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Can I Qualify for Medicare if I have a Disability?

August 14th, 2015

Medicare is well-known for providing health insurance for people age 65 and older. However, Medicare can also provide health coverage for younger people with disabilities, so if you have a disability, it is important to know how you may qualify for Medicare. Medicare

The first step is to apply for disability benefits through the Social Security Administration. To qualify for Social Security disability insurance (SSDI) benefits, you must not be working a substantial amount, you must have paid FICA taxes for a long enough period to qualify, and you must have a severe medical condition that prevents you from working and has lasted or is expected to last at least one year, or result in death. If you have not paid enough into the system with your taxes, then you may still be able to apply for Supplemental Security Income (SSI), if you meet the income and asset limits.

Once you have been entitled to Social Security disability benefits, or Railroad Retirement Board benefits, for 24 months, then you will automatically be enrolled in traditional Medicare (Parts A and B), as opposed to a Medicare Advantage plan (Part C). If you wish to switch to Medicare Advantage, or enroll in Medicare Part D prescription coverage, you may do so during your initial enrollment period, which starts three months before your 25th month of disability and ceases three months after your 25th month of disability. You may also make such changes during the yearly enrollment period, which is from October 15 to December 7 each year.

As noted above, after becoming entitled to SSDI benefits, there is a two-year waiting period to become eligible. However, there are two exceptions. People with amyotrophic lateral sclerosis (ALS) can get Medicare when they are entitled to receive disability benefits. For people with end-stage renal disease with kidney failure who require a kidney transplant or ongoing dialysis, Medicare coverage can start three months after your dialysis starts.

 

Learn more about our special needs planning and special education advocacy services at www.littmankrooks.com or www.specialneedsnewyork.com.


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Navigating the Process of Applying for Social Security Disability Benefits

May 14th, 2013

Disabled individuals who cannot work are entitled to Social Security disability benefits, but the process of applying can be lengthy and difficult. The majority of applicants are denied benefits at the outset, and they may be uncertain of how to proceed.

When we discuss Social Security disability benefits, we are talking about two different programs. Social Security Disability Insurance (SSDI) is available to people who have paid into the Social Security system through taxes during the 10 years before they became disabled. Supplemental Security Income (SSI) is available for people who have not paid enough into the system to be eligible for SSDI. To be eligible for either type of benefits, one must be “unable to engage in any substantial gainful activity” – i.e. “work” – because of a “medically determinable” disability lasting one year or more or expected to result in death. The questions of whether or not an individual is disabled and whether or not he or she can work are the key factors in determining eligibility for benefits.

The first stage in the process is the initial interview. A disabled individual may contact the Social Security Administration (SSA) to set up an appointment. One must have been disabled for five months before applying for SSDI benefits; there is no waiting period for SSI benefits. An applicant should bring two forms of identification to the interview, and any medical records that provide evidence for the disability. If there are records the person has not obtained, he or she may sign a medical records release form permitting the SSA to obtain them. If an individual is not able to go to a Social Security office, he or she may conduct the interview by telephone or appoint another person such as a family member to represent the disabled person at the interview. The process of deciding on the application takes from three to six months.

The majority of claims are denied at the initial application stage, but this should not deter disabled individuals from continuing with the process. Often a denial is the result of insufficient records or information that has not been presented persuasively. The second stage of the process is a request for reconsideration, which also involves an interview and the submission of any additional evidence. If the request is denied, then the third stage is to file for a hearing before an administrative law judge. An attorney can assist an applicant at any stage of the process; at the hearing stage and beyond, such assistance may be invaluable.

At an administrative hearing, the disabled person may present the testimony of witnesses and any other additional evidence. The government may also hear the testimony of a vocational expert and/or a medical expert who will offer their expert opinions regarding whether the applicant is disabled and whether he or she is unable to work. If the applicant is unsuccessful at this stage, he or she may file a claim with the Appeals Counsel Review Board. If the appeal is denied, then the last option is a civil lawsuit in District Court.

At any stage at which the benefits are granted, they will be retroactive to the date of the original application. If it is determined that the disabled individual is not able to handle the cash benefit appropriately, then a representative payee will be appointed to handle the money for the disabled person’s benefit.

For more information about disability law, visit www.specialneedsnewyork.com.

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