Medicare and Medicaid may come with your disability benefits, depending on your case. If you qualify for Social Security Disability Insurance (SSDI) benefits, you will automatically receive Medicare benefits after a two-year waiting period. Those who also qualify for Supplemental Security Income (SSI) may be eligible for Medicaid benefits without a waiting period.
At the Law Offices of Ogle, Elrod & Baril, PLLC, we can help you understand all the benefits available to you. Call us at 865-546-1111 to schedule a time to talk about your situation and learn about the benefits and resources you need.
Does Medicare or Medicaid come with SSDI?
You become eligible for Medicare benefits two years after the date you first met the qualifications for SSDI. The Social Security Administration (SSA) keeps track of your date of entitlement—which may be up to a year before you applied for disability benefits—and automatically enrolls you in Medicare after 24 months.
This coverage includes Medicare hospital insurance and medical insurance, Part A and Part B. Hospital insurance, sometimes called Part A, is free and covers inpatient costs and other expenses related to hospitalization. Medical insurance, or Part B, requires a monthly premium. It covers visits to your primary care physician, outpatient treatment, and other care. You can also purchase additional supplemental policies or to pay for prescription drugs.
There are some instances where you may receive your first SSDI benefits well into the two-year waiting period, especially if the SSA denied your application initially. Occasionally, this time my actually expire while you wait for approval. If this occurs, your Medical coverage begins at the same time as your SSDI benefits.
Some people who draw SSDI may not earn enough to cover the Medicare premiums. If you cannot afford these premiums, you may be eligible for Medicaid or other state-run programs to help you pay for your healthcare coverage. You can learn more by calling your state Medicaid office or giving us a call. We can look into your situation and help you identify the programs you may qualify for.
How can I get healthcare coverage during the 24-month waiting period?
Regardless of whether you received approval or denial for your SSDI benefits after your initial application, the SSA will not enroll you in Medicare until 24 months pass. This means if you suffer a debilitating back injury and cannot return to work, you will not receive Medicare coverage—or your previous benefits from your full-time job—for two years.
You have two options for healthcare coverage:
- Attempt to qualify for Medicaid; or
- Invest in a private health plan.
Low-income Americans with few assets can often qualify for Medicaid, which provides no- or low-cost healthcare coverage. You can apply for Medicaid through the Healthcare Marketplace by answering “yes” when the prompts ask if you suffer from any type of disability. You can also contact your local Medicaid office for information about applying. This process can vary from state to state, but almost always involves providing proof your income and assets fall below a set level.
If you do not qualify for Medicaid, you can buy into a private health plan on the Healthcare Marketplace or through another broker. While there are some tax incentives available, you should expect for this policy to be much more expensive than Medicare coverage. Does qualifying for SSI mean I can draw Medicaid?
Unlike Medicare, which is a federal program, each state runs its own Medicaid program. This means the qualifications for this program may vary by state. In many states, those who qualify for SSI automatically receive Medicaid benefits with no waiting period. In these states, the SSA typically manages Medicaid enrollment just as they do Medicare enrollment. If you live in one of these 30-plus states, the SSA automatically enrolls you in Medicaid when they approve your SSI claim. You should have access to this health care coverage immediately.
In the states where the qualifications for Medicaid are set at a limit that may exclude some SSI recipients, residents have to apply for Medicaid benefits separately. Once they approve this application, you will receive immediate access to your Medicaid benefits with no waiting period.
What can I do if I am denied the healthcare benefits I deserve?
There are rarely hiccups in the automatic enrollment process for Medicare, but getting Medicaid approval in some states is more difficult than you might imagine. If the state agency did not approve your application but you believe you qualify, you should contact our disability lawyers as soon as possible to discuss your options.
There is an appeals process we can pursue to aggressively fight for the full range of benefits you deserve. Typically, this is similar to the disability appeals process. If the SSA or state agency denies your request for healthcare benefits, you will receive written notification. Then we can go to work, filing a request for reconsideration or scheduling a hearing with an administrative law judge to rule on your case.
We can help you determine the type of health plan you qualify for, based on your income and assets, your state’s laws, the date you suffered your injuries, and other factors. We can help you prepare your initial application and represent you throughout the appeals process. We will fight to ensure you receive the full benefits due to you.
How can I reach a disability lawyer who can help me understand these benefits?
At the Law Offices of Ogle, Elrod & Baril, PLLC, we have helped people from all walks of life and in a variety of financial situations. We can educate you about the disability and healthcare benefits you qualify for, help you prepare your application, and fight aggressively to ensure you get the resources you need. Call us today at 865-546-1111 to schedule a time to discuss your situation with a disability lawyer and let us go to work for you.