Many people don’t know that Social Security Disability benefits include Medicare and Medicaid health insurance programs. This means that disabled claimants suffering from serious, ongoing medical problems gain access to health insurance in addition to their ongoing monthly disability payments.
Medicare or Medicaid?
As we’ve mentioned in previous posts, there are two Social Security Disability programs: Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI).
SSDI is a federal insurance program that helps people with disabilities who are no longer able to work because of one or more severe medical conditions. Disabled workers are eligible to apply for SSDI if they have worked long enough and earned sufficient wages over the past 10 years. A worker’s Social Security account is “fully insured” for purposes of eligibility with at least 20 quarters of earnings in the past 10 years, or 40 quarters in total.
SSI is a financial needs-based program for disabled claimants with income and assets below a certain level.
The type of health insurance a disabled person receives depends on the disability program they qualify for. Claimants approved for SSDI benefits receive Medicare, while those approved for SSI benefits receive Medicaid.
In rare cases, some claimants apply for and receive concurrent benefits from both SSDI and SSI. In these cases, it’s best to contact your local Social Security Office to determine whether you will receive Medicare or Medicaid benefits.
Medicaid and SSI Benefits
Medicaid is a state-administered program, not a federal program. Like SSI, Medicaid is subject to income and asset restrictions. If you qualify for SSI, you are automatically approved for Medicaid benefits in North Carolina. There is no waiting period for these benefits to kick in, although processing times vary by Social Security office and by state.
Medicaid provides for a certain amount of doctor’s visits and prescriptions per month, as well as a certain amount of nursing home care. Onceindividuals receiving SSI benefits reach the age of 65, they can file an “uninsured Medicare claim” for Medicare and enroll in the federal Medicare program which provides more coverage than Medicaid programs.
Medicare and SSDI Benefits
Disabled individuals receiving SSDI benefits qualify for Medicare coverage, no matter their age. This coverage becomes effective two years after the individual’s “alleged onset date of disability.” This date of disability is the date the individual and Social Security Administration agrees they became disabled. For many of our clients, the waiting period is minimal since their alleged date of disability is in the past and since the process of applying for disability can be lengthy. Once they receive and the SSA processes their approval, many claimants begin receiving their monthly payment and insurance benefits immediately.
In closing, it’s not an overstatement to say that having access to health insurance AND a monthly stipend is life-changing for disabled people. If you or someone you know is struggling with disability and is unable to return to work, we’d be happy to provide you with a free consultation on your claim. We serve claimants throughout North Carolina.