Can I still Get Medicare or Medicaid if I'm Receiving Social Security Benefits?

medicaid_medicare_eligibility

An individual eligible to apply for, and receive, disability benefits through the Social Security Administration may also qualify for other benefits through different state and federal programs, including Medicare and/or Medicaid. As a result, many people have questions about whether securing benefits through one program will interfere or impede their ability to procure additional benefits through other programs. This article is intended to answer this important question.

If you are a recipient of Social Security disability benefits, there could be an impact on your ability to qualify for health benefits under Medicare and/or Medicaid, depending on your particular situation.

Issues with Disability Benefit Recipient Limited to Specific Components of Medicare

Medicare is a multi-part program comprised of Parts A through D. Individuals receiving disability benefits would only encounter potential issues with Parts A and B. Specifically, disabled individuals are eligible for hospital insurance pursuant to Part A of the Medicare program. In addition, disabled individuals are eligible for medical insurance pursuant to Part B of Medicare.

Impact of Disability Benefits on Qualifying for Medicare Benefits

Someone who is receiving Social Security Disability Insurance (SSDI) benefits will still qualify for Medicare benefits, but they are subject to a 24-month waiting period. This waiting period commences on the date you begin receiving disability benefits. For example, if you were to apply for disability benefits, secured approval, and began receiving benefits on October 1, 2021, you would need to wait until October 1, 2023 to apply for Medicare benefits.

Confusion Surrounding the Medicare Waiting Period

Many people find the 24-month waiting period to be unnecessarily confusing. This is largely attributed to the fact that there is an additional five month waiting period between the date someone is determined to be disabled and the date that person will actually begin receiving SSDI benefits.  This means someone who is deemed disabled could be forced to wait as long as 29 months before being entitled to receive both disability benefits and Medicare benefits.

Two Important Exceptions to the Medicare Waiting Period

There are two noteworthy exceptions you should be aware of regarding the 24-month waiting period for Medicare benefits. The first exception involves individuals with End-Stage Renal Disease (ESRD), which impacts your kidneys. When someone is diagnosed with ESRD and is receiving disability benefits, federal law states that Medicare benefits can commence for an applicant in the fourth month of dialysis, or sooner in certain circumstances.

The second exception involves individuals diagnosed with Amyotrophic Lateral Sclerosis (ALS), which is also referred to as Lou Gehrig’s Disease. In this situation, when someone has ALS and is receiving disability benefits, they can start receiving Medicare benefits the same day they receive disability benefits.

Recipients of Disability Benefits Seeking Medicaid Benefits

Individuals who are disabled could potentially qualify for health benefits through Medicaid, a hybrid program administered by the states, but involving federal funds. The specific eligibility rules will vary from state to state. Nevertheless, many states rely on the federal poverty level (FPL) to determine Medicaid eligibility. In 2021, the FPL is approximately $12,880 for a one-person household. This means if you earn more than $12,880 you could be denied benefits under Medicaid.

Disability Benefit Recipients Routinely Struggle with Medicaid Income Limits

It is fairly common for someone who is receiving disability benefits to struggle staying under the income limits for Medicaid eligibility. have incomes that are too high to qualify for Medicaid under current law. Also, with only a few limited exceptions, people who qualify for disability benefits do not become eligible for Medicare until two years after the date they are deemed eligible to receive benefits.

In too many instances, this means an individual who receives a health disability benefit check will be forced to go without health insurance during the two-year waiting period for Medicare coverage. As a result of this issue, some states offer “buy-in” programs to expedite your eligibility to access Medicaid coverage.

Medicaid Buy-In Programs

Multiple states offer “Medicaid buy-in” programs which enable low-income disabled individuals to obtain Medicaid coverage for a nominal premium. However, it is important to note that these programs are generally limited to low-income disabled individuals who are still working, although the work requirement is usually quite limited (e.g., a few hours each month).

Medicaid Spend-Down Programs

If you receive SSDI and have high medical expenses that reduce your monthly income to the Medicaid eligibility level, you might be able to qualify for Medicaid if your state has a Medicaid spend-down program. These programs (usually called “medically needy” programs) allow disabled individuals to qualify for Medicaid when they (or their spouse or child) have high medical expenses (either ongoing or past due bills). Contact your state’s Medicaid agency to find out whether you qualify for a spend-down program.

Impact of the Affordable Care Act for Disability Benefit Recipients

The Medicaid program was expanded greatly under the landmark Affordable Care Act (ACA). For example, the ACA encouraged states to increase the income cutoff for Medicaid eligibility to 133 percent of the Federal Poverty Level. In 2021, the eligibility threshold is set at $17,130 in annual income for an individual.

In addition to encouraging states to expand eligibility for Medicaid, the ACA also overhauled the way states calculate income and assets for Medicaid eligibility in ways that allowed more low-income disability benefit recipients to qualify for supplemental security income during the two-year waiting period. However, it is important to note that multiple states opted not to participate in the expansion of Medicaid, so you need to check the relevant rules and regulations in effect in the state you reside.

Have Questions About the Impact of Disability Benefits on Your Eligibility for Medicare or Medicaid? Get Answers by Completing a Free Evaluation Form

If you are interested in applying for disability benefits, or are currently in the process of applying for benefits, you may have important legal questions that need to be answered by an experienced professional. This is why you should complete the free evaluation form on this page so you can be connected to an experienced and knowledgeable disability benefits lawyer in your area.

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