Does Medicaid of Medicare Come with Disability?

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medicare and medicaid for disabilities

Learn More About SSDI Cases W/ Video

Common Questions Asked About SSDI & SSI

Not sure if you’re able to collect Medicaid or Medicare on disability? Having more information at hand can help you determine what you’re entitled to. Although applying for disability can be complicated, there are a lot of benefits. First you and your family will benefit from taking the time to find the right program for your situation.

Let’s Begin.

How Does Medicare and Disability Work?

When learning about Medicaid or Medicare it’s important to know how it works with disability. Medicare is often seen as a health insurance policy offered to senior citizens. However, it is also available to those under 65 who are disabled in unique ways. Although Medicare and disability are considered an entitlement for those who paid Medicare taxes.

Disabled people receive medicare after they are approved for Social Security disability (SSD) insurance. However, the benefits with disability from Medicare come in four parts. However, while some parts require payment of a monthly premium, the program is not based on financial need.

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Part A: Hospital Insurance

First, Medicare Part A covers bills related to hospital facilities. For instance, inpatient hospital care, and a limited amount of care after a hospitalization. This part of Medicare is free for workers over the age of 65. For workers who have received disability benefits for two years or more, and workers who receive Social Security retirement benefits.

Part B: Medical Insurance

Next, Medicare Part B involves medical insurance that will cover all medical care that does not require hospitalization. Examples include:

  • Routine doctor’s visits
  • Clinical or in-office treatments
  • Medical tests
  • Outpatient medical procedures

There is a monthly premium for Medicare medical insurance. Depending on your income, you may or may not qualify for help with these premiums.

Parts C: Medicare Advantage

Then there is Medicare Part C. After the two-year mark of drawing Social Security Disability (SSD), you also become eligible for Medicare Parts C and D.

Medicare Part C offers an alternative to traditional Medicare coverage. This coverage allows you to get all your medical care and other health services from plans offered by private companies. Medicare approves all Part C plans.

Part D: Prescription Drug Coverage

Finally, private insurance companies administer Medicare Part D. This covers a portion of your prescription medications. However, being enrolled in Medicare Part D can have a major impact on your financial health.

How Does Medicaid and Disability Work?

Medicaid is a public assistance program based on financial need. SSI approved individuals will receive Medicaid coverage.

Medicaid and disability benefits are paid for with public funds collected through taxes. Both state governments and the federal government fund Medicaid. This is how the program is able to provide health insurance to low-income Americans of all ages.

Although benefits sometimes vary by state, each state is required to cover specific types of care. For instance inpatient and outpatient hospital services. For instance, nursing home and home healthcare, laboratory and x-ray diagnostic services, and transportation to a medical facility.

Medicare doesn’t just fund Medicare-related expenses such as hospitalization, doctors, and medicines. Although it funds a lot already it offers two additional types of care that Medicare does not.

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Custodial Care

Custodial care, or personal care, help with daily activities. For instance cooking, eating, bathing, bathroom use, and dressing. However, custodial care can be provided many ways. For example, a nursing facility, or at home to avoid a nursing home.

Nursing Home Care

Medicaid is the primary provider of long-term nursing home care. Nursing care under Medicaid is a complex subject and may require personal funds to pay part of the cost. However this depends on your income, the value of your assets, and tax deductions.

In addition to custodial and nursing home care, some states may provide benefits beyond the mandatory requirements. For instance prescription drug coverage, physical and occupational therapy, optometry, chiropractic services, and dental care.

Are There Special Considerations for Medicaid or Medicare Coverage?

If you’re not eligible for Medicaid, you may qualify for one of three Medicare Savings Programs (MSPs). Some states have more liberal allowances, so it might be worth applying even if you’re over the limit.

Qualified Medicare Beneficiary (QMB) Program

The QMB helps pay for Medicare Part A premiums, Medicare Part B premiums, co-insurance, deductibles, and co-payments. However, income limits and value of assets may determine if you qualify for the QMB program or not.

Specified Low-Income Medicare Beneficiary (SLMB) Program

The SLMB helps pay for the cost of Medicare Part B premiums. Income limits and asset valuation also applies to the SLMB program.

Qualifying Individual (QI) Program

The QI program helps to pay for the cost of Medicare Part B premiums only. Annual applications are needed for the QI program, and benefits with disability granted on a first-come, first-served basis.

If you qualify for a QMB, SLMB, or QI program, you automatically qualify for Medicare Part D coverage. First they must determine the value of your resources. For instance by looking at your bank account balances, as well as the value of all stocks and bonds.

Can I Qualify for Medicaid or Medicare?

Qualifying for both medicaid or medicare makes you what is called dual-eligible. Under this status, most or all of your healthcare costs will be covered. Medicaid will pay for most of your Medicare Parts A and B premiums and more. For instance, your deductibles and any co-payments you may have.

However, if you are dual-eligible and receive full Medicaid, your prescription drug coverage will go through Medicare. However, you will automatically qualify for help in paying for your medicines. In addition, Medicaid may cover some drugs that Medicare does not.

Medicaid is a needs-based program. Although states have the option of charging out-of-pocket fees. However, certain groups, such as children and people living in institutions, are generally exempt from these costs.


Quick Answers

How Does Medicare and Disability Work?

Available to those under 65 who are disabled in unique ways. However, you need to be SSDI eligible.

How Does Medicaid and Disability Work?

Medicaid is a public assistance program based on financial need. SSI approved individuals will receive Medicaid coverage.

Can I Qualify for Medicaid or Medicare?

Qualifying for both makes you what is called dual-eligible.


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