I Am 54 And Living With A Permanent Disability And For The Past 12 Months I Have Been Receiving Social Security Disability Insurance Payments But I Do Not Have Health Insurance I Am Required To Wait Another 12 Months Before I Can Go On Medicare Due To The Two
Yes, you are eligible to purchase coverage through the Marketplace, and if your income is between at least 100% of poverty you will qualify for premium tax credits to help make Marketplace coverage more affordable. If you live in a state that has expanded its Medicaid program to cover adults under age 65 with incomes up to 138% of poverty , you might also be eligible for this coverage, depending on your income.
If you apply for and receive Marketplace coverage and subsidies, keep in mind that your eligibility for Marketplace subsidies will end when your Medicare Part A and Part B coverage automatically begins after the two-year waiting period. At that point, you will have to pay the full price for your Marketplace coverage, but you could instead drop your Marketplace coverage and enroll in Medicare Part A, Part B and Part D. If you keep both Medicare and Marketplace coverage, Medicare will be the primary payer.
Once your Medicare coverage begins, depending on your income, you may qualify for Medicaid in addition to Medicare or for extra help with premiums and cost sharing for your Part D prescription drug benefits. A good place to turn for information about these programs and whether you might qualify is your local Social Security Administration office or the State Health Insurance Assistance Program in your state. Medicare provides links and phone numbers for these and other organizations at the following website: .
Since We Are Talking About Mostly Adults Cant They Qualify Under Medicaid Expansion
People who are older than age 65 or have Medicare are not eligible for coverage under expansion. There is a possibility that some younger people may qualify under a different eligibility program. Also, income is a factor. We will look at every individual and his or her situation to make sure we help them explore all of their options.
What Conditions Qualify As A Disability
No matter whether you have SSI, SSDI, Medicaid, ABD Medicaid or Medicare, the medical requirements are the same. First, you must meet the non-medical disability requirements. These are based mainly on your work history and social security taxes youve paid. Then, monthly disability benefits are paid if a medical condition is expected to last at least 1 year or result in death.
Different types of medical conditions that qualify as a disability for adults over age 18 are listed in the chart below. Note that the chart shows a general list. It doesnt include every condition that may qualify adults for social security disability. For a full list of qualifying conditions visit the Social Security Administration website Theres also a separate childhood listing that shows impairments for children with disabilities.
Also Check: Tens Unit Covered By Medicaid
Why Is Medicaid Coverage Beyond The Ssi Pathway Important For People With Disabilities
Even though their needs do not rise to the stringent SSI level, nonelderly Medicaid adults with disabilities but not SSI still report serious functional limitations that can affect their health, making coverage important. A majority of non-SSI Medicaid adults with disabilities report serious difficulty with cognitive functioning, and nearly half report serious difficulty with mobility.5 Two in five non-SSI Medicaid adults with disabilities report serious difficulty with independent living tasks, such as visiting a doctors office or shopping alone.6 Smaller shares report serious difficulty with vision , self-care tasks such as dressing or bathing , and hearing , compared to the other limitations that make up the ACS disability definition.7 Nearly half of nonelderly Medicaid adults with a disability but not SSI have multiple functional limitations, reporting impairment in two or more of the six ACS areas.8
Figure 2: Demographics of Nonelderly Medicaid Adults with a Disability But Not Receiving SSI, 2019
What Is Medicaid And Who Is Eligible
Medicaid is a federal and state program that provides health care coverage to qualified individuals. People who are eligible for Medicaid include:
- Pregnant women with low income
- Children of low-income families
- Seniors with low income
- Parents or caregivers with low income
Medicaid programs are state-run. So states can choose to provide Medicaid to more people, such as individuals with low income who may or may not have children.
Recommended Reading: Is Medical Marijuana Covered By Medicaid
How Health Care Reform Affected Eligibility For Ssdi Recipients
Many more people became eligible for Medicaid because the federal Affordable Care Act encrouaged states to raise the income cutoff for Medicaid to 133% of FPL. . In addition, the ACA overhauled the way states count income and assets for Medicaid eligibility in ways that allowed more low-income SSDI recipients to qualify for SSI during the 24-month waiting period. However, a number of states declined to participate in this “Medicaid expansion,” so these changes only apply to residents of some states.
How Is Disability Defined
While SSI is sometimes used as a shorthand to identify people with disabilities, not all people with disabilities qualify for SSI. SSI is a monthly cash payment to help low-income people with disabilities pay for housing, food, and other basic needs. To qualify for SSI, individuals must have low incomes, limited assets, and an impaired ability to work at a substantial gainful level as a result of old age or significant disability. The SSI disability criteria are more stringent than other definitions of disability, such as those used in national surveys. The American Community Survey classifies a person as having a disability if the person reports serious difficulty with hearing, vision, cognitive functioning , mobility , self-care , or independent living .1 The ACS definition of disability is intended to capture whether a person has a functional limitation that results in a participation limitation and also is used in other federal surveys, such as the Current Population Survey and the Survey of Income and Program Participation.
