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Do I Have To Pay For Medicare On Ssdi

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Tulsa Social Security Disability Attorneys On Your Healthcare Options

Do I Have to Pay for Medicare Part A Hospital Insurance?

Social Security Disability Insurance 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.

When Does Social Security Disability End

Social Security Disability benefits are available to those who are unable to work due to a significant medical condition or have a health issue that is expected to result in death. For a disability to qualify, it must be significant enough that it would prevent you from working for at least one full year.

If you are disabled, Social Security will continue to monitor your condition on a regular basis through Continuing Disability Reviews. These reviews must occur every 18 months, three years, or seven years depending on your condition. If you suffer from a condition that is likely to improve, you can expect a shorter review cycle. However, chronic conditions that are unlikely to improve may involve a longer time between reviews.

If you are currently receiving Social Security Disability benefits, it is important to know what circumstances would cause them to end and what your limitations are regarding income. In addition, you should be aware of what changes to your benefit income you may see as you reach retirement age.

Returning to WorkSince disability benefits are generated due to an inability to work, one common means of benefit termination is returning to work. In 2020, Social Security Disability allows a recipient to generate up to $1,260 per month, or $2,110 for those who are blind. However, any income over this amount, and potentially an amount below it, could qualify as substantial gainful activity, disqualifying you from receiving Disability benefits.

Persons With Disabilities Should Be Able To Get Free Health Care

By Bethany K. Laurence, Attorney

If Social Security grants you disability benefits, you will become eligible for health care through Medicare or Medicaid. Which program you will be eligible for, and when you’ll be enrolled in the health care program, depends on whether you are approved for Social Security disability insurance or Supplemental Security Income benefits.

Recommended Reading: What Is The Difference Between Medicare Advantage And Regular Medicare

Services Equipment & Access

People younger than age 65 who have Medicare due to a disability occasionally have difficulty obtaining specialized Medicare-covered services, equipment and supplies. While some younger people are relatively healthy despite their disabilities, others have serious physical and mental conditions that require coordinated care from highly trained specialists. Some people also need unusual or customized equipment. In addition, certain specialized equipment and supplies may not be covered by Medicare. Getting the necessary services, equipment and supplies you need may depend on your ability to advocate for it. This may involve a great deal of persistence.

You have the right to assistance or equipment that provides you with the same access as others to services and facilities. For example, if you have a hearing, speech or language disability, you have the right to an interpreter or some other method or equipment for communicating with medical providers. You have the right to accessible equipment, such as examination tables and mammography equipment that can accommodate wheelchair users. However, it must be reasonable for a medical provider to supply these accommodations, and doing so cannot create an undue burden on the financial resources of the provider. The U.S. Department of Justice, Civil Rights Division oversees these issues.

Reasons To Delay Medicare

Do I have to pay for Medicare? The Truth May Surprise You

If youre thinking about deferring Medicare, discuss the pros and cons with your current insurer, union representative, or employer. Its important to know how or if your current plan will work with Medicare, so you can choose the most comprehensive overage possible.

Some of the common reasons you may want to consider deferring Medicare include:

  • You have a plan through an employer that you want to keep.

Read Also: How To Sign Up For Aetna Medicare Advantage

Where Can I Get Disability For A Veteran

Disability Compensation There is disability compensation offered through the U.S. Department of Veterans Affairs. The compensation is available for veterans who have medical conditions, are disabled, or who have incurred military-related injuries. You will need to supply your medical and military records when applying for the program.

How Returning To Work Affects Medicare Coverage

If you are receiving SSDI and decide to return to work, you can receive at least 93 months of Medicare hospital and medical insurance after your trial work period, as long as you still have a disabling impairment. There is no premium for hospital insurance during this time, even if your cash benefits have ceased due to your return to work.

When your SSDI Medicare stops because you have returned to work, but you still have a disability, you are eligible to purchase Medicare coverage. If you are offered the option to purchase Medicare, you can:

  • Buy Part A and Part B at the same monthly cost which uninsured eligible retired beneficiaries pay.
  • Buy Part A without buying Part B. Medicare beneficiaries can only buy Part B coverage if they purchase Part A coverage first.

If you purchase Medicare and have health coverage through your work, Medicare generally becomes the “secondary payer” used to cover expenses not paid by your employer-provided coverage.

Recommended Reading: What Is Medicare Part G

Determining If You Are Disabled

To qualify for SSDI, you must meet the criteria Social Security has in place to determine if you are officially disabled.

Social Security uses a five-step process centered around five questions you must answer.

Are you working?

If you are working and averaging earnings of more than $1,260 in 2020, you will not be considered disabled in most cases. If youre not working, your application will be sent to Disability Determination Services to decide if your medical condition qualifies for benefits. DDS will ask the remaining four questions.

Is your condition severe?

