In the majority of cases, Social Security disability comes with either Medicaid or Medicare benefits. Which type of health coverage you receive depends on the Social Security disability program: Social Security Disability Income (SSDI) or Supplemental Security Income (SSI).
If you receive approval for SSDI, you will not receive Medicaid along with your disability benefits, but you will obtain Medicare after an applicable waiting period. Upon approval for SSI, you will generally receive Medicaid at the same time, though a few states do not grant automatic Medicaid benefits for SSI recipients.
SSDI and SSI with Different Health Coverages
SSDI is tied to Medicare, while SSI associates with Medicaid. Why is this? The two disability programs cater to different recipients in diverse circumstances.
SSDI and Medicare
SSDI is a government-run disability insurance program. It caters to people who have worked and paid a certain amount into the Social Security system. As you work and have payroll taxes deducted from your paychecks, you rack up work credits, and once you accumulate a certain number of these credits, you are eligible to file for SSDI if you become disabled. If you do not have enough work credits, either because you have not worked long enough or have not earned enough, you do not qualify for SSDI.
Medicare draws its funding from the same place as Social Security: workers’ payroll taxes. So a worker who is eligible to collect benefits from SSDI also becomes eligible to receive Medicare.
SSI and Medicaid
Eligibility for SSI requires having income and total assets that fall below certain thresholds. It has nothing to do with how much you have worked, how many work credits you have or the amount you have paid in payroll taxes. In fact, if you make too much money from work or have too high of a network, you will be denied SSI benefits due to lack of financial need.
Because SSI is a government welfare program, it aligns with Medicaid, a health benefits program also for those with financial need. In most states, the income and asset limits for SSI are the same as for Medicaid. So an SSI approval confers automatic Medicaid benefits. In only a few states — namely, Illinois and Ohio — the income and asset limits for Medicaid are lower than for SSI. It is thus possible in those states to fall into the in-between zone where you qualify for SSI but earn too much money for Medicaid.
When to Expect Medicaid or Medicare Once Approved for Social Security
You are eligible to begin receiving Medicaid immediately upon approval for SSI. But if your Social Security benefits come from SSDI, you might have to wait to receive Medicare. The length of your wait depends on a couple of factors. One, your eligibility date; two, how long you have already waited since your eligibility date to get your SSDI approval.
Your eligibility date is the date your disability began (known as your disability onset date) plus five months. Your SSDI entitlement begins on this date. Even if you do not get approved for SSDI until months afterward, you are eligible for back pay beginning on your entitlement date. The waiting period to begin receiving Medicare, however, is two years, and it starts on your entitlement date.
For an illustration of how all these different dates and waiting periods play out, consider this scenario: Your doctor diagnoses you with a disabling medical condition on February 1, 2016 — this is your disability onset date. You apply for SSDI right away.
On July 1, 2016, five months after your onset date, you become eligible to start receiving benefits — this is your entitlement date, assuming you get approved. But your application is still pending at this point.
Finally, on December 1, 2016, you receive your approval notice. You begin receiving benefits, plus you collect back pay for the period from July to December 2016.
But your Medicare benefits do not begin until July 1, 2018 — two years after your entitlement date. In the meantime, if your income is low enough, you might qualify for Medicaid as a stopgap measure. Your disability attorney can work through your options with you and also provide you with information about how long you can receive social security disability benefits.
Schedule a Free Social Security Disability Case Evaluation Today
Applying for Social Security can be confusing and frustrating, but the attorneys at the Disability Advantage Group, want to simplify the process and give you the best chance of success. To schedule a free case evaluation, call our office today at 1-865-566-0800.