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Is Medicare or Medicaid Included with Disability?

Claimants approved for disability benefits will also get Medicare or Medicaid, depending on whether you receive SSDI or SSI benefits.

Disabled people that get approved for Social Security disability insurance (SSDI) benefits will receive Medicare, and those who are approved for Supplemental Security Income (SSI) will receive Medicaid. However, SSDI recipients aren’t eligible to receive Medicare benefits until two years after their date of entitlement. For more information on calculating how this is calculated, see our article on when you’ll receive Medicare benefits. There is no waiting period for SSI recipients to receive Medicaid.

Medicaid & SSI

In the majority of states, when a disabled person gets approved for SSI, they are automatically approved for Medicaid benefits as well. There is a small number of states, including Illinois & Ohio, that are exceptions to the rule. These states may have a lower income or asset limits for the Medicaid program than the Supplemental Security Insurance program.

Medicare & SSI

Do you receive Medicare coverage if you are approved for SSI? Claimants who are approved for SSI only, will typically receive Medicaid coverage in the majority of states. Like SSI, Medicaid is subject to income and asset parameters. Medicaid is a needs-based program that is administered by the state and county. Services provided can include a number of doctor visits, prescriptions each month, and potential nursing home care under certain conditions.

Can you get Medicare if you get SSI? Medicare coverage for SSI recipients does not occur until an individual reaches 65 years of age. At 65 years of age, these individuals are able to file an “uninsured Medicare claim,” which saves or reduces their need for state supplemented coverage. Basically, the state pays the medical premiums for an uninsured individual to be on Medicare so that the cost in health coverage provided through Medicaid is reduced for the recipient.

For people with limited income and assets, Medicare offers “Extra Help” for the cost incurred for prescription drugs. This Extra Help covers the costs of a Medicare prescription drug plan.  This includes monthly premiums and prescription co-pays.

Are You Eligible For SSDI Benefits?

Some disability recipients will be approved for concurrent benefits.  This means that they will receive SSDI and SSI benefits at the same time. In these cases, the issue of whether a claimant will get Medicare or Medicaid is not so simple. Claimants who are approved for concurrent disability benefits should consult their local Social Security office regarding their Medicare/Medicaid eligibility.

You can also use our free eligibility tool here to see if you would qualify for benefits.  

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