Don’t Miss: How To Get Help With Medicaid
What Will Happen To Health Care Providers If A Majority Of Their Patients/residents No Longer Have A Payer Source
We expect this will have an impact on any provider who serves Medicaid patients. This is a major concern for the Department not only for now but for the future, as there is a possibility that some providers may go out of business and not be able to reopen if they lose Medicaid patients for as little as a month.
Talk To A Disability Lawyer
Need a lawyer? Start here.
Read Also: Iowa Dhs Medicaid Income Guidelines
How Do People With Disabilities Qualify For Medicaid
While nearly a quarter of nonelderly adults with Medicaid report having a disability, relatively few of these enrollees qualify for Medicaid because they receive SSI benefits . While people who receive SSI generally automatically qualify for Medicaid, the SSI population encompasses only a subset of all people with disabilities. Over six in 10 nonelderly Medicaid adults with disabilities do not receive SSI . This group can be eligible for Medicaid as ACA expansion adults or Section 1931 parents . There is no way with federal survey data to separate people who qualify due to the Medicaid expansion from those who would have qualified under pre-ACA eligibility rules. They also may be eligible for Medicaid through an optional disability-related pathway .2 Without the expansion pathway, Medicaid coverage for people with disabilities typically is limited to people who receive SSI because other disability-related pathways are provided at state option. And, in addition to using a more restrictive definition of disability compared to other measures, SSI income and asset limits are more restrictive than those required for Medicaid expansion adults and many optional disability-related Medicaid coverage pathways.3
Figure 1: Disability and SSI Status of Nonelderly Adults with Medicaid, 2019
Additional Eligibility Requirements For Ltss Coverage
Medicaid enrolleesâincluding the ABD populationsâmay have long-term care needs as well. In general, to receive Medicaid LTSS coverage, enrollees must also meet state-based level-of-care eligibility criteria. In other words, they must demonstrate the need for long-term care. In addition, such individuals may be subject to a separate set of Medicaid financial eligibility rules to receive LTSS coverage.
Level-of-care eligibility criteria for most Medicaid-covered LTSS specify that individuals must require care provided in a nursing facility or other institutional setting. A state’s institutional level-of-care criteria, in general, are also applied to Medicaid Home and Community-Based Services eligibility. That is, eligibility for Medicaid LTSS, both institutional care and most HCBS, is tied to needs-based criteria that require an individual to meet an institutional level-of-care need.
Don’t Miss: What Is The Household Income Limit For Medicaid
Medicare For Ssi Recipients
Do you get Medicare coverage if you were approved for SSI? Claimants who are approved for SSI only typically receive Medicaid coverage in most states. And like SSI, Medicaid is subject to income and asset limitations. Medicaid is a needs-based, state- and county-administered program that provides for a number of doctor visits and prescriptions each month, as well as nursing home care under certain conditions.Can you ever get Medicare if you get SSI? Medicare coverage for SSI recipients does not occur until an individual reaches the age of 65 if they were only entitled to receive monthly SSI disability benefits. At the age of 65, these individuals are able to file an “uninsured Medicare claim,” which saves the state they reside in the cost of Medicaid coverage. Basically, the state pays the medical premiums for an uninsured individual to be in Medicare so that their costs in health coverage provided through Medicaid goes down.
For people with limited income and assets, Medicare offers “Extra Help” for prescription drug costs. This Extra Help covers the costs of a Medicare prescription drug plan — including monthly premiums and prescription co-pays. The application is online at www.socialsecurity.gov/prescriptionhelp. For more information, see Nolo’s article on the Extra Help subsidy.
How To Get Help With Medicare If Youre Disabled And Under 65
We understand Medicare is confusing. Thats why we take our time to answer all your questions. Our agents consider the coverage you need and make the best recommendation based on your situation. Dont waste your time calling each company individually. To get started with a quote, complete this form to see what options are available in your area.
- Was this article helpful ?
Don’t Miss: How Do You Apply For Medicaid In Ny
What Is The Long Term Care Special Income Level Program
The Long Term Care Special Income Level program covers individuals who are aged, blind or disabled and who qualify for institutional level of care because of their medical needs with monthly income over $750. These members are either in facilities such as nursing facilities or group homes or may be receiving home and community-based waiver services .
