Making sense of the disability system: Medicare coverage

Most Oregon residents who have applied for Supplemental Security Income or Social Security Disability Insurance have not found the system to be terribly user-friendly. In fact, the rules, medical evidence requirements and procedures often seem downright hostile to people who are simply trying to obtain benefits they’re entitled to under the law.

With health care being a major area of concern for all applicants (and major source of confusion for many), we thought a few words about these critical disability benefits would be in order.

When will I receive Medicare coverage?

If you file a claim for SSDI benefits and the Social Security Administration determines that you are disabled, you will automatically be enrolled in the Medicare program after receiving two years worth of benefits. Stated another way, if your claim was approved after a hearing with an administrative law judge (the majority of cases), chances are you won’t have to wait more than a few months to qualify.

Individuals approved for SSI benefits, by contrast, are immediately enrolled in the Medicare program.

What are the benefits?

Once you’re eligible for Medicare under the SSDI or SSI programs, you will be able to take advantage of Medicare Part A (hospital insurance), Part B (medical insurance) and Part D (prescription drug coverage).

The hospital insurance benefit is free (financed by the taxes you paid while working) and helps pay for inpatient hospital bills and some follow-up care.

The medical insurance benefit requires most people to pay a sliding scale premium and has enrollment deadlines. If you opt for this coverage, it will help pay for doctors’ bills, outpatient hospital care and other medical services.

The prescription drug coverage benefit pays a portion of the cost of medications that doctors prescribe for treatment, but it also requires a premium in most cases and has its own enrollment deadlines as well.

Lastly, if you can afford the premiums, you can also choose to go with Medicare Part C (Medicare Advantage Plans) and have your health care needs taken care of by a private company contracting with Medicare to provide disability benefits.

Source: ssa.gov, “Disability Planner: Medicare Coverage If You’re Disabled,” Aug. 3, 2012

By |2019-02-08T20:19:53+00:00August 30th, 2012|Social Security Disability|0 Comments
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