Medicare and Medicaid Health Benefits through Supplemental Security Income and Social Security Disability Programs

Medicare is available to persons who have qualified for Disability Insurance Benefits after the appropriate waiting period. For most recipients, there is a 24 month waiting period from the first month of benefit entitlement before Medicare is offered. Medicare benefits are administered by the Social Security Administration.

Persons who are sufficiently needy and disabled may also qualify for Medicaid benefits. Medicaid is administered by the state Department of Human Services/Public Aid. Generally disabled individuals who are receiving Supplemental Security Income (SSI) are eligible to receive Medicaid benefits. It is important to remember that this eligibility is not automatic when a SSI claim is approved. Rather, the person receiving Supplemental Security Income must apply for Medicaid through the Department of Human Services or Public Aid office. If a claim is already pending, the person should bring the favorable SSI determination or award notice to his caseworker's attention. If the claimant has incurred large medical bills which are unpaid and for which a Medicaid claim is already pending, it is especially wise to provide this proof as soon as possible after a favorable determination. Medicaid may sometimes be applied for a short period before the date of the application.

In Illinois, the application for Supplemental Security Income, by itself, is not grounds for approval of the Medicaid claim.

Medicaid will usually pay for prescriptions. However it may be difficult to find a medical provider who will accept payment by Medicaid due to the low rates and lengthy delays in payment. If a disabled person has the option to also obtain Medicare, he will receive far better treatment options with dual coverage.

The premiums for Medicare may be payable by the DHS or Public Aid Department, depending upon the claimant's income level. This special program encourages the disabled person to obtain Medicare without a reduction to his monthly Social Security Disability benefit from the Medicare premiums.

This web site is designed for general information only. The information presented at this site should not be construed to be formal legal advice nor the formation of a lawyer/client relationship.

© 2012 Jan L. Kodner & Associates