Eligibility For SSDI And Medicare

Social Security Disability Insurance (SSDI) provides important benefits to people who are unable to work due to an injury or illness. This money can help with expenses like rent or mortgage payments, food and other essentials. In addition, most people who have a disability often need extra medical treatment. While SSDI payments can help offset these costs, if you lose your health insurance as a result of being unable to work, these medical bills can grow quickly. However, if you receive SSDI benefits, you will be eligible for Medicare coverage after a set waiting period.

At Troutman & Troutman, P.C., our Tulsa Social Security Disability attorneys have helped many Oklahoma residents get SSDI and Medicare coverage. Applying for these federal programs can be difficult. However, with a qualified, experienced lawyer by your side, you have the best chance of getting approval. We can explain the entire process, including the waiting period for Medicare benefits, to ensure that your application is complete and accurate.

What Kind of Health Insurance Can I Get with SSDI?

If you receive SSDI benefits, you will receive Medicare coverage as well (not Medicaid). However, there are some conditions. Most importantly, you are not eligible for Medicare right away. Instead, your coverage begins two years after your date of entitlement.

When you apply for disability benefits, the Social Security Administration (SSA) examines your medical history and application to determine when your disability began. This may be the date of a disabling accident or the onset of an illness. This is the established onset date (EOD). The date of entitlement, on the other hand, is the EOD plus five months, since there is a mandatory five month waiting period for disability benefits. You are eligible for benefits starting from the date of entitlement, which usually means you will receive disability back pay.

Your Medicare coverage will start two years after the date of entitlement established by the SSA during your application process. For some, this means that you may be eligible for coverage as soon as you get approval for SSDI benefits. This is especially true if you appeal an initial denial of benefits. However, most applicants will have to wait at least a few months for healthcare coverage.

There are some exceptions to this two-year interval before Medicare begins. If you have certain disabling medical conditions, your coverage may start sooner. Kidney failure and amyotrophic lateral sclerosis (ALS) are two common conditions that will exempt you from this waiting period.

What Are My Medicare Coverage Options?

Once you are eligible for both SSDI and Medicare, there are several different parts to the coverage you may receive. Your enrollment in some of these parts is automatic, while you may have to apply separately for others. The different parts of Medicare are:

• Part A – This is sometimes known as “hospital insurance.” It covers care you receive in a hospital as well as some follow up procedures. Your enrollment in Part A is automatic after your approval for SSDI benefits. This part is paid for by payroll taxes, so the premium is usually free.
• Part B – This helps cover the cost of regular visits to the doctor and routine healthcare expenses. Your enrollment in Part B is also automatic. However, you will have to pay a premium for this coverage, so you may refuse it if you choose.
• Part C – Also known as “Medicare Advantage,” this provides additional benefits to help cover costs that Parts A and B do not. You may also get the same kind of “gap coverage” from a Medigap plan, which is provided by a private company rather than Medicare. You must opt into this coverage, since your enrollment is not automatic.
• Part D – This part helps cover prescription medication costs. However, you will have to pay a premium for this part and your enrollment is not automatic.

Contact us online or call our office in Tulsa and schedule a free evaluation of your case today.