Social Security Disability, Medicare & Medicaid Benefits

Social Security Disability, Medicare & Medicaid Benefits

Please note this is a general overview and available benefits are always evaluated on a case-by-case basis for each applicant.

With a diagnosis of ALS am I eligible for Social Security Disability?

Yes. If you have been diagnosed with ALS you should qualify for Social Security disability benefits because ALS is considered a presumptive disability. The applicant must meet specific criteria but most pALS (patients with ALS) meet these. You have to stop working to apply for Social Security disability benefits, but you can be using short- or long-term disability benefits through your employer or other private plans you might have. (There are some cases where one does not qualify for Social Security disability. This is normally found when someone does not have any work history or a long enough history of paying into the Social Security system while employed.) For more information, visit www.ssa.gov  1-800-772-1213

Social Security Disability Income (SSDI), Supplemental Security Income (SSI), Medicare & Medicaid

Medicare and Medicaid are social health insurance programs. SSDI and SSI are financial benefits.

Medicaid is not the same as Medicare. SSI and SSDI are not the same, either.

Medicare and Medicaid: Health Insurance Benefits

Medicare is a federal program. Traditional Medicare (Medicare A/B) is the same in every state. It provides health coverage (1) when someone turns 65 or (2) at any age if you qualify for Social Security Disability. You must be a qualified worker. Typically this means you have paid into the social security system for at least ten years. You can learn about Medicare at www.medicare.gov 1-800-MEDICARE

Medicaid is a federal program run by each state. Therefore, Medicaid is different in each state. Eligibility is based on income. The income threshold is quite low; see Georgia Medicaid guidelines for information. https://medicaid.georgia.gov  1-877-423-4746

Note: If you are eligible for both Medicare and Medicaid, you can have both and they will provide you with well-rounded health coverage.

Medicare-eligible pALS, there are different parts you need to be aware of:

Very briefly:

• A= hospital insurance (free)
• B= medical/outpatient insurance (requires monthly insurance premium)
• D= pharmacy/medication insurance (requires monthly insurance premium)
• C= not a separate benefit, but a private policy that allows private health insurance companies to administer Medicare benefits known as Medicare Advantage Plans. These are NOT supplemental plans but replace original/regular Medicare. We often refer to these as Medicare Replacement plans as it makes clearer what is occurring if you select one of these plans. The private insurance companies take charge and have their own individual policies about benefits coverage. They also maintain a network of providers, so be sure that your health care providers are in network when choosing a plan. To see if your Emory team is in network, you can go here. We also encourage you to speak directly with your insurance company to confirm your in-network providers. https://www.emoryhealthcare.org/medicare-advantage/index.html 
• Medigap/Supplement plan: Medigap is Medicare Supplement Insurance that helps fill "gaps" in Original Medicare and is sold by private companies. Original Medicare pays for much, but not all, of the cost for covered health care services and supplies. A Medicare Supplement Insurance (Medigap) policy can help pay some of the remaining health care costs, like copayments, coinsurance and deductibles. A Medigap policy is different from a Medicare Advantage Plan. Those plans are ways to get Medicare benefits, while a Medigap policy supplements your Original Medicare benefits. You pay the private insurance company a monthly premium for your Medigap policy. You pay this monthly premium in addition to the monthly Part B premium that you pay to Medicare. Unfortunately, if you are under the age of 65, the costs of Medigap can be quite high due to Georgia’s rules. You can read about that here: https://www.healthinsurance.org/medicare/georgia/#Medigap 

Luckily there is free help navigating Medicare! The website https://aging.georgia.gov/georgia-ship provides resources including the state SHIP program (state health insurance assistance program). They can be reached at 866-552-4464 option 4.

SHIP offers free one-on-one counseling and will explain all of your options regarding Medicare and many other issues. SHIP services support people with limited incomes, Medicare beneficiaries under the age of 65 with disabilities, and individuals who are dually eligible for Medicare and Medicaid. Ms. Shirley Thomas, sthomas@glsp.org, 470-552-3167, specifically helps patients with ALS.

More on SSDI and SSI www.ssa.gov 1-800-772-1213

Social Security disability insurance (SSDI, associated with Medicare-qualified pALS) is typically available to any person who has paid into the Social Security system for at least ten years (qualified workers). As of July 23, 2020, there is no waiting period if the reason for disability is ALS (this differs from other diagnoses). You also, therefore, have immediate access to Medicare.

Social Security insurance (SSI, associated with Medicaid-qualified PALS) is funded by general tax revenues, not by taxes taken from individual workers’ paychecks. SSI has very strict financial requirements. These benefits typically are retroactive to the date you are deemed disabled, but check with your disability contact person in the SSA for details. SSI Beneficiaries Typically Receive Medicaid.

pALS should also have expedited approvals for a disability claim. This is called a TERI case and should always be mentioned while you are applying.

Note: Typically the dependent children of recipients of SSI and SSDI are eligible for some benefits also. To apply for disability benefits, call the Social Security Administration at (800) 772-1213, online at www.ssa.gov, or visit your local Social Security office.