You are eligible for enrollment in Medicare coverage 2 years after the first month that you are eligible for Social Security Disability Insurance (SSDI). Eligibility is determined by your onset date for benefits plus the required 5 month waiting period for benefits.
This does not necessarily mean you have to wait an additional 2 years from your decision date to be eligible for Medicare. Your Medicare coverage enrollment date depends on your disability onset date (the date you were determined disabled by the Administrative Law Judge) plus the mandatory 5 month waiting period for benefits.
The Social Security Administration may award you retroactive or back benefits up to a maximum of 12 months prior to the date of filing for benefits. The number of months of back benefits you may be awarded can reduce your wait time for Medicare eligibility. The date that you became disabled and the date you applied for benefits can impact the date you will become eligible for Medicare benefits.
The application and appeals process for Social Security Disability benefits can take many months. Unfortunately, a favorable decision does not mean you are immediately eligible for Medicare coverage.
You will be eligible to receive Medicare coverage if you receive Social Security Disability Insurance (SSDI) benefits, 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 be eligible for Medicaid.
The Social Security Disability lawyers at Berger and Green can explain how Medicare or Medicaid eligibility comes with disability benefits. If you have not yet applied with the Social Security Administration (SSA), your lawyer can help you file your claim. If the SSA issued a denial, your lawyer could also handle your appeal.
How Does Medicare Coverage Work for Those Receiving Disability?
Once you are eligible for Medicare enrollment you will receive:
- Hospital insurance; and
- Medical insurance.
These 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 are awarded Social Security Disability Insurance (after 24 months after you become eligible for benefits), those who receive Social Security retirement benefits, and workers over age 65.
Medical Insurance (Part B)
Medicare Part B is the part of your medical insurance that will cover 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 are eligible for Medicare you become eligible for Medicare Parts A and B, you will 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 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 impact your financial health if you have a chronic health condition or develop a serious illness.
For a free legal consultation, call 412-661-1400
How Do I Know If I Can Enroll for Medicare?
You can enroll in this coverage when you become eligible for Medicare or during regular enrollment periods. You could also qualify for other programs to 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 Wait for Medicare?
Depending on your financial situation, you might be eligible for Medicaid coverage during your wait for Medicare enrollment eligibility. In Pennsylvania, you can apply online with the Pennsylvania Department of Human Services or 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 instructions 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.
What If I Am Not Eligible for Medicaid Coverage?
However, if you do not meet the strict income and asset limits for Medicaid, you can also visit HealthCare.gov to find a private health insurance plan that meets your needs.
You will have to pay for this plan until your wait for Medicare eligibility is over. You may qualify for a premium subsidy based on your income, especially if your income is low.
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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. 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 benefits you deserve. Our team can help you apply for Social Security disability benefits or appeal a denial. The staff can also explain your Medicare and Medicaid eligibility and go over other options for getting health insurance coverage.
What Our Lawyers Can Do for Your Disability Case
You have enough to deal with. Our team is ready to take on your case in its entirety. You will not have to do anything. Your lawyer can:
- Take a look at your situation
- Inform you of your options
- File your application for benefits
- Communicate with the SSA
- Appeal your claim for benefits if you were wrongfully denied
- Stand by you through the reconsideration and hearing stages of your case
- Protect your legal rights
- Collect supplemental evidence for your appeal
Our Team Can Provide Evidence of Your Eligibility for Benefits
Your lawyer will collect and organize sources of evidence that support your claim appeal. This could include:
- Written statements from loved ones about how they assist you because of your disability
- Pay stubs from when you were working
- Gather medical records from your providers
- Meet all deadlines
Our Mission Is to Help You Secure Disability Benefits
Your lawyer will have the experience and knowledge of past cases to benefit your circumstances. Our past clients have come away from their partnership with us saying things like the following:
- “They were… very compassionate and understanding, and they let me speak…”
- “… They really stepped in and made things happen for me…”
- “Working with Berger & Green was amazing…[they] calmed me down… I know [they will] be there if I need [them] again later in life…”
Berger and Green Is Ready to Help You in Any Way We Can
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. Our representatives can discuss how Medicare or Medicaid could come with disability benefits.