WHAT'S THE DEAL WITH MEDICARE?

Disability benefits usually come with either MEDICARE or MEDICAID--two different health insurance programs.

MEDICARE is a federal benefit provided when you win SSDI benefits, also called Title 2 benefits. This is the main Social Security disability insurance benefit for workers who have become unable to work. Medicare is subject to a 29- month waiting period, which will be discussed later in this post.

MEDICAID , on the other hand, is a state benefit provided when you are awarded SSI, or Supplemental Security Income benefits. It is a state benefit that has no waiting period and benefits may start the month after you file your application.

When you are approved for Social Security Disability (SSDI), you automatically get Medicare health insurance 29 months after your disability onset date. Note: This may not be the date you filed your application, and it may not be the date someone at Social Security decided to approve your claim. The onset date is the date that Social Security accepts as the official date you became disabled. From that date, you wait 29 months to get Medicare coverage. The 29 months includes the 5-month waiting period for SSDI benefits plus the 24 months for Medicare itself. There is no way to get Medicare faster, unless you can get your onset date set earlier. This is why "onset date" is so important. The earlier the onset, the sooner you can get Medicare.

Let me explain Medicare eligibility this way:

You wait 5 months from your onset date to start getting SSDI payments (the waiting period).

You wait an additional 24 months to become eligible for Medicaid (a total wait of 29 months).

MEDICAID AND SSI. An individual who has not worked enough (or recently enough) to qualify for SSDI, may get Supplemental Security Income or SSI. This is a needs based program for low income individuals who are elderly or disabled. It has no waiting period. In fact, Medicaid can be retroactive to cover some past medical bills, back to your "onset date." Medicaid comes through your state government, not through the US government, although some federal funding may come from the federal government to the state.

For example, if a claimant becomes disabled on June 1 and files an SSI application in July, he/she may be approved with an onset date in June. Let's say it takes Social Security 5 or 6 months to process and approve the SSI claim. Medicaid can be effective in July (the month after the application was filed). And Medicaid benefits can be retroactive back to July. They can be used to pay medical bills back to July.

MEDICARE, on the other hand, is not retroactive. Under SSDI, if an individual is found to have become disabled on June 1st, he will not become eligible for a payment until November due to the 5=month waiting period. Then, he must wait another 24 month to be eligible for Medicare, a total of 29 months. Medicare is not retroactive. So , if disability occurs on June 1, 2020, Medicare coverage begins 29 months later.

OK, we admit this can be confusing. Part of the service at my firm is to explain Medicare and Medicaid-- and also to make sure each client gets the health insurance he or she qualifies for, as quickly as the law permits.

Sometimes, the value of Medicare or Medicaid can be as much, or more, than the actual cash benefits. They can also greatly improve qualify of life by making excellent medical care and prescription drugs available to those who otherwise couldn't afford them.