Medicaid and Medicare FAQs

June 16, 2015 | By Riddle & Brantley Accident Injury Lawyers
Medicaid and Medicare FAQs

FAQ: How will I pay for my ongoing medical care even if I am successful in winning my Social Security Disability case?

Winning your Social Security Disability (SSD) case results in a monthly cash benefit paid to you by the federal government. However, it does not solve the problem of how to pay for your ongoing medical bills and future prescriptions. This is an especially serious problem for so many of our disability clients because they have very often lost the health insurance benefits they had while they were working.

Moreover, the medical problems that resulted in the award of disability benefits now become “pre-existing conditions.” Those conditions disqualify disability clients from obtaining private health insurance unless they pay extremely high premiums.

Two government programs, Medicaid and Medicare, can be used to address this problem.

Strict Medicaid Requirements

Medicaid is a joint federal and state program of reimbursement to doctors, hospitals and other health care providers for treating low-income individuals.  The eligibility requirements are very strict.

As set forth on the North Carolina Medicaid website, “Medicaid serves low-income parents, children, seniors, and people with disabilities.”  Among the requirements, you should be aware that:

  • You must be a U.S. citizen or legal resident and either have a Social Security number or have applied for one.
  • An individual without children or other special circumstances must be found to be disabled and have practically no income and own practically no property of any kind to qualify. The income and property ownership limitations are set forth here.
  • Families with children are often able to get their children enrolled, but only if they meet those strict income and property ownership limits.
  • Furthermore, ALL sources of income are counted, including SSD benefits.

Most Medicaid recipients do not pay for any of the medical services they get under the program, but some do require a small co-payment for certain services.

Most disability claimants who are awarded SSD benefits are automatically disqualified from the Medicaid program because the average SSD monthly award is approximately $1,100/month, and that level of income is normally higher than the Medicaid system allows.

Medicare is Help for Older Persons

Medicare, on the other hand, is the government’s health insurance system for older persons and the disabled who have worked during their lives and paid into the Medicare system from their wages. You will find more information here.

Medicare consists of four parts:

  • Part A (hospital insurance);
  • Part B (medical insurance, i.e. doctor bills);
  • Part C (Medicare Advantage, i.e. a Medicare supplement covering things like vision, dental, and hearing); and
  • Part D (prescription drug coverage).

There is no requirement that Medicare recipients have low income or own a limited amount of property.  As long as the applicant meets the minimum age requirement OR is found to be disabled, he or she can participate as an insured person (subject to the payment of premiums) and be covered for medical services, as well as prescriptions.  However, participants do have to pay deductibles as well as insurance premiums.

The Medicare system is very complex and your eligibility should be discussed with your trusted advisor.

Medicaid versus Medicaid

Generally speaking, there are more and better medical services available under the Medicare system than the Medicaid system, for the simple reason that Medicare pays doctors, hospitals, and other health care providers more for their services than the Medicaid system.

So, how can the Medicaid and Medicare programs benefit you, as a SSD claimant?

First, if your level of income and property ownership are low enough to make you eligible for Medicaid, that program can be available totally independent of your application for SSD benefits.

If you are just at the point of applying for SSD benefits and have not yet been approved, you can apply separately for Medicaid through the state Social Services system and, if found eligible, be approved for Medicaid before you are approved for SSD.  Then, even if you are later awarded SSD benefits that eventually disqualify you from the Medicaid program, you can still use Medicaid to pay for your medical care during the five-month waiting period before you receive SSD monthly benefits or become eligible for Medicare (see below).

Second, once you are found to be disabled and thus entitled to SSD benefits, you are eligible to participate in the Medicare program as if you were of retirement age.  Your actual age is irrelevant; even if you are in your 20s, if found to be disabled, you are eligible for Medicare coverage just as though you were 65 or older.

Two Catches for Medicare Benefits

There are two catches to your ability to participate in Medicare:

First, you must wait two years from the date you become eligible to receive monthly SSD benefits before you can participate in the Medicare system.  For that reason, we advise all our clients to KEEP any existing health insurance they have, at least until they win their SSD case.  For example, many of our clients are able to participate in their spouse’s employer-provided health insurance during that two-year waiting period, even if it means paying for the coverage under the COBRA law.

Also, the SSD system moves so slowly that by the time a claimant has gone through the application and appeal process and appeared before a judge who awarded disability benefits, the two-year waiting period has usually passed and the person is eligible for Medicare immediately.

Currently, the average time it takes from the filing of an initial application to a hearing before an administrative law judge and the judge’s award of benefits is close to two years.

The second catch is that the disabled person must continue to pay monthly insurance premiums (usually a relatively small amount) for Medicare coverage.  In most instances, if the person elects to be covered by Medicare, a monthly deduction is taken from the benefit check to pay those premiums.

Ready For Your Benefits? Call The NC Social Security Attorneys At Riddle & Brantley Today

The experienced disability lawyers at Riddle and Brantley can guide you through the disability, Medicaid, and Medicare systems and help you take advantage of the health insurance programs that can help you continue receiving the ongoing medical care you need. Call us today for a free, no-obligation consultation about your case.