Medicare and Medicaid

In addition to income benefits, approved disability claimants also become eligible for medical insurance in the form of Medicare or Medicaid.

Medicare and SSDI

If you are found disabled and you have enough credits to qualify for SSDI, you automatically become eligible for Medicare.  However, you do not get Medicare immediately.  Instead, you become eligible beginning with the 25th month after your first SSDI payment.

Calculating your Medicare eligibility date can be confusing, because you may be subject to a 5 months “waiting period” for SSDI.  If the waiting period applies, the 24 months delay in your Medicare begins running the same month your first become eligible for your SSDI payment.  In such a situation your Medicare would begin on month 30 after you first get paid SSDI.

There are a few exceptions to the 24 month delay

  • if you qualify for SSDI based on ALS (Lou Gerhig’s disease), there is no 24 month waiting period – your eligibility for Medicare starts the first month you are eligible to receive your SSDI payment.
  • if you qualify for SSDI based on kidney disease that necessitates a transplant, your eligibility for Medicare begins the month you have your transplant
  • if you qualify for SSDI based on end stage renal disease or kidney failure, the 24 month waiting period is reduced to 3 months – your eligibility for Medicare starts with the 3rd month after you are first eligible for SSDI.

Medicaid and SSI

If you are found disabled for SSI benefits, you automatically become eligible for Medicaid.  Unlike SSDI/Mediare, there is no 24 month waiting period – the first month you become eligible for SSI, you also become eligible for Medicaid.

Medicaid is a joint federal-state program that provides a source of payment for medical services for low income individuals.  Each state sets out the benefits available under Medicaid – click on the link to visit the Georgia Department of Community Health Medicaid page.

How to Start Coverage

Generally, if you are approved for SSDI (Medicare) or SSI (Medicaid), your health insurance coverage will start automatically.  In SSDI cases, you will receive a letter from Social Security advising you when your coverage starts and how much your premium will be.  You can expect that your monthly SSDI benefit will be reduced by your Medicare premium.

Remember, in most SSDI cases, your eligibility for Medicare will not begin for 2 years after the date you first become eligible for payment.   The applicable dates will be included in a letter you receive shortly after your SSDI approval notice.  Still, I recommend to my clients that they post a written or electronic reminder for the date when Medicare is supposed to start so you can follow up with Medicare if you do not receive your Medicare card prior to your eligibility date.

In SSI cases, Medicaid will write you with details about how to claim your Medicaid card.  Here, too, you may need to follow up with the Georgia Department of Community Health by calling 404-657-2700.