Many Americans, whether veterans or civilians, suffer disabilities. Often these disabilities not only make life difficult physically, emotionally and mentally, but also financially. This leaves these suffering individuals needing help. There are two programs that offer help: Social Security Disability (SSD or SSDI) and Supplemental Security Income (SSI). It’s important you know the difference between the two, as they affect when you are eligible for Medicare.
Supplemental Security Income (SSI)
SSI is mainly income based. While being disabled is one criterion, you can be eligible for SSI with no disability. The three main criteria, of which you must meet one, includes:
- Being 65 or older
- Being legally blind
- Have a disability
While there is more criteria, having one of the above and limited resources are the major differentiators between its sister program, SSD.
Social Security Disability Insurance
SSD or SSDI is disability based. Age is not a factor, other than being a working adult under the age of 65. If you have a qualifying disability that will last a minimum of 12 months or that may result in death, you may be eligible for SSD. Your disability cannot be partial or a short-term disability.
SSD and SSI and Medicare
Which program you are eligible for determines when you may be eligible for Medicare and whether you must pay Parts A and B premiums. Let’s look at each.
1. SSI and Medicare
While SSI recipients are not eligible for Medicare prior to 65, they are eligible for Medicaid. And because SSI payments probably will fall at or below the poverty line, most recipients will qualify.
When an SSI recipient turns 65, they are eligible for Medicare by filing a Medicare uninsured claim. In other words, since they are on Medicaid, the state would prefer to pay your Medicare Parts A and B premiums (if you did not qualify for Medicare by working 40 quarters/10 years) than all your medical care, shifting the burden to the federal government.
Moreover, since you are on Medicaid and Medicare, you would be eligible for Dual Eligible Special Needs Plans (D-SNP) which offers the lowest possible cost to you, the beneficiary.
2. SSD and Medicare
Recipients of SSD are eligible for Medicare after 24 months of receiving SSD, except in certain circumstances. If you have End Stage Renal Disease (ESRD) or ALS (Lou Gehrig’s Disease) you are eligible for Medicare immediately. However, if the recipient did not work sufficient quarters, he or she will have to pay Parts A and B premiums, which in 2021 are $471 and $148.50, respectively.
However, depending on resources and income, an SSD recipient may qualify for Extra Help and a Medicare Savings Program (MSP). If so, the MSP will pay for the Medicare premiums, and depending at what level he or she qualified for, it may also pay for deductibles, copays and coinsurances.
If you need help with Medicare and you are on SSD or SSI, contact your agent. If you don’t have one, feel free to contact us. We are licensed in Florida, South Carolina and Texas. But you don’t need to live in one of those states to get your questions answered. We are here to help you regardless.
