Do Disability Recipients Automatically Qualify for Medicare and Medicaid?

medicare and medicaidIf the Social Security Administration (SSA) grants you disability benefits, you may at some point qualify for Medicare or Medicaid health care coverage. Individuals receiving disability benefits are either unable to work or are not working enough hours to be eligible for health insurance from their employer.

Qualifying for Medicare or Medicaid will depend on whether you are approved for Social Security Disability insurance (SSDI) or Supplemental Security Income (SSI). If you have questions about receiving or retaining your disability benefits, a Social Security Disability attorney in Green Bay is here to assist you. An initial consultation is completely free and confidential.

Call our legal team today at (877) 888-5201.

Medicare Eligibility Requirements

Medicare is a health insurance program for individuals aged 65 years or older, certain disabled individuals under age 65 and individuals diagnosed with end-stage renal disease or kidney failure.

Different parts of Medicare cover specific services. Part A is hospital insurance. This helps cover hospitalization, nursing home facility care, hospice care and some home health care services. Most individuals generally do not have to pay for hospital insurance.

Part B is medical insurance, which helps cover doctor visits, outpatient care, medical equipment and preventative services. Most individuals must pay premiums on a monthly basis for medical insurance.

How Does One Qualify?

Individuals receiving SSDI benefits may qualify for Medicare after a 24-month or two-year waiting period. The months are counted from the date you became eligible for disability benefits, even if you did not receive payments until months later because your claim was not yet approved.

During this waiting period, you may be eligible for health insurance through your former employer. You will need to contact him or her for more information about health insurance coverage.

Individuals receiving SSI benefits may also qualify for Medicare, but not until they reach age 65. For those with limited income and assets, Medicare can help cover the cost of prescription drugs.

What If I Start Working?

Individuals who qualify for Medicare may be able to receive up to 93 months of hospital and medical insurance once the trial work period ends, as long as they have a disabling condition.

Your Medicare health care coverage would continue if you work and engage in substantial gainful activity. Additionally, you would not have to pay a premium for hospital insurance.

After 93 months have passed, you would have the option to purchase Medicare hospital and medical insurance if you are still disabled.

Medicaid Eligibility Requirements

Medicaid is a public insurance program that is funded by the state and federal government. Health care coverage is provided to low-income families and individuals, including seniors, parents, children as well as blind and/or disabled individuals.

If the state provides Medicaid to individuals receiving SSI, they will continue to be eligible for Medicaid. This coverage can continue even if a recipient earns too much to receive an SSI cash payment.

How Does One Qualify?

To qualify for Medicaid, a disability recipient must:

  • Be eligible for an SSI cash payment for no less than one month
  • Still be disabled
  • Meet all other eligibility standards, including a resources test
  • Require Medicaid to be able to work
  • Have gross earned income that cannot replace SSI, Medicaid or any publicly-funded care

When Enrollment is Automatic

Most states, including Wisconsin, let the SSA handle Medicaid enrollment in which Medicaid eligibility is automatic for SSI recipients. The SSI application is also the Medicaid application. Medicaid eligibility also starts the same months as SSI eligibility. There is no waiting period for Medicaid.

Some states, however, make their own Medicaid decisions based on SSI standards. Medicaid is not automatic when you are approved for SSI benefits and you must file a separate application with the state Medicaid agency to become enrolled in the health care program.

Other states use their own criteria to determine if a disability recipient qualifies for Medicaid.

Learn More in a Free Consultation

If you have been approved for disability benefits but denied Medicare or Medicaid, you may want to consider contacting a lawyer with extensive experience handling these kinds of claims. Our attorneys at Sigman Janssen are prepared to help you navigate the entire process from start to finish.

Learn more about your eligibility during a risk-free, zero-obligation consultation. We charge no upfront fees to retain our services. We only receive payment if we successfully help you obtain benefits.

Proven Results. Millions Recovered. (877) 888-5201