Does your condition significantly limit your ability to perform basic living tasks such as standing, walking, sitting, lifting, or remembering? These issues must have persisted for at least the past 12 months.

Is your condition found on the Social Securitys list of disabling conditions?

For each of the major body systems, Social Security maintains a list of medical conditions that it considers so severe that it keeps a person from working in a substantial way. If it is not on the list, DDS will have to decide the severity of your condition through added review.

To speed reviews, Social Security maintains a Compassionate Allowances list and a Quick Disability Determinations program. Each of these screens applicants for a high probability of approval.

Can you do the work you did previously?

Can you do other types of work?

There are other special situations where you may also qualify. These include:

Ssdi And Other Disability Benefit Programs

Do I automatically get Medicare benefits if I am eligible for disability benefits?

Many people who are on SSDI benefits are also eligible for other disability benefits programs like Medicare or Medi-Cal. Its important to understand how these different programs interact as benefits from one program may impact eligibility for another program.

If you have questions about how programs interact with each other, talk to a benefits planner. You can also use the DB101 Benefits and Work Estimator for estimates on how working may impact your SSDI benefits and other benefits.

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Do Disability Benefits Include Medicare Or Medicaid

Should you or a family member be awarded Social Security Disability Insurance or Supplemental Security Income , you will probably receive Medicare or Medicaid, respectively. It can take time, however, and in a handful of states, the approval of Medicaid programs requires filing a separate application.In 1972, the US Federal government decided to move all welfare programs to state control. SSI is considered to be a welfare program since recipients arent earning benefits based on job history. As a result of that decision nearly a half-century ago, getting Medicaid isnt quick or automatic. In fact, SSI disability benefits do not guarantee Medicaid coverage in several states.We wrote this article to help you make sense of the medical coverage you can receive, and the differences between human service agencies in the various states. Medicaid is state-run, so every state processes applications somewhat differently.If you need a better understanding of Medicare vs. Medicaid before reading on, click to navigate to our resource. Weve also covered how to apply for Medicare in great detail.

How Much Will Medicare Or Medicaid Pay For The Wheelchair

  • You must have difficulty moving around in your home
  • You must be unable to perform activities of daily living including dressing, getting out of bed, bathing or using the restroom and the use of a cane, crutch or walker is not sufficient.
  • You must be able to safely operate a motorized device such as a scooter or wheelchair or you are supervised by someone is available to help you.
  • Your home must be able to safely accommodate a wheelchair.
  • Recommended Reading: Do I Need To Sign Up For Medicare Part B

    Do I Get Prescription Drug Coverage With Disability Ssdi

    You don’t directly get prescription drugcoverage with Social Security Disability Insurance. Social Security will mainlypay disability benefits when you have sufficiently proved that you are indeeddisabled, based on the eligibility criteria they have.

    However, if you have been receivingdisability benefit payments for 24 months, you may become eligible underMedicare and receive medical benefits, including prescription drug coverage. Youneed to sign up for this coverage. You are required to sign up within theperiod covered by three months prior to your 25th month receivingSocial Security disability benefits up to the three months after your 25thmonth. Confusing? This just means that you can sign up between the 22ndmonth to the 28th month that you are receiving Social Securitybenefits. You need to do this. Otherwise, you may also need to pay a penalty.

    The Medicare benefits provided include:

    • Medicare Part A benefits
    • Medicare Part B (covering mainly outpatient services and other expensesnot covered by Medicare Part A
    • Medicare Part D
    • Other optional plans such as Medicaid

    This is not just for the disabled beneficiary,but also for his dependents. Also, the prescription drug coverage covers notjust generic prescription drugs but also brand-name medications.

    In 2010, the beneficiary will receive arebate of $250 when his medication expenses exceed $2,700. Come 2011, discountsof up to 50% will be given for medicines, particularly brand-name drugs.

    Not a bit

    When Will My Medicare Begin

    I have VA Benefits. Do I need Medicare?

    In most situations you can receive Medicare disability benefits once you receive Social Security disability income benefits for 24 months. Medicare disability coverage begins the 25th month. The 24-month period begins the month you are entitled to receive Social Security disability benefits. In some cases this could be earlier than the month you receive your first disability benefit check. A person who has ALS and is under age 65 can get Medicare benefits the first month he or she is entitled to SSDI or railroad retirement disability benefits. If you have ESRD , you are eligible for Medicare benefits:

    • the first month you start to administer a regular course of dialysis treatment after receiving selfcare training, or
    • the fourth month you receive treatment at a dialysis center , or
    • the month the transplant is done or the month of hospitalization as an inpatient up to two months before the transplant, if pre-transplant testing has begun.

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    If You Get Medicare For Disability And Then Return To Work

    If you get Medicare due to disability and then decide to go back to work, you can keep your Medicare coverage for as long as youre medically disabled.3 And, if you do go back to work, you wont have to pay the Part A premium for the first 8.5 years.

