Getting Medicare or Medicaid if Approved for Disability

If Social Security grants you disability benefits, you will become eligible (at some point) 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 (SSDI) or Supplemental Security Income (SSI) benefits.

Does SSDI Come With Medicare?

Disability applicants who are approved for Social Security disability (SSDI) are eligible for Medicare, but only after a two-year waiting period. The two years are counted from the date that the applicant became entitled to be paid disability benefits. This is the date when benefits should have started, even if the applicant didn't receive the payments until months later because Social Security hadn't yet decided the claim. This date can be no earlier than five months after the applicant's "onset date of disability," which is the day the applicant became unable to work due to a medical condition. (The five-month delay is due to SSDI's waiting period.)

For most SSDI recipients, Part A Medicare (hospital coverage) will be free, but many will have to pay a monthly premium for Part B (doctor's visits) and Part D (prescription drug coverage). State programs, called Medicare Savings Programs, can help those with low income pay these Part B and Part D premiums, as well as some deductibles and co-pays.

Social Security should automatically enroll you in Medicare at the two-year mark, and will start deducting Medicare premiums from your SSDI check. Contact Social Security if you don't receive enrollment information or a Medicare card at that time.

Does SSI Come With Medicaid?

Most states automatically grant Medicaid eligibility to those who are approved for SSI disability benefits. If you're approved for SSI in these states, you'll be eligible for Medicaid the month after you apply for SSI (as long as Social Security finds you were disabled at that point).

But the federal government does allow states to have more restrictive Medicaid eligibility requirements than that of the SSI disability program, and some states don't automatically approve SSI recipients for Medicaid. The states with different eligibility criteria for Medicaid are Connecticut, Hawaii, Illinois, Indiana, Minnesota, Missouri, New Hampshire, North Dakota, Oklahoma, and Virginia.

In all of these states, at least one of the eligibility criteria is different than for SSI. About half of these states use the federal SSI resource limit as the asset limit for Medicaid, but the other half of these states use a slightly lower asset limit, meaning you have to have less money to qualify for Medicaid than for SSI.

As to income limits, most of these states' limits are close to the SSI income limits, though Hawaii's is actually higher because of Hawaii's high cost of living. Some of these states have different rules than the SSI program as to what income is counted toward the eligibility income limit.

All of these states, however, allow Medicaid applicants to deduct their medical expenses from their income when the state Medicaid agency is determining their eligibility for Medicaid. This is called "spend-down" ability. For example, if the Medicaid income limit in Illinois is $700 per month, and a Medicaid applicant has $800 per month in income but pays $170 in medical expenses, the applicant would be eligible for Medicaid because of the spend-down.

If you live in one of the above states with different eligibility criteria, call your state's health and human services department about your state's Medicaid eligibility rules.

What Can I Do If I Was Denied Medicaid Coverage?

If you've been approved for disability benefits through the SSI program but your state has denied you Medicaid benefits, read Nolo's article on appealing a Medicaid denial and consider contacting a disability lawyer.