• FreeAdvice has a new Terms of Service and Privacy Policy, effective May 25, 2018.
    By continuing to use this site, you are consenting to our Terms of Service and use of cookies.

SSDI and medicaid/medicare

Accident - Bankruptcy - Criminal Law / DUI - Business - Consumer - Employment - Family - Immigration - Real Estate - Tax - Traffic - Wills   Please click a topic or scroll down for more.

criss11401

Junior Member
What is the name of your state (only U.S. law)? North Carolina

I know some of the questions are very "duh" to those well versed in SSDI inner workings, so I apologize if I come off as sounding very noobish. This is due to the fact that, quite frankly, I AM very noobish in these matters, so please be kind. :) I also apologize if I give you too much/not enough info!


My husband (age 31) recently (November 2009, retroactive to June 2009) qualified for SSDI due to a debilitating mental health condition that leaves him unable to work. The main thing I am confused about is how healthcare works and what services he is eligible for.


He initially received SSI until the SSA determined his amount and began SSDI payments. I am aware that SSI and medicaid go hand in hand. Once his SSDI began, the money he received from SSI was deducted from the SSDI backpay (as it should have been) and he received a letter stating when his "automatic" medicaid coverage would end (again, as expected). A month later he received a different letter stating the coverage would end at a different (and later) date. After contacting the case worker provided on the letter, she informed him that he might qualify for medicaid under a sliding scale fee with a deductable? I assume that means we pay a certain amount per year and then it is as though he has medicaid? When he went to the office in person, they told him he had been denied medicaid coverage and would need to reapply. He HAD been denied coverage in 2008, but they seemed to not be aware that he was CURRENTLY covered, even though he had his card right there with him. The right hand was obviously not aware what the left was doing.


In attempting to research this on my own, I seem to recall coming across something that referenced eligibilty for medicare after a certain amount of time on SSDI. I have always been under the impression that medicare was insurance for retired persons. It is VERY possible that I am just mixing up something totally unrelated - after a while all the articles tend to run together!


My main concern is that he HAS to be covered by some type of insurance, be it private or government, so that he can continue to receive medical treatment for his condition. It seems like every time I speak to someone at a government office, I get a different "official" answer than before (sometimes from the exact same person I talked to previously) and I have confused myself even more by trying to research it. At this point, I am ready to learn to live with less and just pay for a costly private insurance policy so that I don't live in fear of what letter the mailbox may bring today in regards to his healthcare coverage. We are not trying to abuse or work around the system by any means, but if he is eligible for services I certainly would like to utilize them.


Thank you in advance for your help!
 


TheGeekess

Keeper of the Kraken
Your husband will be eligible for Medicare since he is on SSDI. However, the time it will begin (one or two years) I can't recall correctly. When he is eligible for Medicare, he can be enrolled in one of the Senior-type insurance programs.
 

BL

Senior Member
Medicare kicks in after two years of receiving SSDI .

He may or may not have to pay the premiums depending on your incomes and assets . If below poverty level ,the State usually picks up the tab.Less money the State has to pay out .

What the State may be saying is that he is no longer eligible for SSI Medicaid ,and must re-apply as if he were not .

All income and assets then would be considered ,and it's possible he may have to pay a fee .

Medicare also has RX plans .
 
NC has a "spend down" or sliding scale type of medicaid program, giving you several different ways to qualify.

If your household income is less than the limit you automatically qualify, or they offer a deductible program where they determine a deductible based on your household income and any bills you owe over that are then covered by Medicaid.

Check here: NC DMA: Medicaid for the Aged, Blind, and Disabled
 

wannabe_law

Junior Member
It never ends...

Get used to this kind of treatment...I have been dealing with these same sort of people for the last 9 months. However, in answer to your question, your husband will be notified by Medicare that he is eligible for medicare about one month before he becomes eligible, which will be 2 years from the month in which he became eligible for SSDI. For example, if he began SSDI in March 2009, he will be eligible March 2011. In the meantime, the rules of your state will impact the eligibility of Medicaid, however, generally, if you are receiving disability you are likely to be eligible for Medicaid but will have to pay a monthly premium. Good luck and be careful not to trust just anyone who tells you something. A general rule of thumb I would use is if it doesn't sound quite right, ask questions until you get answers that do sound right, even if you have to ask multiple people. Don't give up....you will pay dearly in the long run and they will not accept 'lack of knowledge' or 'that a state/federal employee did not inform you' as a legitimate reason for not acting on your own behalf. My losses are over $10,000 at this point, and still adding up.
 
Last edited:

Find the Right Lawyer for Your Legal Issue!

Fast, Free, and Confidential
data-ad-format="auto">
Top