Does Disability Qualify You For Medicaid


How Much Work Do You Need

Do I Have To Be Receiving Social Security Disability Benefits To Apply For Medicaid?

In addition to meeting our definition of disability, you must have worked long enough and recently enough under Social Security to qualify for disability benefits.

Social Security work credits are based on your total yearly wages or self-employment income. You can earn up to four credits each year.

The amount needed for a work credit changes from year to year. In 2021, for example, you earn one credit for each $1,470 in wages or self-employment income. When you’ve earned $5,880, you’ve earned your four credits for the year.

The number of work credits you need to qualify for disability benefits depends on your age when you become disabled. Generally, you need 40 credits, 20 of which were earned in the last 10 years ending with the year you become disabled. However, younger workers may qualify with fewer credits.

For more information on whether you qualify, refer to How You Earn Credits.

How To Enroll In Medicare With The Government

Medicare is a federal health insurance program for people who are 65 and older. When you are turning 65 and enrolling in Medicare for the first time, there are important dates and other things to consider before making your decision.

There are coverage gaps in Original Medicare . Most people choose one of two ways to cover the gap, Medicare Supplement plans , or Medicare Advantage Plan.

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Will Military Retirement Or Va Disability Benefits Count As Income For Ssdi

Neither military retirement nor VA disability count as earned income for the SSDI program. This means you can continue to draw these benefits without them affecting your eligibility or benefit amount for SSDI. In addition, there will not be an offset for any of your benefits. This means you will continue to draw the full amount from each program with some exceptions.

In some cases, drawing payments from another source of benefits might count as earned income for SSDI.

While SSDI is not an income-based program, you do need to have an earned income below a certain level to qualify. This is the substantial gainful activity limit. If you work a job, are self-employed, or otherwise have an earned income above this monthly limit, you will not be eligible for SSDI because it appears you can earn a living.

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Special Rules For People Who Are Blind Or Have Low Vision

We consider you to be legally blind under Social Security rules if your vision cannot be corrected to better than 20/200 in your better eye or if your visual field is 20 degrees or less, even with a corrective lens. Many people who meet the legal definition of blindness still have some sight and may be able to read large print and get around without a cane or a guide dog.

If you do not meet the legal definition of blindness, you may still qualify for disability benefits if your vision problems alone or combined with other health problems prevent you from working.

There are a number of special rules for people who are blind that recognize the severe impact of blindness on a person’s ability to work. For example, the monthly earnings limit for people who are blind is generally higher than the limit that applies to non-blind disabled workers.

In 2021, the monthly earnings limit is $2,190.

Should I Reapply For Medicaid

SC Medicaid: Healthy Connections South Carolina Medicaid Program

No. We want to keep you in your current eligibility group as long as possible and you should continue to access your benefits. However, it is important that you make sure all your information with us is up to date. This includes your contact information and income information, so that we can be in the best prepared position for when the legislature decides on a state budget. Our call center can help you with that.

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Medicare Benefits For People With Disabilities

Whether you qualify for Medicare based on age or a disability, Medicare Part A and Part B coverage stays the same. Medicare beneficiaries have the same benefits and can access the same services. The same coinsurance and copayments also apply to Medicare beneficiaries under 65. Heres a brief rundown of what each covers:

Special Needs Plans With Medicare

If you or a loved one has a specific chronic illness, requires nursing care, or becomes eligible for Medicaid, there are Medicare plans designed to meet your needs. Medicare plans for individuals with special needs offer coverage for services typically covered by traditional Medicare with the addition of enhanced benefits, such as vision, dental, transportation assistance and meal delivery. Furthermore, you can transition to a special needs plan as soon as you meet the criteria. There is no need to wait for Annual Open Enrollment.

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Benefits For A Disabled Child

A child under age 18 may be disabled, but we don’t need to consider the child’s disability when deciding if he or she qualifies for benefits as a dependent. The child’s benefits normally stop at age 18 unless he or she is a full-time student in an elementary or high school or is disabled.

Children who were receiving benefits as a minor child on a parents Social Security record may be eligible to continue receiving benefits on that parents record upon reaching age 18 if they are disabled.

What If My Social Security Disability Application Is Denied

If I am approved for Social Security Disability, will I get Medicare and Medicaid health insurance?

There is an appeals process for those denied for SSA benefits. The SSA official site says there are two basic categories for denial of SSA benefits: medical reasons and nonmedical reasons.

Those who need to appeal based on medical reasons must submit an Appeal Request and Appeal Disability Report. This report requires the applicant to furnish updated medical information including any tests, treatments, doctor visits, etc. since the SSA decision was made.

Those who need to appeal an SSA decision based on nonmedical reasons must contact their nearestSocial Security Office and request a review of the case and get an appeal. This can also be done by calling 1-800-772-1213 to request the appeal.

