What Insurance Do You Get With Social Security Disability?

If you receive disability benefits from the Social Security Administration, you are also eligible to receive health insurance. If you receive SSDI benefits, you are eligible to receive Medicare, and if you receive SSI benefits, you are eligible for Medicaid.

A Look At SSDI And SSI Benefits

There are two types of disability benefits provided by the Social Security Administration. These include:

• Social Security Disability Insurance: SSDI benefits are provided to individuals who have a qualifying disability that has prevented them from working for at least one continuous calendar year or more. In addition, the recipient must be “insured,” meaning that they worked a job through which a portion of the salary was regularly paid to the Social Security system for a sufficient time.
• Supplemental Security Income: As with SSDI benefits, those who receive SSI benefits must have a qualifying disability that has rendered them unable to work for a year or more. However, to receive SSI benefits, an individual need not be “insured.” Instead, they must have income and resources below a certain limit established by the Social Security Administration.

Depending on your circumstances, you may receive SSDI, SSI, or a combination of both. The type of benefit you receive will determine whether you are eligible for Medicare, Medicaid, or both.

What is Medicaid?

The federal government and the various states administer Medicaid as a partnership. As a result, the rules and administration may vary in certain ways, depending upon the state in which you live.

State programs follow federal guidelines when establishing the benefits and services they offer through Medicaid, and all states offer “mandatory” Medicaid benefits. Some of these include:

• Inpatient and outpatient hospital services
• Home health services
• Screening and diagnostic services
• Family planning services
• Transportation to receive medical care
• Pediatric and family nurse practitioner services
• And more.

Beyond the required mandatory benefits, however, each state has some flexibility in deciding which services are offered. These are known as “optional benefits,” and may often include:

• Physical therapy
• Occupational therapy
• Case management
• Dental services
• Hospice
• Chiropractic services
• Optometry services
• Speech and hearing services
• And more.

In most states, if you apply for SSI benefits and are approved, you will automatically be eligible for Medicaid. In certain states, however, you must separately apply for Medicaid benefits through a state-administered agency. Those interested in obtaining more information about Medicaid and the particular rules in their state regarding Medicaid administration can visit the Medicaid website at www.medicaid.gov.

What is Medicare?

Medicare is also a federally administered health insurance program. Unlike Medicaid, Medicare is only federally administered, so it is the same in every state. Medicare is intended for those age 65 and older and those eligible for SSDI benefits following a mandatory two-year waiting period. Individuals who have Lou Gehrig’s Disease or end-stage renal failure may have the two-year waiting period waived.

Medicare is administered in four parts, which include:

• Part A: This is intended to cover inpatient care. There is usually no premium for Part A.
• Part B: Part B requires a monthly premium and is intended to cover medically necessary services, such as doctor’s visits and outpatient services.
• Part C: This consists of Medicare Advantage Plans and optional health plan selections (like PPOs or HMOs) provided through private, Medicare-approved agencies.
• Part D: Part D consists of prescription drug coverage.

Generally, Medicare is managed by the Centers for Medicare and Medicaid Services, or CMS for short. The Social Security Administration works with CMS to ensure that eligible individuals are enrolled in Medicare.

Can I Receive Both at the Same Time?

Often, our clients want to know if they can receive Medicaid and Medicare benefits simultaneously. This is an understandable question. If you meet the income requirements for Medicaid, you may be able to stay on it even when you become eligible for Medicare. This is known as being “dual eligible.”

In a situation of dual eligibility, Medicare would remain the primary health insurance source and the source first billed by providers after obtaining treatment. However, Medicaid may cover certain things that Medicare does not cover and may also be used to offset Medicare premiums.

Without question, the law regarding these benefits can be complicated and confusing. That’s understandable. It’s also why the talented and experienced team at Keener Law is here to help.

Keener Law – Here For You

Being disabled is difficult. Having to worry about complicated legal matters only adds to that difficulty. It’s stress that you don’t need – and the good news is, there is help available. Our knowledgeable and experienced attorneys at Keener Law will be there to help you every step of the way. We understand every aspect of the law pertaining to disability benefits, and we’re ready to put that knowledge to work for you. If you’re ready to get started, give us a call today. We look forward to speaking with you soon.