How long after I've qualified for SSI disability am I eligible for Medicare?

2 answers | Last updated: Apr 25, 2013
A fellow caregiver asked...

I recently got approved for SSI Disability, after a little over a year. I have fibromyalgia, osteoporosis and a degenerative spine, as well as neck and shoulder intractable pain. I am on regular pain medication- Opana, and it is working pretty well. I am also receiving physical therapy, and am working very hard at my program to enable me to get around. I still have intractable pain, and am going to see a neurosurgeon due to "failed back surgery".
I am now getting letters from SSI asking me to take classes to get me back to work. I will probably never be able to work again, especially as an RN. My lawyer has advised me to ignore these, as did my personal physician. What is your advice? My second question is when do I get Medicare? I heard that once you get SSI Disability, you are eligible for it. I have heard both 1 year later and 3 years later. Do you know which one it is and what I need to do to start this process? Will I get the information sent to me? Thank you.

Expert Answers

There are actually two different disability benefits programs run by the Social Security Administration, so the first thing for you to do is to get clear about which type of benefits you're receiving. One type is Social Security Disability Insurance, referred to as SSDI. To qualify for SSDI benefits, you have to have earned a certain amount of work credits before you became disabled, which are accumulated by paying Social Security taxes. If you worked and paid Social Security taxes for a number of years, you almost certainly qualify for SSDI benefits if you meet the SSDI definition of disabled (which depends on your inability to perform any work that would earn you more than $980 per month). You receive SSDI benefits regardless of how much you have in assets or current non-earned -- meaning not from current work -- income.

The other type of federal disability benefit is Supplemental Security Income, known as SSI. This benefit is available only if you are not only disabled but also you have very few assets and very low income from any source. If you qualify for SSDI, you may also qualify for SSI benefits, though for many people their monthly SSDI benefits make their income too high to also qualify for SSI.

Now let's move to your Medicare eligibility question.
"¢ If you're eligible for SSDI, you will automatically become eligible for all parts of Medicare once you have actually received SSDI benefits for 24 months. About three months before this 24-month period is reached, you should be contacted by Social Security to apply for Medicare. If you don't receive this application information, you can contact Medicare directly to begin the enrollment process so that you'll be covered by Medicare as soon as the 24 months are reached. "¢ If you're eligible for SSI benefits based on your disability, but not for SSDI, then you are immediately eligible for full Medicaid coverage; however, SSI-only eligibility does not make you eligible for Medicare. "¢ If you're eligible for both SSDI and SSI, Medicaid can provide full medical coverage for you until you qualify for Medicare (after 24 months of SSDI benefits), after which Medicaid can continue to pay portions of medical bills that Medicare doesn't pay.

Finally, there are these letters from Social Security about taking classes to help you get back to work. You should understand that SSDI and SSI rules define disability not as the inability to perform your regular work (in your case, as an R.N.) but an inability to perform ANY gainful employment. Gainful employment is defined as any work, or any type, that pays you $980 per month or more. So, these classes may be to help retrain you to perform work that is less demanding than your previous work and that your physical condition might permit. The question of whether you can ignore them depends on whether they are merely notices that such classes are available or instead are requirements for you to continue collecting benefits. It is risky to ignore any notice from Social Security unless you are completely clear that it is merely an offer and not a requirement. You should contact your local Social Security office to determine which it is in your case. If Social Security says that the classes are required, you can ask your doctor to write a letter stating that you are physically unable to attend the classes.

Community Answers

Syrsw answered...

Thank you....a very concise answer to a very complex system.