Can I receive Medicare or Medicaid benefits at the same time as I receive Social Security disability benefits?
Attorneys such as John T. Nicholson who practice Social Security law often hear questions about whether someone could receive Social Security disability benefits at the same time as Medicare or Medicaid benefits. In general, someone who satisfies all of the relevant eligibility requirements can receive Social Security disability benefits and Medicare or Medicaid at the same time. Whether anyone in particular could receive these benefits, however, would depend upon the specific circumstances.
The Centers for Medicare & Medicaid Services (“CMS”) has administrative responsibility for Medicare and Medicaid. Medicare is
a national health insurance program serving U.S. citizens (and permanent residents) who have reached at least age 65, as well those younger than 65 who have certain disabilities, permanent kidney failure or amyotrophic lateral sclerosis (“ALS,” commonly known as Lou Gehrig’s disease). Medicare comes in four types.
1. Part A (hospital insurance). Medicare Part A helps to pay for the cost of inpatient care in hospitals and skilled nursing facilities—including care in critical access hospitals, but excluding custodial and long-term care in nursing facilities. Although the other types of Medicare usually require payment of a monthly premium, payroll taxes and self-employment taxes cover premiums for Medicare Part A in most cases.
2. Part B (medical insurance). Medicare Part B helps to pay for the cost of doctors’ services and outpatient care; in addition, it helps to pay for the cost of some of the services provided by physical and occupational therapists, as well as some of the cost of home health care. Those whose Medicare Part A premiums are covered by payroll or self-employment taxes may enroll in Part B. Coverage under Part B generally requires payment of a monthly premium.
3. Part C (Medicare Advantage plans). Those insured under Medicare Parts A and B can choose to enroll in a Medicare Part C, or “Medicare Advantage,” plan. Medicare Advantage plans, which must be approved by Medicare, are offered by private insurers. The coverage provided under these plans must be at least as good as what Medicare provides, but coverage otherwise varies from insurer to insurer. Medicare pays private insurers a specified amount each month for every Medicare Advantage member. Coverage under Medicare Advantage requires payment of a monthly premium for Medicare Part B, as well as a monthly premium for the private insurer.
4. Medicare Part D (prescription drug coverage). Medicare Part D helps to pay for the cost of prescription drugs. Those insured under Medicare Part A, Medicare Part B or Medicare Part C (Medicare Advantage) may choose to enroll in Part D. Medicare Part D generally requires payment of a monthly premium.
Medicaid is two programs that provide disability benefits: Social Security Disability Insurance (“SSDI”) and Supplemental Security Income (“SSI”). SSDI provides benefits to insured workers with disabilities, or in other words, those who: (1) have been employed for at least five of the last ten years; (2) have paid FICA (“Federal Insurance Contributions Act”) taxes; and (3) have a “disability” as the Social Security Administration defines the term. A disability, for purposes of Social Security, is a serious medical condition that lasts (or has lasted) for more than a year and prevents someone from being gainfully employed. In addition, SSDI will provide benefits to the disabled children of insured workers, so long as the children became disabled before they reached the age of 22, as well as to the disabled surviving spouses of insured workers who have died.
SSI, on the other hand, pays benefits to disabled adults and children who have little or no income, or other financial resources. The program also provides benefits to adults without disabilities who are age 65 or older and whose financial means fall within the applicable limits.
Someone who receives SSDI benefits, or who is eligible to receive SSDI benefits, is also eligible to receive Medicare at the same time. Eligibility for Medicare begins after a waiting period of 24 months from the first date of eligibility for SSDI. For those with kidney disease who are on dialysis, however, the waiting period is reduced to three months from the date on which they began receiving dialysis. Medicare eligibility begins immediately for those with a terminal illness expected to cause death within six months, as well as for those with ALS. Those over age 65 are generally not eligible to receive SSDI benefits.
Likewise, eligibility for SSI and Medicare is also possible. Those under age 65 can receive SSI and Medicare benefits at the same time as long as they satisfy the eligibility requirements of both programs. For those age 65 and over, eligibility for Medicare is essentially automatic, and they can receive SSI benefits if their financial means are within the limits established under the Social Security Administration’s rules.
