Do I Automatically Receive Healthcare When I Get Approved?

The Social Security Administration (SSA) offers two different benefit programs. Social Security Disability Insurance (SSDI) is based on how long you worked and how much you paid into Social Security taxes. Supplementary Security Insurance (SSI) pays benefits based on income limits. There are also two types of healthcare offered, Medicare and Medicaid, and the rules and types of coverage are different for each program .

If you receive SSDI benefits, you are eligible for Medicare two years after you start receiving benefits, which is 29 months (2 years plus the 5 month waiting period) after your reported onset date.

There are four parts to Medicare: Medicare Parts A, B, C, and D. Medicare A is hospital insurance. It covers inpatient treatment in hospitals and nursing facilities. In some cases, it can also cover hospice and other home health care. Generally there is no premium for Part A, because it’s covered by the taxes you or your spouse paid into Social Security.

Part B is medical insurance that covers doctors’ visits, outpatient care, some physical therapy expenses. It also contributes to some home health care, prescriptions, and medical devices when deemed medically necessary. Unlike Part A, there is a premium for Part B. In 2016, most recipients will pay $121.80 per month with a $166 deductible. However, these may be higher depending on your income.

Parts C and D are not part of Original Medicare, but were added to those who felt their coverage wasn’t enough. Part C is the Medicare Advantage Plan and Part D is the Prescriptions Drug Plan. Parts C and D are offered only through private insurance companies. They offer at least everything that Parts A and B have; however, the plans, prices, and eligibility may be different than Original Medicare.

SSI recipients are eligible for Medicaid. Similar to the requirements of SSI, Medicaid is offered to low income individuals and families who cannot afford to buy private health care. Medicaid is funded at the state and federal levels, so each state has different rules. 32 states and the District of Columbia do not have a separate SSI and Medicaid application, so if you live in those states and are approved for SSI then you are automatically started on Medicaid. Unlike Medicare, Medicaid starts as soon as your start receiving your SSI benefits. Some states have different forms, but the same rules, and some states separate the two completely.

Dual Eligibly
It’s possible to be eligible for both Medicare and Medicaid. If you are receiving concurrent benefits (both SSDI and SSI), then you will be eligible for both health care plans. It is also possible apply for Medicaid if you’re Medicare isn’t enough. People who are eligible for both Medicare and Medicaid have their Medicare Part B and Part D premiums paid for by the Medicaid benefits.

Additional Resources