Disability And Government Insurance

If you have a disability, you could be eligible to receive government health insurance benefits through Medicaid, Medicare or both. Read on for a overview of how people with disabilities qualify for each program and the benefits that each program offers. 

Medicaid Eligibility for People With Disabilities

• Medicaid is a health insurance program funded by both federal and state governments that covers medical expenses for 69 million Americans with limited financial resources. The program is shaped by broad federal guidelines, but each state administers its own Medicaid program and sets its own eligibility and payment standards.
  
  
• Although each state sets its own Medicaid insurance eligibility standards, there are certain groups that must be included in order for states to participate in the program, including low-income families, qualified pregnant women, children and people receiving supplemental security income.¹
  
  
• If you are disabled, you are eligible for Medicaid if you meet the standards for supplemental security income (SSI), a program administered by the Social Security administration. To qualify, you must demonstrate that you are either completely disabled or that you do not have other means to support yourself.
  
  
• Some states have established government insurance programs for people considered “medically needy” whose income is too high to qualify for Medicaid through the traditional SSI eligibility standards. To find out if you meet the requirements, contact your local Social Security office. 

What Medicaid Covers

Medicaid covers a broad range of health care services mandated by the federal government such as hospital and doctors services, and states can choose to cover additional services.

Mandatory benefits offered by every state include (but are not limited to):

• Inpatient hospital services
• Outpatient hospital services
• EPSDT (Early and Periodic Screening, Diagnostic and Treatment)
• Nursing facility care
• Home health care
• Doctors services
• Rural health clinic services
• Labs and x-rays
• Family planning
• Nurse midwife services
• Pediatric and family nurse practitioner services
• Medical transportation

Optional benefits include (but are not limited to):

• Prescription drug coverage
• Clinic services
• Dental care
• Vision care
• Physical therapy
• Chiropractic services

Medicare Eligibility

• Medicare is a federal health care program for people over age 65, but you may also be eligible for Medicare if you have a long-term disability or a qualifying disease, such as end-stage renal disease or amyotrophic lateral sclerosis (ALS, also known as Lou Gehrig’s disease).
  
  
• People under 65 are eligible to receive Medicare benefits if they have received Social Security Disability benefits (SSD) for 24 months. SSD benefits are different from SSI benefits (which are used to determine Medicaid eligibility). To qualify for SSD benefits, you need to have accumulated a certain amount of work credits, which you gain by making contributions to Social Security through income taxes.
  
  
• Once you have been receiving SSD benefits for 24 months, you are automatically enrolled in Original Medicare (Part A and Part B). To find out if you are eligible for Medicare, use the eligibility calculator from Medicare.gov.

What Medicare Insurance Covers

People who qualify for Medicare because of a disability receive the same benefits as people who qualify after turning 65. Medicare benefits have four parts, and each part is structured a little differently and covers a different range of medical services. 

• Medicare Part A covers hospital services and other types of inpatient care, such as hospice and skilled nursing facility care.

• Medicare Part B covers doctors services that are necessary to diagnose or treat a medical condition, such as doctor appointments, lab tests and ambulance services. Part B also covers preventative care and outpatient medical services.

• Medicare Part C, or Medicare Advantage, is a way to get all of your Original Medicare benefits from a private insurance company rather than from the federal government. Private insurance companies contract with the government in order to sell plans that must offer at least the same benefits as Original Medicare. Many plans offer additional benefits such as prescription drug coverage, vision coverage, or dental coverage included in one plan. 

• Medicare Part D, or Medicare prescription drug coverage, covers prescription drugs. Part D plans are sold separately from Original Medicare and come with their own monthly premium. Many Medicare Advantage plans include Part D benefits.

Dual Eligibility for Medicare and Medicaid

If you meet the income and disability requirements for Medicaid and Medicare, you could be one of the 8.3 million Americans who are dual eligible to receive benefits from both government insurance programs.

• Dual eligibility includes anyone who is enrolled in Original Medicare who also receives full Medicaid benefits or cost-sharing assistance through one of the Medicare Savings Programs (MSP). People who are dual eligible are usually Medicare recipients. View the current dual eligibility standards at the Centers for Medicare and Medicaid Services.
  
  
• For dual eligible beneficiaries, Medicare generally pays first for all Medicare-covered services. Medicaid may then cover the costs that Medicare does not cover or does not cover completely (such as coinsurance, copayments and deductibles). In some states, Medicaid pays for more services than Medicare, such as vision and dental care. For dual enrollees in these states, you can keep the additional benefits on top of your Medicare coverage.  

To find out if you are dual eligible, look at the letter you received from your state Medicaid office or call them and ask about your status.  

Learn more about Medicare options for people with disabilities by reading through our helpful guide.

¹ https://www.medicaid.gov/medicaid/eligibility/