Eligibility for Medicaid often varies according to state law. In Ohio, children up to age 19; families with children under age 19; pregnant women; those with disabilities; and those over age 65 are eligible to receive Medicaid benefits if they meet certain financial requirements. Ohio residents under 65 who qualify for Medicaid can receive SSDI benefits, as well, if they qualify for SSDI under the rules of the Social Security Administration. Those over age 65 are usually not eligible to receive SSDI benefits.
Medicaid and SSI are similar programs inasmuch as they serve those with limited financial means. Ohio residents who have qualified to receive SSI benefits under the Social Security Administration’s rules can also qualify to receive Medicaid benefits if they qualify based on the rules established by the Ohio Department of Job and Family Services.
Although the receipt of benefits through all four of these programs is technically possible, the eligibility rules can be complicated—especially for receiving benefits from multiple programs at once. Furthermore, applications for disability benefits are often denied at first. If you think that you might be eligible to receive Social Security disability benefits, or if your application for benefits has been denied, then you should speak with a lawyer, like John T. Nicholson, who focuses on Social Security law.
What happens if a claimant dies while her SSI claim for disability benefits is still pending?
As with most law related questions the answer is maybe. Unfortunately, the rules for SSI claims are quite different from SSDI claims in situations where the claimant dies before a ruling is made on their application for benefits. The rules are as follows.
Benefits may be paid to the surviving spouse if the surviving spouse was living at the time of death or within six months proceeding the month of death.
Benefits may be paid to the parents of a disabled or blind child who was living with the parent or parents at the time of death or within six months proceeding the month of death.
If one of the above conditions does not apply then SSI benefits dies with the claimant, that is, no one gets paid SSI benefits.
Can I receive Social Security disability benefits for having problems with drugs or alcohol?
Someone can receive Social Security disability benefits despite having a problem with drugs or alcohol, but not solely on the basis of the drug or alcohol problem itself. Since 1996, those with drug or alcohol addictions are not eligible to receive Social Security disability benefits if their drug or alcohol addictions are their only disabilities. On the other hand, if they would have disabilities even without problems with drugs or alcohol, then they could still qualify for benefits.
In general, a “disability” as defined by the Social Security Administration is a serious medical condition that has lasted (or will last) for at least one year, and prevents someone from being gainfully employed. Although a drug or alcohol addiction might seem to satisfy this definition, the Social Security Administration’s rules state that drug or alcohol addiction—by itself—is not a qualifying disability. Specifically, those who have problems with drugs or alcohol that are contributing factors “material” to their disabilities will not be found eligible by the Social Security Administration to receive disability benefits.
A drug or alcohol addiction is “material” to a person’s disability if the person would not be disabled but for the use of drugs or alcohol. In other words, those who would not be disabled if they completely stopped using drugs or alcohol are generally not eligible for Social Security disability benefits because their use of drugs or alcohol is “material.” For example, if a person suffers from chronic liver disease and abuses alcohol, then the person would probably not be found disabled by the Social Security Administration if the cessation of alcohol use would result in the improvement of the person’s condition. If, however, the person’s condition were so advanced that cessation of alcohol use would not result in any significant improvement, then the person could be eligible for disability benefits. In the latter case, the person’s alcohol use would not be “material.” The distinction becomes somewhat more difficult to prove in the case of mental, as opposed to physical, disabilities.
If you have been denied a claim for Social Security disability benefits on the basis of drug or alcohol problems, then you should speak with an attorney who focuses on Social Security law. An attorney can explain what you have to prove to establish your eligibility for benefits, and can help you obtain the benefits you need. Call or click here for a free online consultation with John T. Nicholson.
If the Veterans Administration determines that I am disabled, will the Social Security Administration also find that I am disabled?
If the Veterans Administration determines that I am disabled, will the Social Security Administration also find that I am disabled?
