When a disabling medical condition prevents you from continuing to work, the cost of treatment can be overwhelming. Unless you have medical insurance coverage through an employer or through a spouse or other family member, you could be in a difficult situation.
If you are approved for Social Security Disability Insurance through the Social Security Administration, you probably already know about the monthly SSDI payments you’ll receive. An additional benefit is medical insurance through enrollment in the Medicare program.
Understanding how Medicare works is essential for someone with a disability who cannot work. The disability professionals at Clauson Law know that Medicare and SSDI benefits can be confusing, so they make themselves available to answer Medicare questions for the people they represent. If you have questions or concerns about Social Security Medicare entitlement, contact a Clauson Law representative for a free consultation.
When does Medicare begin for SSDI recipients?
It’s important to understand how Social Security Disability and Medicare benefits work together. Normally, Medicare coverage begins at age 65 for people who worked and paid Social Security and Medicare payroll taxes. However, when you receive Social Security Disability Medicare coverage is included after a waiting period.
Most people approved for SSDI gain access to Medicare after a 24-month waiting period. The waiting period begins when you are approved for SSDI and begin receiving monthly payments.
The 24-month waiting period applies regardless of the severity of your medical condition, with two exceptions. Individuals approved for SSDI benefits with end-stage renal disease or amyotrophic lateral sclerosis (ALS), also called Lou Gehrig’s disease, are entitled to early enrollment in Medicare.
Medicare coverage begins upon approval of SSDI benefits for a person with ALS. Individuals with end-stage renal disease may be entitled to Medicare coverage without the 24-month waiting period, depending on their treatment plan:
· An individual undergoing a home dialysis program, coverage begins on the first day of the month the program begins.
· An individual receiving treatment at a dialysis facility may enroll in Medicare at the start of their fourth month of treatment.
· Kidney transplant patients can enroll in Medicare when they are admitted to a Medicare-approved hospital for the procedure or for medical services in preparation for it.
During the 24-month waiting period before Medicare coverage begins, health insurance may be available to you through an employer. Depending upon the requirements for approval, you could receive coverage through your state’s Medicaid program, provided you meet the income limitations. If you have questions about Medicare and Medicaid coverage for a specific medical condition or in general, a disability representative at Clauson Law can answer them.
Medicare coverage for SSDI recipients
The Medicare program provides different coverage options, such as:
· Medicare Part A Hospital Coverage: Covers costs associated with inpatient treatment at a hospital and skilled nursing facility. It also pays for some home health services.
· Medicare Part B Medical Coverage: Pays toward treatment at a doctor’s office and other forms of outpatient services. It also pays toward durable medical equipment and preventive services,
Medicare also offers other coverage options, such as Part D, prescription drug coverage, that you have the option of applying for once the waiting period ends.
Recipients of SSDI automatically become enrolled in Medicare Part A and B after the 24-month waiting period. There is no charge for Part A coverage, but there is a premium for Part B coverage. You may elect to have the premium deducted from your SSDI benefits, or you can decline Part B coverage.
Working while receiving SSDI and Medicare benefits
The SSA offers work incentive programs to individuals receiving SSDI benefits. Some of them allow you to test your ability to work and retain the money you earn without losing your SSDI benefits.
For example, a trial work period gives you nine months to work and earn more than the substantial gainful activity (SGA) earnings threshold while continuing to receive SSDI benefits. Typically, a month of earnings exceeding the SGA threshold would stop your monthly SSDI benefits.
At the end of a trial work period, you may continue working under another work incentive called the “extended period of eligibility”(EPE). An EPE gives you another 36 months to work while receiving disability benefits, but the benefits stop when your monthly earnings exceed the SGA threshold.
An added incentive to the work programs is that you keep your Medicare coverage during the trial work period and throughout the 36 months of the EPE. Medicare Part A continues without charge, and Part B continues as long as you pay the premium.
Call on our disability team when you need help with SSDI and Medicare benefits
Don’t struggle with the complicated rules and regulations that govern SSDI and Medicare benefits. Rely on the team of disability professionals at Clauson Law for advice and representation. We help people with disability claims nationwide, so contact Clauson Law today for a free consultation.