When Doesmedicare Or Medicaid Start
SSDI recipients aren’t eligible to receive Medicare benefitsuntil two years after their date of entitlement to SSDI . Because it oftentakes a year or two to be approved for disability benefits, however, SSDIrecipients often become eligible for Medicare soon after they get their awardletter from Social Security.
In the states where Medicaid eligibility is automatic for SSIrecipients, there is no waiting period for SSI recipients to receive Medicaid.In other states, you need to apply separately for Medicaid, but there is nowaiting period.
You May Like: Till What Age Does Medicaid Cover
Can I Receive Medicaid And Social Security
It is possible for someone receiving Medicaid also to collect Social Security. However, each program has its own separate applications, separate requirements and will make its own eligibility decisions. In general, receiving SSI benefits will not affect your Medicaid eligibility.
However, SSD benefits, because they are typically higher payments, could affect your eligibility for Medicaid based on your individual states asset threshold. In other words, if you are receiving SSD benefits which put you over the minimum amount that your state permits for total assets, you might become ineligible for Medicaid. In some instances, Medicaid will require the individual to pay some of the monthly medical expenses out of the SSD money.
In Which Statesis Medicaid Enrollment Automatic
The Social Security Administration handles Medicaid enrollmentfor the many states in which Medicaid eligibility is automatic for SSIrecipients. Your state will contact you with information after you receive yourSSI award letter from Social Security. These states are:
Note that SSI recipients in Indiana will be automatically enrolled in Medicaid starting on June 1, 2014. At that point, Indiana switches from being a 209 state to an automatic enrollment state.
Recommended Reading: Do Chiropractors Take Medicaid In Nc
Medicaid Eligibility: Older Adults And Individuals With Disabilities
Medicaid is a joint federal-state program that finances the delivery of primary and acute medical services, as well as long-term services and supports , to a diverse low-income population. In general, individuals qualify for Medicaid coverage by meeting the requirements of a specific eligibility pathway. An eligibility pathway is the federal statutory reference that extends Medicaid coverage to certain groups of individuals.
Each eligibility pathway specifies the group of individuals covered by the pathway . It also specifies the financial requirements applicable to the group , including income and, sometimes, resources . In addition, an eligibility pathway often dictates the services that individuals are entitled to under Medicaid. Some eligibility groups are mandatory, meaning all states with a Medicaid program must cover them other eligibility groups are optional.
This report focuses on the ways in which adults aged 65 and older and individuals with disabilities qualify for Medicaid based on their age or disability status that is, the eligibility pathways where the categorical criteria are being aged, blind, or disabled . Individuals who qualify for Medicaid on the basis of being blind or disabled include adults under the age of 65 as well as children. Generally, ABD populations qualify for Medicaid through an eligibility pathway under one of two broad coverage groups described in this report: Supplemental Security Income -Related Pathways and Other ABD Pathways.
What If Youre Under Age 65 And Have A Disability
People under age 65 with disabilities automatically qualify to get Original Medicare after theyve been receiving disability benefits from Social Security for 24 months. If you also qualify for Medicaid or Medicaid disability, your state Medicaid program may help pay for costs and services that Medicare does not cover. For any services that are covered by both Medicare and Medicaid , Medicare will pay first. Medicaid may also pay for added costs or services, but only after the Medicare share has been used up.
Recommended Reading: Is Invisalign Covered By Medicaid
Medicaid Disability Benefits Rules
Your ability to qualify for Medicaid is going to vary depending upon which program you are receiving disability benefits through. Many people obtain disability benefits from the Social Security Administration , while some people receive disability income through workers compensation or through a private disability insurer.
If you are receiving disability benefits through workers compensation for a work injury, your workers comp benefits should cover your medical care for all health issues arising from your work injury. With coverage through workers comp for medical care, you may not need Medicaid. If you still want or need Medicaid coverage to supplement the care that workers comp is paying for, your ability to qualify will depend upon your income and resources.
If you are receiving disability benefits through private insurance, your income will also be determinative regarding whether you are eligible for Medicaid. The amount of countable assets you own is going to matter as well. Medicaid is a needs-based program and people with too many resources or with high incomes cannot get benefits coverage.
Most People Who Are Approved For Disability Benefits Through The Social Security Administration Get Medicare Or Medicaid Eventually
By Bethany K. Laurence, Attorney
Generally, if you are approved for Social Security disabilityinsurance benefits, you will receive Medicare, and if you are approvedfor Supplemental Security Income , you will receive Medicaid. However, thisisn’t true in all states. Medicaid is operated by the states,and the states are allowed to set eligibility criteria that are different thanSSI’s criteria. As a result, whether getting approved for SSI gets you Medicaiddepends on your state, as we’ll discuss below.
Also Check: How To Find Your Medicaid Number