The Veterans Administration (“VA”) and the Social Security Administration (“SSA”) have their own, independent rules for determining whether someone is disabled for purposes of receiving disability benefits. Under the VA’s guidelines, someone who is not completely disabled can qualify for disability benefits. In other words, the VA recognizes partial disabilities (in terms of percentages) as well as total disabilities.
The SSA, however, generally recognizes only total disabilities. Under the SSA’s guidelines, a disability is a serious medical condition (mental or physical) that has lasted (or will last) for at least one year and prevents a person from engaging in any substantial, gainful activity. This definition incorporates not only the type of disability (for example, post-traumatic stress disorder or chronic heart failure) but also the extent or severity of the disability. As a result, someone could have a type of disability recognized by the SSA, but nevertheless not be eligible for Social Security disability benefits if the severity of the disability were found to be insufficient. A mental or physical condition severe enough to qualify as a disability under the SSA’s rules would likely be considered at least a 90% disability under the VA’s rules.
At the same time, a determination by the VA that someone is disabled does not necessarily mean that the SSA will also make the same determination. For example, even if the VA determines that someone is 90% or 100% disabled, the SSA does not automatically reach the same conclusion. The SSA requires that everyone who applies for disability benefits must submit medical documentation to prove the type and severity of their medical condition. Under the SSA’s regulations, only documentation provided by certain physicians is sufficient to establish that someone has a qualifying disability. The SSA does consider other evidence, such as a person’s own statements or disability evaluations by other government agencies, but the SSA only considers the other evidence for purposes of judging the extent or severity of a disability.
A disability determination from the VA can be useful for purposes of applying for Social Security disability benefits, but it will not be binding on the SSA. In many cases, a 90% or a 100% disability finding by the VA will go a long way towards proving a disability to the SSA, but it will probably not—by itself—be enough to establish a disability under the SSA’s rules. If the VA has determined that you are disabled and you have questions about how that could help you qualify for Social Security disability benefits, then you should consult an attorney familiar with Social Security law.
Can I get Social Security disability benefits if I am disabled but have never worked?
The Social Security Administration runs two programs that provide disability benefits: Social Security Disability Insurance (“SSDI”) and Supplemental Security Income (“SSI”). SSDI provides benefits to: (1) disabled workers who worked for five out of the last 10 years, called “insured workers” by the Social Security Administration; (2) the disabled children of insured workers, as long as the children became disabled before they reached the age of 22; and (3) the disabled surviving spouses of deceased insured workers. SSI pays benefits to disabled adults and children who have little or no income, or other financial resources; it also provides benefits to adults without disabilities who are over 65 and whose financial means are under certain limits.
Whether someone with a disability who has never worked can receive Social Security disability benefits depends upon the circumstances. For someone who has never worked and became disabled after reaching age 22, SSDI benefits would not be available. SSDI benefits could be available, however, to either a disabled child of an insured worker, as long as the child became disabled before reaching age 22; or, to the disabled surviving spouse of a deceased insured worker. Neither disabled children, nor disabled surviving spouses, have to satisfy the SSDI work requirement on their own.
SSI benefits, on the other hand, could be available to someone who has never worked, regardless of age. The reason that SSI could be available to someone ineligible for SSDI is that eligibility for SSI is based only on disability and financial means. Therefore, someone with a disability who has never worked can qualify for SSI benefits.
In order to qualify for either program, applicants must prove that they have a “disability” under the Social Security Administration’s rules (with the exception of those age 65 or over who apply for SSI benefits). With respect to adults, a “disability” is a serious medical condition that has lasted (or will last) for at least one year, and prevents someone from being gainfully employed. With respect to children, a “disability” is a serious medical condition that causes severe functional limitations and can either be expected to cause death, or be expected to last for at least one year.
Qualifying for either program can be difficult. The Social Security Administration often finds that applicants are not disabled, and proving a disability would be critical for someone who has never worked and would only be eligible for SSI benefits. If you are disabled and have never worked, then you should speak with an attorney who understands the Social Security Administration’s disability rules and can help you understand how to qualify. Complete our free online consultation form today.