estimate of how many work credits you need. It does not cover all situations. If you are statutorily blind, you must only meet the duration of work test. When statutory blindness is involved, there is not a recent work test requirement.

NOTE: This table is an estimate only and does not cover all situations

If you become disabled

Enrolling In Medicare Advantage

Anyone eligible for Medicare can enroll in a Medicare Advantage plan. Once you get your Medicare ID card and effective date, you can apply for any plan sold in your area.

If you choose Medicare Advantage, you may have to pay a separate premium to your insurance company in addition to your Part B premium. Most people have access to a $0 premium, $0 deductible Medicare Advantage plan.

If you are concerned about out-of-pocket spending with Original Medicare, a Medicare Advantage plan might be a good option. All Medicare Advantage plans have an annual out-of-pocket maximum. This means that once you reach your plans limit, the insurance company pays 100% of your costs.

While the government maximum is $7,550 in 2021, the average out-of-pocket maximum among Medicare Advantage plans is about $4,900.

Some people with disabilities qualify for a Medicare Advantage Special Needs Plan . These plans always include Part D coverage. They usually have $0 premiums and $0 deductibles, and include extra benefits such as dental, vision, and care coordination to help you manage your condition. Benefits are specifically tailored to help keep costs low.

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Your Health Care Rights

The Americans with Disabilities Act of 1990 , federal legislation and California state law all prohibit discrimination on the basis of a disability. However, these laws are limited in a number of ways, and they dont require insurance companies to sell you policies.

Medical providers cannot refuse to treat you because you have a disability. But they can refuse to accept you as a new patient if they are refusing other Medicare patients, or if they dont treat anyone with Medicare. Medical providers are also permitted to refer you to another provider if the care you need is not within the scope of their practice.

If you think a physician or health care plan is denying your disability rights, file a complaint with your medical group, your plan and the U.S. Department of Justice . If you need help, contact your local Health Insurance Counseling & Advocacy Program office for free counseling and information.

Is It Mandatory To Sign Up For Medicare After Age 65

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No, it isnt mandatory to join Medicare. People can opt to sign up, or not.

If you don’t qualify for Social Security retirement benefits yet, you may need to manually enroll in Medicare at your local Social Security office, online or over the phone when you turn 65. You can also apply online for your Medicare coverage at www.medicare.gov.

Enrolling in Medicare as soon as youre eligible ensures you get the subsidized health care you deserve without waiting periods or financial penalties.

If you continue to work for a company employing 20 or more people after you turn 65, you could delay your Medicare enrollment. Your employee group plan provides enough medical coverage while youre working, meaning you may be able to wait to sign up for Medicare once you retire without incurring any late penalties.

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Maintaining Insurance Coverage When Ssi Or Ssdi Payments End

If you work and the earnings make you ineligible for a continuation of SSI or SSDI monthly payments, you may be able to continue the insurance benefits for SSD. The general rule for individuals whose SSI payments end because of their earnings is that you may continue the Medicaid coverage as long as you continue to be blind or disabled and meet all other SSI eligibility criteria.

The rules to continue Medicare coverage after earnings from working causes your SSDI payments to end is that you may continue coverage for up to 93 months. A condition for being allowed to purchase Medicare Part A, which is Premium Hospital Insurance, and Medicare Part B, which is the Premium Supplemental Medical Insurance, is that you continue to be disabled. The disability must meet the definition used by Social Security and be due to the physical or mental impairment that lets you qualify for SSDI benefits.

How Soon Can I Get Benefits

For years, the standard 24-month waiting period had been reduced to five months for people living with ALS. Thanks to advocacy efforts by the ALS community, Congress passed a law in December 2020 that waived the five-month waiting period altogether. In March 2021, a follow-up bill made the change retroactive for people who had already applied. This means that you can begin receiving your benefits right away. Your application will be fast-tracked, so you should know within a few weeks if you qualify.

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Medicare With Als Or Esrd

There are two exceptions to the 2-year waiting period. If you have amyotrophic lateral sclerosis , also known as Lou Gehrigs Disease, youll be enrolled in coverage in the first month you receive SSDI.

If you have end stage renal disease , your Medicare coverage normally begins after youve received 3 months of dialysis treatment.

Which Statesuse Their Own Criteria For Granting Medicaid

2020 SSDI Benefits Eligibility and How to Apply

Theremaining states do not automatically grant Medicaid to persons withdisabilities who qualify for SSI because they use their own criteria fordetermining whether someone is eligible for Medicaid. These states may haveincome limits that are higher or lower than SSI’s, different asset limits, ordifferent requirements for what makes someone disabled.

Inmost of these states, however, the income limitsfor Medicaid aren’t too different from the income limit for SSI . And many of them use thesame resource limit as SSI program, although several have a lower assetlimit than SSI , and a couple states have a higher asset limit .

These states are called “209 states,” named after a sectionof the legislation that created the SSI program in 1972. This legislationprohibited states from making their Medicaid eligibility criteria stricter thanthe criteria the states were using in 1972. In these states, you must apply forMedicaid with your state’s Medicaid agency or health and human services department.

The 209 states are:


Note that Indiana ceased being a 209 state in 2014.

Even though some 209 states have lower income limits than theSSI program, these states have to let Medicaid applicants deduct their medicalexpenses from their income when their eligibility for Medicaid is beingdetermined. This is called “spending-down.” This means that SSIrecipients with high medical bills will qualify for Medicaid in these states.

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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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