What Insurance Do You Get With Social Security Disability?

When a person cannot work because of a disability or blindness, monthly Social Security disability payments provide much-needed relief from financial hardship. Equally as important, although frequently overshadowed, are the insurance benefits for SSD recipients.

The two disability programs administered by the Social Security Administration, Supplemental Security Income and Social Security Disability Insurance, each provide insurance coverage. Beneficiaries of SSI may qualify for Medicaid coverage, and individuals receiving benefits through SSDI may be eligible for Medicare.

As you read through the information that follows about the rules to determine what insurance do you get with SSD, consider scheduling a free consultation with a Social Security disability lawyer at the Clauson Law Firm, PLLC. An SSD lawyer provides insight into the insurance coverage available based on your specific circumstances and can handle applications or, in case of a denial of benefits, appeals.

SSD benefits through the SSI program

SSI is a need-based program offering benefits to eligible adults and children who are blind or disabled. It also provides benefits to anyone who is not blind or disabled as long as they are at least 65 years of age and have limited resources and income.

To qualify for SSI benefits, the total value of resources you own may not exceed $2,000 for an individual and $3,000 when spouses each qualify for benefits. Your income cannot exceed $794 per month in 2021 or $1,191 per month if you and your spouse each qualify for SSI benefits.

It is important to keep in mind that not all income or resources count when determining eligibility for SSI. For example, the value of a house counts toward resource values for eligibility purposes. However, the value of a home that you occupy as your principal residence does not count as a resource regardless of how much equity you may have in it.

Exceptions exist for income as well. For example, if you work at a job, Social Security does not count all of your earnings as income. You may exclude the first $65 of earned income each month and one-half of the remaining balance. For instance, if you earn $1,265 this month by working at a job, deduct the first $65, which leaves $1,200. You then exclude one-half of the $1,200. That leaves a balance of $600.

You have an additional exclusion of $20 that may be used each month against unearned income or, if you do not have unearned income, it can be used to reduce earned income. The balance of your earned income of $580 reduces your monthly SSI benefit to $214.

Insurance available with SSI

If you qualify for SSD benefits through SSI, you can apply for Medicaid coverage, which provides hospital and medical coverage to low-income children and adults. Although Medicaid coverage follows federal guidelines, it is administered by state agencies. Each state can set its own eligibility guidelines for Medicaid, which may be more restrictive than the federal guidelines.

The method for obtaining Medicaid coverage depends on where you live. States follow one of three enrollment methods:

  • Most states, including North Carolina, South Carolina, Florida, and Georgia, follow an automatic enrollment method that makes your application and approval for SSI benefits serve as enrollment for Medicaid coverage. You do not need to file a separate application with a state for Medicaid coverage.
  • Only a few states, such as Alaska, Oregon, and Utah, require that you file a separate application for Medicaid coverage with them, but coverage is automatic, provided that you have been approved for SSI.
  • The remaining states, including Connecticut, Oklahoma, and Virginia, require a separate application for Medicaid and apply their own eligibility standards, which may differ and be more restrictive than federal standards. The fact that you qualify for SSI benefits does not automatically make you eligible for Medicaid.

A disability lawyer at the Clauson Law Firm knows the law and application process to ensure that you receive all SSD benefits that may be available to you, including Medicaid. If your state requires submission of a separate application for Medicaid, your SSD lawyer submits it for you after determining the eligibility guidelines in your state.

If your financial resources and income allow you to qualify for SSI and Medicaid, your children may be eligible for Medicaid. Eligibility depends on the Medicaid program in your state, but your SSD lawyer can review the requirements to determine whether your children are eligible.

Medicare insurance through SSDI

Someone with an earnings record at jobs or through self-employment may qualify for benefits through the SSDI program. You must have contributed to the Social Security system through the taxes you paid on your earnings to qualify for benefits, but if you do qualify, it includes Medicare insurance benefits for SSD.

You must have worked long enough and recently enough to establish an earnings record that meets the criteria to qualify for SSDI. As with SSI, your disability must meet the medical requirements established for the program, which include a requirement that the mental or physical impairment causing the disability last for a continuous period of at least 12 months or be expected to cause death.

An SSD lawyer at the Clauson Law Firm can help you throughout the application process to ensure that you meet all requirements for benefits through the SSDI program. Once approved for SSDI benefits, you must receive payments through SSDI for 24 months to be eligible for Medicare insurance. It is important to note that you must be disabled for at least five months before you begin collecting SSDI benefits.

The 24-month waiting period for Medicare coverage does not apply to someone receiving SSDI benefits because of permanent kidney failure requiring dialysis or a kidney transplant. It also does not apply to SSDI beneficiaries diagnosed as suffering from amyotrophic lateral sclerosis, which is commonly referred to as ALS or Lou Gehrig’s disease.

Medicare Part A, which is also referred to as Medicare Hospital Insurance, pays the costs related to medical care provided in a hospital setting. Part B, or Medicare Supplementary Medical Insurance, pays for outpatient care, including office visits. Once you become eligible for Medicare coverage, Part A will be provided without cost to you. If you elect to add Part B coverage, you must pay a monthly premium for it.

SSDI and Medicaid

Although eligibility for SSDI does not automatically qualify you for Medicaid as happens when someone qualifies for SSI, Medicaid may be available to you while waiting for the 24-month waiting period for Medicare to elapse. Depending on the income guidelines for Medicaid eligibility in your state and the amount of the SSDI benefit that you receive each month, you may be eligible for Medicaid.

If you live in one of the states that have expanded Medicaid eligibility to include more people than before, your income level while on SSDI may allow you to qualify. Speak with a disability lawyer at the Clauson Law Firm who can review your case and advise you about Medicaid options available to you.

Some people whose work record allows them to qualify for SSDI may also qualify for SSI depending on their income and financial resources. Social Security refers to this as “concurrent benefits.” When you qualify for concurrent benefits, the monthly SSDI benefits less the $20 unearned income exclusion, reduces the payment you receive from SSI.

Even though SSDI reduces your SSI payment, qualifying for SSI means you also qualify for Medicaid coverage during the 24-month period that you must wait for Medicare coverage to start. Once you become eligible for Medicare, two important things happen to your insurance coverage:

  • Medicare becomes your primary insurance with Medicaid serving as the secondary payer insurance.
  • Most states have programs that pay the premium for Medicare Part B coverage for individuals who also qualify for SSI.

You should review insurance options with an SSD lawyer to make certain that you do not miss out on benefits offered by your state for people receiving concurrent benefits through Social Security disability.

Insurance coverage when working while disabled

Social Security offers work incentives to encourage people who want to try returning to work even though they continue to be disabled. If your SSDI benefits end because of earnings from work, your Medicare Part A coverage remains in effect for 93 months as long as your disability continues. You may remain on Medicare Part A after the 93-month period by paying the premium.

Individuals whose income from work causes their SSI benefits to end may continue coverage through Medicaid until it exceeds the income limit set by their state. The cost of a person’s health care may cause the income limit to be increased above state levels, so check with your SSI lawyer.

Learn more about insurance benefits for SSD

It can be difficult to understand the insurance options available through Social Security disability. A free consultation with a disability lawyer at the Clauson Law Firm provides insight and sound advice to help you make informed decisions. Whether looking for answers to questions or experienced representation for an application or appeal, you can find it by contacting the Clauson Law Firm today.

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Clauson Law has focused on representing the injured and disabled for over 10 years. We have handled thousands of cases. Each client is important to us and has a unique situation.

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