What is Medicare?

Medicare is a national health insurance program run by the federal government. Medicare covers, people age 65 and older and some people under age 65 who may qualify due to a disability or another special situation.

Why is it important to those with Medicaid?

Medicaid can provide secondary insurance: For services covered by Medicare and Medicaid (such as doctors’ visits, hospital care, and home care) Medicare is the primary payer. Medicaid is the payer of last resort, meaning it always pays last. When you visit a provider or facility that takes both forms of insurance, Medicare will pay first and Medicaid may cover your Medicare cost-sharing, including coinsurances and copays.

Medicaid can provide premium assistance: In many cases, if you have Medicare and Medicaid, you will automatically be enrolled in a Medicare Savings Program (MSP). MSPs pay your Medicare Part B premium and may offer additional assistance.

Who qualifies?

Disabled people who are approved for Social Security disability insurance (SSDI) benefits will receive Medicare, and those who are approved for Supplemental Security Income (SSI) will receive Medicaid. However, SSDI recipients aren’t eligible to receive Medicare benefits until two years after their date of entitlement.

You automatically get Part A and Part B after you get one of these:

  • Disability benefits from Social Security for 24 months
  • Certain disability benefits from the Railroad Retirement Benefits for 24 months

What does Part A and Part B mean?

Part A helps pay for hospital and facility costs. This includes things like a shared hospital room, meals, and nurse care. It can also help cover the cost of hospice, home health care, and skilled nursing facilities.

Part B helps pay for medical costs. This is care that happens outside of a hospital. It includes things like doctor visits and outpatient procedures. It also covers some preventive care, like flu shots

How do I Qualify for SSDI then?

The definition of disability under Social Security is different than other programs. Social Security pays only for total disability. No benefits are payable for partial disability or for short-term disability. One is disabled under Social Security rules if:

  • You cannot do work that you did before;
  • Social Security decides that you cannot adjust to other work because of your medical condition(s); and
  • Your disability has lasted or is expected to last for at least one year or to result in death.

What about a child with a disability?

A child under age 18 may be disabled, but Social Security doesn’t need to consider the child’s disability when deciding if they qualify for benefits as your dependent. The child’s benefits normally stop at age 18 unless they are a full-time student in an elementary or high school (benefits can continue until age 19) or is disabled.

What next?

If you think you qualify or are interested in knowing more, Southern Tier Connect works with Matthew Requa, a Community Outreach and Engagement Specialist with Southern Tier Independence Center (STIC). Southern Tier Independence Center is offering FREE health insurance enrollment services via telephone. This is a personal and confidential service available to any and all individuals seeking health insurance coverage.  One of their experienced Navigators will guide you through the enrollment process and ensure you have everything needed to obtain a health insurance plan. STIC Navigation services are offered in the following counties: Broome, Chenango, Cortland, Delaware, Tioga, and Tompkins.