A TTY number for hearing impaired applicants is also available: 1-800-325-0778.

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Medicare Eligibility At 65 And Older

You can apply for Medicare the year you turn 65, but you generally must meet three eligibility requirements to qualify for full Medicare benefits at this age.

The chief requirement is that you must be a U.S. citizen or permanent legal resident who has lived in the U.S. for at least five years.

In addition, you must meet one of the following other requirements:

  • You or your spouse must have worked long enough to also be eligible for Social Security benefits or for railroad retirement benefits. This usually means you have worked for at least 10 years. You must be eligible for these Social Security benefits even if you are not yet receiving them.
  • You or your spouse is either a government employee or retiree who did not pay into Social Security but did pay Medicare payroll taxes while working.

If you pay Medicare payroll taxes for 10 full years, you wont have to pay premiums for Medicare Part A, which covers hospital care.

You dont need the work credits to qualify for Medicare Part B, which covers doctor visits or outpatient services, and Medicare Part D, which covers prescription drugs. Everyone pays premiums for both regardless of work history.

If you are still working at 65, you dont have to sign up for Medicare but there are benefits to signing up while still employed. Similarly, if you have never worked, you can still get Medicare. It may be more expensive depending on your spouses work history.

Workers With Too Few Social Security Credits

Can you get Social Security if you never worked? No, because a minimum requirement to collect Social Security retirement benefits is performing enough work. The Social Security Administration defines enough work as earning 40 Social Security credits. More specifically, in 2021, an individual receives one credit for each $1,470 in income, and they can earn a maximum of four credits per year. So, 40 credits are roughly equal to 10 years of work.

If you earn the federal minimum wage of $7.25 an hour, then youll need 202.75 hours of work to receive one . By working just 17 hours a week for 50 weeks at this wage , you can earn the maximum credits per year. That means even those who work part-time so they can attend school or care for a childor those who work part-time because they cannot find full-time workcan amass Social Security credits without too much trouble.

Earned credits never expire, so anyone who has left the workforce with close to 40 credits might consider going back and doing the minimum additional work they need to qualify. You can check the number of credits you have so far by opening a Social Security account on the Social Security website and downloading your Social Security statement.

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If I Work I Will Lose My Health Care Benefits

Losing your health care benefits can be a huge concern if you are thinking about work. However, there are several ways you can keep your health care benefits when you go to work. Many jobs will also offer employer-sponsored health care benefits. In general, you can keep your Medi-Cal or Medicare benefits when you start working. The sections below will explain several different options for health care benefits.

Medicare If You Have A Disability And Are Under 65

Do you qualify for Medicaid? Understanding how the government looks at ...

If you are under 65 and have a disability you may qualify for Medicare. You will usually need to receive Social Security Disability Income for 24 months before becoming eligible for Medicare. Exceptions are made for those with end stage renal disease or Amyotrophic Lateral Sclerosis , also known as Lou Gehrig’s Disease. To qualify for SSDI you must meet the standards for disability set by the Social Security Administration and you or your spouse must have paid Social Security taxes while employed.

Social Security Protection If You Become Disabled from the Social Security Administration can help you determine whether or not you are eligible for Social Security Disability Income .

If you qualify for Medicare our Medicare information page may be of interest to you.

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Who Misses Out On Social Security Benefits And Why

Does everyone get Social Security? No. Still, American workers who will not qualify for Social Security retirement benefits are relatively rare. If you are one of them, its important to know, so you can secure other sources of income or determine whether its possible for you to become eligible. What follows are the eight most common categories of workers who lack Social Security eligibility and thus are not entitled to benefits.

Medicaid Eligibility And Ssi Program Rules

SSI program rules form the foundation of Medicaid categorical and financial eligibility criteria for older adults and individuals with disabilities. Medicaid generally uses SSI categorical criteria to define the ABD populations.24 In addition, Medicaid often uses or adapts SSI’s financial standards and counting methodologies to specify the financial eligibility requirements applicable to the SSI-Related Pathways and the Other ABD Pathways.25 Thus, understanding SSI program rules is important to understanding Medicaid eligibility rules for older adults and individuals with disabilities.

SSI is a federal assistance program authorized under Title XVI of the SSA that provides monthly cash payments to aged, blind, or disabled individuals who have limited income and resources. SSI is intended to provide a guaranteed minimum income to adults who have difficulty covering their basic living expenses due to age or disability and who have little or no Social Security or other income. It is also designed to supplement the support and maintenance of needy children under the age of 18 who have severe disabilities. Unlike Medicaid, SSI eligibility requirements and benefit levels are based on nationally uniform standards. SSI is administered by the Social Security Administration but is not part of the Old Age, Survivors, and Disability Insurance program, commonly known as Social Security.