    Part A is premium-free for those with a disability and under 65 only if you get Social Security or Railroad Retirement Board benefits for 24 months or have ESRD and meet certain requirements.4

    If youre 65 or older, Part A is premium-free if you or your spouse worked and paid Medicare taxes for at least 10 years, you already get retirement benefits from Social Security or the Railroad Retirement Board, or youre eligible for these benefits but havent filed for them yet.5

    Are Lottery Winnings Considered Earned Income

    Lottery winnings are considered taxable income for both federal and state tax purposes and must be reported as such. Lottery winnings are taxed the same as a wage or salary, regardless of whether the winnings are taken as a lump sum or an annuity.

    Lottery winnings of more than $5,000 are reported to the Internal Revenue Service by the lottery agency. Winnings of less than $5,000 are the responsibility of the winner to report on their taxes.

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    Your Health Care Rights

    The Americans with Disabilities Act of 1990 , federal legislation and California state law all prohibit discrimination on the basis of a disability. However, these laws are limited in a number of ways, and they dont require insurance companies to sell you policies.

    Medical providers cannot refuse to treat you because you have a disability. But they can refuse to accept you as a new patient if they are refusing other Medicare patients, or if they dont treat anyone with Medicare. Medical providers are also permitted to refer you to another provider if the care you need is not within the scope of their practice.

    If you think a physician or health care plan is denying your disability rights, file a complaint with your medical group, your plan and the U.S. Department of Justice . If you need help, contact your local Health Insurance Counseling & Advocacy Program office for free counseling and information.

    How Much Does Medicare Cost On Disability

    Do I Get Medicare If I’m Getting Social Security Disability Benefits?

    If you qualify for SSDI, you’ll typically qualify for premium-free Medicare Part A based on your work record. Part B requires a monthly premium , automatically deducted from your Social Security check. You can technically opt out of Part B if you dont want to pay the premiums. Just know that without Part B, youll forego extensive medical coverage. Its usually not a good idea to opt out of Part B unless you have other health insurancelike from an employer.

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    Medicare Waiting Period Eliminated

    Thanks to advocacy efforts, Congress passed a law in December 2020 that waived the five-month waiting period for ALS Medicare and SSDI benefits. In March 2021, a follow-up bill made the change retroactive for people who had already applied. If youre still waiting for benefits, contact your local ALS organization.

    Qualifying For Medicare When Receiving Disability Benefits

    Medicare coverage kicks in for most SSDI recipients two years after the first month they are eligible for their monthly disability benefits. However, this doesnt automatically mean that every person approved for SSDI must wait two years to get their Medicare coverage. The two-year Medicare waiting period generally gets calculated from the date of your SSDI entitlement . Normally, this is the date your disability began plus the five-month SSDI waiting period.

    However, things get a little tricky depending on your disability onset date. Depending on how far back you became disabled, you may have met a good portion of the waiting period by the time you are approved for benefits. But, because Social Security only allows a maximum of 12 months of retroactive benefits, plus the 5-month waiting period for benefits, the earliest that you can become eligible for Medicare is one year after you apply for Social Security disability.

    But, if you recently become disabled and were approved with an entitlement date of August 2018, you would not become eligible to receive Medicare benefits until August 2020. There are exceptions to this rule if your disabling diagnosis is End Stage Renal Disease or Amyotrophic lateral sclerosis . People with these conditions receive expedited Medicare coverage.

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    Eligibility Rules For Disabled Children/family Benefits

    When a child under 18 may or may not be disabled, Social Security doesnt consider the childs disability when deciding if he or she qualifies for benefits as a parents dependent. The childs benefits normally stop at age 18 unless he or she is a full-time student in an elementary or high school in which case benefits can continue until age 19, or he or she is disabled.

    In some cases, your spouse or child may qualify for SSDI with an amount of up to half of your benefit. There is a limit of 150-180% of your full benefits.

    Also, if you get divorced, you may be eligible for benefits based on your ex-spouses SSDI if:

    • your marriage lasted for at least ten years
    • you have not remarried
    • your ex-spouse is at least 62 years old
    • you are eligible for Social Security disability or retirement benefits.

    This benefit cannot exceed the amount of money you could receive based on your work history instead of your ex-spouses.

    If an is adult disabled before 22, he or she may be eligible for a childs benefits if a parent is deceased or starts receiving Social Security retirement or SSDI benefits. It is considered a childs benefit because funds are paid based on a parents earnings record.

    An adult child must be unmarried, age 18 or older, have a disability that started before age 22, and meets the definition of disability for adults.

    Several rules can qualify for an exemption. If you arent sure about your status, contact Social Security to find out more about possible benefits.

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