Medicare and Medicaid and disability

Medicaid is a federal and state program that provides health care coverage to qualified individuals. People who are eligible for Medicaid include:

• Pregnant women with low income
• Children of low-income families
• Children in foster care
• People with disabilities
• Seniors with low income
• Parents or caregivers with low income

Medicaid programs are state-run. So states can choose to provide Medicaid to more people, such as individuals with low income who may or may not have children.

People with disabilities or chronic conditions and low incomes are eligible for Medicaid. All states also provide aged, blind and disabled (ABD) Medicaid benefits. ABD Medicaid is for adults 65 and older or anyone who is disabled according to Social Security. But you also need to meet the financial eligibility requirements in your state.

Whether you qualify for Medicaid or Medicare depends on the type of disability benefits you’re getting.

• If you have Supplemental Security Income (SSI) disability:
  You’ll be eligible for Medicaid coverage. In many states, you’ll get Medicaid automatically. But in other states, you’ll need to sign up for Medicaid.
• If you’re getting Social Security Disability Income (SSDI):
  You’ll qualify for Medicare.

No matter whether you have SSI, SSDI, Medicaid, ABD Medicaid or Medicare, the medical requirements are the same. First, you must meet the non-medical disability requirements. These are based mainly on your work history and social security taxes you’ve paid. Then, monthly disability benefits are paid if a medical condition is expected to last at least 1 year or result in death.

Different types of medical conditions that qualify as a disability for adults over age 18 are listed in the chart below. Note that the chart shows a general list. It doesn’t include every condition that may qualify adults for social security disability. For a full list of qualifying conditions visit the Social Security Administration (SSA) website There’s also a separate childhood listing that shows impairments for children with disabilities.

People under age 65 with disabilities automatically qualify to get Original Medicare (Parts A and B) after they’ve been receiving disability benefits from Social Security for 24 months. If you also qualify for Medicaid or Medicaid disability, your state Medicaid program may help pay for costs and services that Medicare does not cover. For any services that are covered by both Medicare and Medicaid (such as doctor visits, hospital care, home care and skilled nursing facility care), Medicare will pay first. Medicaid may also pay for added costs or services, but only after the Medicare share has been used up.

More than10 million people qualify for Medicaid based on having a disability.¹ There are also more than 12 million people who qualify for both Medicare and Medicaid.² These people are known as “dual-eligibles” because they’re dually eligible for Medicare and Medicaid. Dual-eligible health plans offer more benefits than Original Medicare. But the thing is, a lot of people who could qualify for a Dual Special Needs Plan don’t know these plans exist.

Dual Special Needs plans are for people who could use some extra help. That may be because of income, disabilities, age and/or health conditions. Dual Special Needs plans are a special type of Medicare Advantage plan. They include everything you get with Original Medicare, plus prescription drug coverage and many other extra benefits on top. And you could get it all with as low as a $0 plan premium.*

To see if you qualify for a Dual Special Needs Plan, read this article. Or use the search box below to find dual health plans available in your area.

¹ MACPAC (Medicaid and CHIP Payment and Access Commission) 
² CMS Medicare-Medicaid Coordination Office analytics webpage
*Benefits and features vary by plan/area. Limitations and exclusions apply.