SSI Categorical Eligibility Criteria

SSI Financial Eligibility Criteria

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Medicaid Adults 65 And Older & People With Disabilities

The Medicaid program provides comprehensive medical coverage to seniors and people with permanent disabilities. People receiving SSI benefits automatically receive Medicaid. Seniors and people with disabilities who are receiving Social Security Retirement or Disability benefits and have income/resources that exceed the SSI limits may be eligible for Medicaid under the rules described in this section.

Note: People with disabilities who are waiting for a decision on eligibility for SSI or Social Security Disability Insurance benefits may be eligible for Medicaid under the MAGI category.

Who Qualifies?

  • 65 and older.
  • People who have a severe physical and/or mental disability that has lasted or will last longer than one year or will result in death and prevents any substantial gainful employment.
  • Must be a citizen or eligible immigrant. Eligible immigrants include refugees or persons granted asylum. Lawful Permanent Residents who entered the U.S. on/after 8/22/96 must be in status for at least 5 years. In addition, immigrants who were in lawful status in the U.S. before 8/22/96 and lived in RI at some time before 7/1/97 may be eligible for coverage.

Income and Resource Limits

How to Apply

You can apply on-line at You can also request a paper application from a DHS office by calling: 1-855-697-4347 or by downloading the form from the EOHHS website at:

For more information on Medical Assistance see the EOHHS website.

Summary Of Benefit Programs:

If I am found disabled, do I qualify for Medicare?
Social Security Disability Insurance

This program requires a person with a disability to have worked for a substantial period in employment covered by Social Security. Beginning at age 18, a dependent, adult child of a worker who is retired, disabled or deceased, may be eligible for benefits if the child became permanently disabled before age 22. Benefits also may be paid to a widow or surviving divorced spouse. SSDI is funded through the Social Security Trust Fund.

Supplemental Security Income

This federally funded program is based on financial need â it is not necessary for persons with disabilities to have worked under Social Security. Basic medical criteria for eligibility are the same for both SSI and SSDI. Recipients of benefits under both programs also may be eligible for Medicaid or Medicare benefits.


Medicaid is a jointly funded, Federal-State health insurance program for low-income and needy people. It covers children, the aged, blind, and/or disabled and other people who are eligible to receive federally assisted income maintenance payments. A separate application for Medicaid must be filed through the Virginia Department of Social Services .

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How To Qualify For Medicare Disability Benefits

If you are under age 65 and get Social Security disability benefits, you may also be eligible for Medicare. Find out if youre eligible, plus how to enroll.

Each Medicare plan and insurance product we feature has been independently selected and reviewed by our editorial team in conjunction with our partners at Medicare Expert USA. If you make a purchase using the links included, may be compensated.

Key Takeaways:

  • Medicare benefits are available to individuals under age 65 if they meet certain disability requirements.

  • Medicare benefits for individuals under age 65 with a disability are the same as those for seniors over age 65.

  • In many cases, if you are eligible for Medicare due to a disability, you will be automatically enrolledyou dont have to sign up.

  • There is typically a 24-month waiting period to enroll in Medicare due to a disability. For certain conditions, that waiting period is waived.

Medicare isnt just for seniors. If you are under age 65, you could qualify for Medicare coverage and its probably easier than you think. Why? Theres not a long list of requirements you must meet to be eligible. In fact, theres just one: You must collect Social Security Disability insurance benefits for 24 months.

Is enrolling in Medicare disability really that simple? There isnt a catch, but there are a few things you should know. Keep reading to find out if youre eligible, what Medicare coverage you can get, and how to enroll.

Can I Get Medicare Benefits For Prescription Drugs If I Have A Disability

Anyone eligible for Medicare benefits is eligible to enroll in a Part D prescription drug plan. However, you must be enrolled in Part A and/or Part B to enroll in a stand-alone Medicare Part D prescription drug plan.

If you get Medicare benefits through Original Medicare, and if you want prescription drug coverage, you typically need to sign up for a stand-alone Medicare Part D prescription drug plan. However, most Medicare Advantage plans include Part D coverage for prescription drugs.

Also Check: Difference Between Medicare And Medicaid Reimbursement

I Have Ssdi Does That Qualify Me What Is The Difference Between Ssi And Ssdi

Social Security Disability Income is not the same as Supplemental Security Income . SSDI is based on an individuals earnings record. Whereas, Supplemental Security Income serves the needy and eligibility is based on having limited income and resources. It is possible for an individual to qualify for both SSDI and SSI benefits but you must apply for SSI with the Social Security Administration to retain Medicaid eligibility if there are budget cuts to these programs. Having SSDI will not maintain your eligibility.


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