How Medicare and Medicaid Relate to Social Security Disability

Submitted by Shane on

Navigating the complex intricacies of the Social Security Disability application process can be overwhelming. This is especially true when trying to determine how Medicare or Medicaid will help you along the way. Though they are similar in nature, both insurance plans are very different, and understanding the difference is key to determining the benefits you will receive. This article will help you have a better understanding of the main differences within the Medicare/Medicaid services.

Medicare is a health insurance plan designed for people 65 years or older. It is also open to people younger than 65 with disabling conditions, or individuals of any age with End-Stage Renal Disease (ERSD). Medicare is broken down into four different parts:

Medicare Part A- (Hospital Insurance)

  • Provides partial coverage for inpatient care during hospital stays
  • Aids in the cost of home health, hospice, and skilled nursing care

Medicare Part B- (Medical Insurance)

  • Aids in the cost of doctor visits, outpatient hospital care, and home health care
  • Provides partial coverage for preventative efforts for keeping you healthy and preventing illness from getting worse

Medicare Part C- (Advantage Plans) There are four different types of Medicare Advantage plans: HMO, PPO, PFFS, & SNP

Medicare Part D- (Medicare Prescription Drug Coverage)

  • A drug option run by private insurance companies
  • Aids in the cost of prescription drugs
  • Aids in lowering prescription drug costs and helps maintain lower rates

When Medicare evaluates your situation to see if you qualify for disability benefits, they do not take into consideration your state of wealth or poverty. There are, however, other eligibility stipulations that are taken into consideration right away. One way an individual might qualify for Medicare is if they have been receiving Social Security Disability for a certain length of time. An individual who has been receiving Social Security Disability Benefits for two years is instantly qualified for Medicare. One great benefit to Medicare is that they pay higher rates to doctors than Medicaid does, which allows many people to find a reputable physician with more ease. One downside to Medicare is that they do not cover many prescriptions.

Medicaid is a health insurance plan that is designed to assist those who struggle making medical payments based on their low income. Everyone needs healthcare. Regardless of your situation, you deserve good medical care and Medicaid makes that possible, even if you are unable to pay for it at the time. You are not reimbursed directly from Medicaid; instead Medicaid pays your health provider directly. Depending on your state's rules and regulations, you make be asked to pay a small amount (a co-pay) for certain medical services. A great variety of people are covered under Medicaid, but there are specific standards that must be met:

  • Age
  • Are you currently pregnant, blind, disabled, or aged
  • Income status
  • Resources- items that could be sold for cash, property, bank accounts
  • Are you a US Citizen, or lawfully admitted immigrant
Rules are different depending on the state in which you are living and your living situation (i.e. whether you are living at home or in a nursing home. If you are in a desperate financial struggle and fit into one of the eligibility groups, you should be encouraged to apply for Medicaid. One benefit to Medicaid is that they cover many prescriptions, though the downside is that they pay very low rates for medical services. Also, because Supplemental Security Income is fashioned to assist the poor, those receiving benefits are instantly eligible for Medicaid. Since each state has different eligibility standards, it is important to contact your local office to find out what those specific requirements are.

Medicare can be extremely beneficial to those already receiving benefits from Social Security Disability. Since the system allows you to automatically qualify if you have been receiving benefits for two years, you might end up saving yourself the trouble of looking much further. Medicare is also the same everywhere since it is a federal program, while Medicaid varies from state to state. The best way to find out what kind of coverage is available through Medicaid would be to contact your state's Medicaid office. Most states offer coverage for people who are between the ages 16 and 64 living with disabilities and working.

Contacting a Social Security Disability attorney or advocate might prove beneficial for helping you further understand the differences and benefits to both Medicare and Medicaid. These professionals are trained to help those individuals with disabilities to navigate the often-confusing world of Social Security Disability benefits. Finding out what works right for your situation is monumental. There are so many resources and benefits available that can help you through your debilitating situation.

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