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Demystifying Medicare & Disability: How Do Medicare and Disability Work?

Disability is not a subject that we often think about when reviewing Social Security benefits. Optimism could be the culprit – after all, becoming disabled is not something that you think could ever happen to you, especially in your younger years. However, the chances of incurring an injury or disability, especially later in life, are much higher than we may think.

Fortunately, programs such as Social Security Disability and Medicare exist to help ease the financial burden of disability. If you are concerned about how disability may affect you and your family, it helps to learn about both programs and how they could benefit you.

What is Social Security Disability (SSD)?

If you’ve researched Social Security benefits, you are probably already aware that Social Security Disability is different from other types of Social Security benefits available.

Simply put, Social Security Disability is a Federal program that benefits people suffering from disabilities. Administered by the Social Security Administration (SSA), the program provides financial assistance to American citizens who are suffering from a disability.

Unlike regular Social Security, you don’t have to be of retirement age to claim your SSD payments. However, In order to qualify for SSD, you must meet certain criteria as well as the SSA’s definition of disability. Once you are approved, the program will provide you benefits to compensate for your wages lost while you are unable to work.

How is Social Security Disability (SSD) Different From Supplemental Security Income (SSI)?

SSD and Supplemental Security Income (SSI) are two of the largest Federal programs available that provide financial assistance to those experiencing a disability. While they share some similar traits, such as being overseen by the SSA, they also have their fair share of differences as well.

SSD is designed to cover lost wages by those who are disabled and are unable to work. To receive SSD benefits for yourself or certain members of your family, you must be “insured” by having worked long enough and paid Social Security taxes.

SSI also benefits those suffering from a disability, however the benefits are not based on the taxes paid into Social Security. Instead, this program is designed to pay benefits based on a family or individual’s financial need.

How Do You Qualify For SSD?

To receive Social Security disability benefits, you must meet certain criteria. The most important of which is having worked a job that is covered by Social Security and meeting the SSA’s definition of disability.

SSD benefits are paid until you are able to work consistently again. If you reach full retirement age and are still receiving SSD, then the disability benefits you receive are converted to retirement benefits. However, the amount of benefits you receive remains the same.

How Does the SSA Define Disability?

When applying to SSD or SSI, you must be able to provide medical information and other details that can help the SSA determine if you meet their criteria for disability. Unlike other programs, Social Security only pays for what is considered total disability. This means that the SSA only considers you disabled if:

  • You are unable to perform the responsibilities of your previous job or other work based on your age, education and prior work history
  • Your medical condition prevents you from learning or performing other work
  • Your disability is expected to last a year or more, or is deemed terminal (resulting in death)

SSD does not apply for any disability that is considered partial or short term. The SSD program operates on the assumption that working families are able to obtain other resources for support during short periods of disability, such as insurance, worker’s compensation or savings.

How Much Work Do You Need to Qualify for SSD Benefits?

It also not enough to simply work in order to qualify for SSD benefits.  In order to receive the Social Security benefits for disability, you must have earned the sufficient amount of worker’s credit by working long enough and recently enough to qualify.

Social Security work credits are units awarded to you based on your total yearly wages. You can earn up to four credits per year. However, the amount of wages needed to earn a work credit change from year to year. For example, the most recent change for 2018 dictates that one credit is earned for every $1,320 of wages or self-employment income.

Also, the amount of work credits you need to qualify for SSD vary depending on your age and when you became disabled. The SSA provides a helpful chart that breaks down how many credits you need by age ( younger people usually need less workers credits to qualify).

How to Apply For SSD

Applying for disability benefits can be done either online, over the phone or by making an appointment at your local Social Security office to file a disability claim. In most cases, the disability claims interview should last about an hour. You can also review the SSA’s Disability Starter Kit to make sure you have everything you need for your claim to run as smoothly as possible.

Don’t hesitate to apply for SSD. It’s best to apply as soon as you become disabled to ensure the process goes as quickly as possible. Once you submit your information, it could take three to five months to process the application – possibly even longer, if there are any administration delays or a lot of medical information to review.

You will need to provide medical records and lab test results from your doctors, therapists, hospitals and any other facility that you’ve visited while seeking treatment. Other details you should include when applying for SSD include basic information, like your Social Security number, birth certificate and your most recent W-2 or federal tax returns from the past year.

Once your application is submitted, it’s reviewed by a an official at a state-run office, who then forwards the acceptance or denial recommendation to the SSA.

Keep in mind that disability approval is not a one-time assessment. If approved, you will be subjected to a review every one to seven years to determine that your condition has not improved. Even if it’s a permanent disability, the SSA will review every seven years.

What to do if Your SSD Application is Denied

If your application for SSD benefits is denied, you still have some options. The SSA website suggest starting with an Internet Appeal to request a review their decision regarding your eligibility for disability benefits.

You must request a review within 60 days of receiving your denial letter, otherwise you will need to re-apply, which further delays your payments.

What is Medicare?

Medicare is a federal program that can help those who are suffering from a disability. Essentially, it is the federal insurance program that helps citizens resolve their medical payments.

Although Medicare was designed for people who are 65 years or older, you can also receive Medicare if you are a younger person suffering from a disability or End-Stage Renal Disease (permanent kidney failure that requires dialysis or a kidney transplant).

Like Social Security, Medicare is an entitlement program for U.S. citizens who earn the right to enroll by working and paying taxes for minimum required period.

What Are The Different Parts of Medicare?

Medicare is available in four different parts, each providing a different type of medical coverage. Enrolling in Medicare automatically signs you up for Medicare Original (Part A and Part B), but you can also opt into Part C and Part D if necessary.

  • Part A (Hospital Insurance): Covers inpatient hospitals stays, hospice care, care in a skilled nursing facility and some home health care. These services are financed by your taxes paid while working, so it’s free.
  • Part B (Medical Insurance): Covers certain doctor’s services, outpatient care, preventative services and medical supplies. This insurance comes with a monthly premium.
  • Part C (Medicare Advantage Plans): A type of healthcare plan that is provided by a private company that contracts with Medicare to offer all of the benefits from Part A and Part B.
  • Part D (Prescription Drug Coverage): Offered by insurance and other private companies approved by Medicare, this plan adds prescription drug coverage to certain Medicare plans, including Original Medicare (Part A and B).

What is The Difference Between Medicare and Medicaid?

Sharing the first six letters, there is often some confusion regarding the difference between Medicare and Medicaid. Both are federal programs that provide health insurance, however the circumstances that qualify you for the programs are what separates the two.

Medicaid is run by the federal government in partnership with states to provide insurance coverage to low income families and individuals. The criteria for qualifying for Medicaid varies from state to state. Some may offer the insurance to anyone who falls below a certain income level, while other states may require additional criteria to qualify (such as disability status, age, pregnancy).

Medicare is a federally funded program that offers insurance to those who are 65 years or older, who collect social security disability or who may be experiencing renal failure. Unlike Medicaid, Medicare is not reliant on income.

When Do Medicare Benefits for Disability Kick in?

Now that you know a bit more about SSD and Medicare, it’s important to understand how the two intertwined. If you qualify for SSD, you are automatically enrolled in Medicare after receiving disability benefits for two years.

The SSA enrolls you into the first two parts of Medicare (Part A and Part B), but you can still opt into Medicare Advantage (Part C) and Prescription Drug Coverage (Part D) as well.

With these two programs, adjusting to life with a disability can be made significantly easier. As your SSD covers wages lost, allowing you to continue paying bills and buying food while being unable to work, Medicare will assist you with medical costs as you treat your illness or disability.

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