You will automatically receive Medicare coverage after two years on Social Security Disability Insurance (SSDI), whether you have reached retirement age or not. Before this time, you might qualify for Medicaid benefits or need to purchase insurance on your own. Most people who qualify for Supplemental Security Income (SSI) will also qualify for Medicaid.
The Social Security Disability lawyers at Berger and Green can explain more about how Medicare or Medicaid comes with disability benefits. If you have not yet applied with the Social Security Administration (SSA), we can help you file your claim. If the SSA issued a denial, we can handle your appeal. Call us at 412-661-1400 for a free consultation.
How Does Medicare Coverage Work for Those Receiving Disability?
After you receive disability benefits for 24 months, the SSA will automatically enroll you in two parts of Medicare. You will receive:
- Hospital insurance; and
- Medical insurance.
There are the two most common parts of Medicare. They are commonly called “Part A” and “Part B.”
Hospital Insurance (Part A)
Medicare Part A, or hospital insurance, covers bills related to inpatient hospital care and a limited amount of your follow-up care after a hospitalization. This part of Medicare is free for those who have received disability benefits for two years or more, those who receive Social Security retirement benefits, or workers over age 65.
Medical Insurance (Part B)
Medicare Part B is the part of your medical insurance that will cover all your medical care that does not require hospitalization. This coverage might pay for:
- Routine doctor’s visits; and
- Clinical or in-office treatments; and
- Outpatient medical procedures; and
- Other medical services.
There is a monthly premium for Medicare medical insurance. You might qualify for help with these premiums, depending on your income.
Medicare Parts C and D
Once you reach the two-year mark of drawing SSDI and the SSA automatically enrolls you in Medicare Parts A and B, you also become eligible for Parts C and D. These coverage options are:
- Medicare Advantage (Part C); and
- Prescription Drug Coverage (Part D).
Part C offers an alternative to the traditional hospital and medical coverage Medicare provides. This coverage allows you to get all your medical care and other health services from plans offered by private companies. Medicare approves all Part C plans.
Part D covers a portion of your prescription medications. This can make a major impact on your financial health if you have a chronic health condition, or you develop a serious illness. You can enroll in this coverage when you become eligible for Medicare, or during one of the regular enrollment periods.
You could also qualify for other programs that will help you pay for prescription medications if you have low income and low assets, but you do not qualify for Medicaid.
How Do I Get Health Insurance Coverage During the Two-Year Wait for Medicare?
Depending on your financial situation, you might be eligible for Medicaid coverage during your two-year wait for Medicare. In Pennsylvania, you can apply online with the Pennsylvania Department of Human Services, or you can apply through HealthCare.gov.
If you opt to apply through the online Health Insurance Marketplace at HealthCare.gov, you will need to:
- Create an account, or sign into your account; and
- Check the box that asks if you suffer from a disability; and
- Follow the instruction to apply for benefits.
This will forward your application to the Pennsylvania Department of Human Services, and this agency will evaluate you for Medicaid. If you do get Medicaid at this point, you might continue to receive these additional benefits even after you qualify for Medicare.
However, if you do not meet the strict income and asset limits for Medicaid, you can also continue through the process on HealthCare.gov and try to find a private health insurance plan that meets your needs. You will have to pay for this plan until your two-year wait for Medicare is over. You might, however, qualify for a premium subsidy based on your income especially if your income is low.
Can I Qualify for Medicaid if I Receive SSI Benefits?
In Pennsylvania, claims representatives use the same criteria to determine if you meet the strict income and assets requirements for SSI and Medicaid. If you get SSI, you should also get Medicaid. In fact, the staff in your local field office can enroll you in Medicaid when they process and approve your claim.
How Can I Get Help Obtaining Disability Benefits and Health Insurance Coverage?
At Berger and Green, our disability attorneys can help ensure you get the full benefits you deserve. We can help you apply for benefits or appeal a denial. We can also explain your Medicare and Medicaid eligibility and go over other options you have for getting health insurance coverage.
If your medical impairment occurred because of someone else’s negligence, you might be able to get additional compensation. Our personal injury lawyers can determine if you qualify for compensatory damages.
Contact our office today at 412-661-1400 for your complimentary consultation.