Attorneys such as John T. Nicholson who practice Social Security law often hear questions about whether someone could receive Social Security disability benefits at the same time as Medicare or Medicaid benefits. In general, someone who satisfies all of the relevant eligibility requirements can receive Social Security disability benefits and Medicare or Medicaid at the same time. Whether anyone in particular could receive these benefits, however, would depend upon the specific circumstances.
The Centers for Medicare & Medicaid Services (“CMS”) has administrative responsibility for Medicare and Medicaid. Medicare is
a national health insurance program serving U.S. citizens (and permanent residents) who have reached at least age 65, as well those younger than 65 who have certain disabilities, permanent kidney failure or amyotrophic lateral sclerosis (“ALS,” commonly known as Lou Gehrig’s disease). Medicare comes in four types.
1. Part A (hospital insurance). Medicare Part A helps to pay for the cost of inpatient care in hospitals and skilled nursing facilities—including care in critical access hospitals, but excluding custodial and long-term care in nursing facilities. Although the other types of Medicare usually require payment of a monthly premium, payroll taxes and self-employment taxes cover premiums for Medicare Part A in most cases.
2. Part B (medical insurance). Medicare Part B helps to pay for the cost of doctors’ services and outpatient care; in addition, it helps to pay for the cost of some of the services provided by physical and occupational therapists, as well as some of the cost of home health care. Those whose Medicare Part A premiums are covered by payroll or self-employment taxes may enroll in Part B. Coverage under Part B generally requires payment of a monthly premium.
3. Part C (Medicare Advantage plans). Those insured under Medicare Parts A and B can choose to enroll in a Medicare Part C, or “Medicare Advantage,” plan. Medicare Advantage plans, which must be approved by Medicare, are offered by private insurers. The coverage provided under these plans must be at least as good as what Medicare provides, but coverage otherwise varies from insurer to insurer. Medicare pays private insurers a specified amount each month for every Medicare Advantage member. Coverage under Medicare Advantage requires payment of a monthly premium for Medicare Part B, as well as a monthly premium for the private insurer.
4. Medicare Part D (prescription drug coverage). Medicare Part D helps to pay for the cost of prescription drugs. Those insured under Medicare Part A, Medicare Part B or Medicare Part C (Medicare Advantage) may choose to enroll in Part D. Medicare Part D generally requires payment of a monthly premium.
Medicaid is for those with low incomes, which is jointly funded by the federal and state governments. The program offers coverage to children, those with certain disabilities and the elderly. Eligibility requirements vary by state, but a financial means test is usually required. For residents of Ohio, the state has its own rules for Medicaid eligibility.
The Social Security Administration runs two programs that provide disability benefits: Social Security Disability Insurance (“SSDI”) and Supplemental Security Income (“SSI”). SSDI provides benefits to insured workers with disabilities, or in other words, those who: (1) have been employed for at least five of the last ten years; (2) have paid FICA (“Federal Insurance Contributions Act”) taxes; and (3) have a “disability” as the Social Security Administration defines the term. A disability, for purposes of Social Security, is a serious medical condition that lasts (or has lasted) for more than a year and prevents someone from being gainfully employed. In addition, SSDI will provide benefits to the disabled children of insured workers, so long as the children became disabled before they reached the age of 22, as well as to the disabled surviving spouses of insured workers who have died.
SSI, on the other hand, pays benefits to disabled adults and children who have little or no income, or other financial resources. The program also provides benefits to adults without disabilities who are age 65 or older and whose financial means fall within the applicable limits.
Someone who receives SSDI benefits, or who is eligible to receive SSDI benefits, is also eligible to receive Medicare at the same time. Eligibility for Medicare begins after a waiting period of 24 months from the first date of eligibility for SSDI. For those with kidney disease who are on dialysis, however, the waiting period is reduced to three months from the date on which they began receiving dialysis. Medicare eligibility begins immediately for those with a terminal illness expected to cause death within six months, as well as for those with ALS. Those over age 65 are generally not eligible to receive SSDI benefits.
Likewise, eligibility for SSI and Medicare is also possible. Those under age 65 can receive SSI and Medicare benefits at the same time as long as they satisfy the eligibility requirements of both programs. For those age 65 and over, eligibility for Medicare is essentially automatic, and they can receive SSI benefits if their financial means are within the limits established under the Social Security Administration’s rules.
Eligibility for Medicaid often varies according to state law. In Ohio, children up to age 19; families with children under age 19; pregnant women; those with disabilities; and those over age 65 are eligible to receive Medicaid benefits if they meet certain financial requirements. Ohio residents under 65 who qualify for Medicaid can receive SSDI benefits, as well, if they qualify for SSDI under the rules of the Social Security Administration. Those over age 65 are usually not eligible to receive SSDI benefits.
Medicaid and SSI are similar programs inasmuch as they serve those with limited financial means. Ohio residents who have qualified to receive SSI benefits under the Social Security Administration’s rules can also qualify to receive Medicaid benefits if they qualify based on the rules established by the Ohio Department of Job and Family Services.
Although the receipt of benefits through all four of these programs is technically possible, the eligibility rules can be complicated—especially for receiving benefits from multiple programs at once. Furthermore, applications for disability benefits are often denied at first. If you think that you might be eligible to receive Social Security disability benefits, or if your application for benefits has been denied, then you should speak with a lawyer, like John T. Nicholson, who focuses on Social Security law.