Monday, December 3, 2012

Do I Automatically Get Medicare with SSDI?

...this is definitely one of the questions most often asked by my clients...  Clients also ask me a lot about whether they will get Medicaid.  I will address these questions separately below:


You will receive Medicare after you receive Social Security Disability Benefits for 24 months. When you become eligible for disability benefits, the Social Security Administration will automatically enroll you in Medicare. 

It is important to note that Social Security starts counting the 24 months from the month you were entitled to receive disability, not the month when you received your first check.  This two year period starts five months after your disability began.  (This is due to the fact that there is a five month waiting period to receive SSDI.)

However, special rules apply to:

End-stage renal disease (permanent kidney failure). People with permanent kidney failure get Medicare beginning:
  • The third month after the month a regular course of renal dialysis begins; or
  • The month of kidney transplantation.
Lou Gehrig's Disease (amyotrophic lateral sclerosis). People with amyotrophic lateral sclerosis get Medicare beginning with the month they become entitled to disability benefits.
Medicare has four parts:
  • Hospital insurance (Part A) helps pay hospital bills and some follow-up care. The taxes you paid while you were working financed this coverage, so it's premium free.
  • Medical insurance (Part B) helps pay doctors' bills and other services. There is a monthly premium you must pay for Medicare Part B and you have the option to refuse this coverage.
  • Medicare Advantage (Part C) plans generally cover many of the same benefits a Medigap policy would cover, such as extra days in the hospital after you have used the number of days Medicare covers. People with Medicare Parts A and B can choose to receive all of their health care services through one of these provider organization under Part C. There might be additional premiums required for some plans; and
  • Prescription drug coverage (Part D) helps pay for medications doctors prescribe for treatment. Anyone who has Medicare hospital insurance (Part A), medical insurance (Part B) or a Medicare Advantage plan (Part C) is eligible for prescription drug coverage (Part D). Joining a Medicare prescription drug plan is voluntary and you pay an additional monthly premium for the coverage.

In Connecticut and Massachusetts, if you are an SSI beneficiary, you may be automatically eligible for Medicaid; an SSI application is also an application for Medicaid.  Typically, SSDI recipients get Medicare and SSI recipients get Medicaid.  SSI recepients do not have to wait a 24 month period to receive Medicaid benefits.