What Happens When An Employee Goes On Long-Term Disability?

People eligible for both Medicare and Medicaid are referred to as “dual eligibles.” While the two programs sound similar, they are each different and provide different benefits to separate populations of qualified individuals. Many people do qualify for both Medicare and Medicaid.

This blog post explains the differences between the two programs, the different eligibility requirements, and the range of benefits available to those who qualify. If you have questions about any aspect of Medicare or Medicaid, contact Sackett and Associates. We focus our entire legal practice on the state and federal benefits programs available to people who are disabled or elderly. We are here to help you.

Dual Eligibility for Medicare and Medicaid

Dual eligibility for Medicare and Medicaid is possible whenever a person’s income and available asset limit meet the criteria of their respective state and they are 65 years old or disabled as defined by the Social Security Administration’s (SSA) regulations.

The SSA defines a disability as “a medically determinable physical or mental impairment that has or is expected to last 12 months (or result in death) and prevents the person from performing substantial gainful activities.” Substantial gainful activities (SGAs) are defined in 2023 as activities through which you could earn at least $1,470 ($2,460 if blind).

Difference Between Medicare and Medicaid

Medicare is a federal program providing hospital and medical insurance to people aged 65 and older or people who are disabled. Persons suffering from end-stage renal disease or amyotrophic lateral sclerosis (Lou Gehrig’s disease) are also eligible for Medicare coverage. To qualify for Medicare coverage, a person must be an American citizen or a legal U.S. resident who has lived here for at least five years preceding the date of the Medicare application.

Medicare’s eligibility criteria and policies are applied nationally since it is a federal program.

Medicaid is a joint federal and state-run program in which states can expand eligibility and available services. As a result, your Medicaid coverage and eligibility will depend on the rules adopted by your state of residence.

Medicare Coverage & Costs

Medicare has several “parts” that are directed to coverage of particular healthcare-related costs.

Medicare Part A is insurance to cover the cost of hospitalization. This is free for anyone who worked or whose spouse worked long enough to accumulate the work credits, usually for at least 10 years. This is the same measure of eligibility for Social Security Disability and Social Security retirement benefits. If someone does not have enough work credits to obtain Medicare Part A coverage, they may purchase it for between $506 and $208 per month, depending on the number of work credits they earned.

The annual deductible for Medicare Part A is $1,600.

Medicare Part B covers the cost of medical care, but there is a monthly premium of $164.90 and a deductible of $226 per year.

Medicare Part C or (Medicare Advantage) Combines Medicare Parts A and B, typically including drug/prescription coverage (Part D). Medicare Advantage is provided through private insurers, sometimes with an additional premium. The plans are usually a Health Maintenance Organization (HMO)or Preferred Provider Organization (PPO) that require in-network care providers, referrals to specialists, and pre-authorization for particular levels of care. Advantage plans frequently offer some dental, vision, and hearing coverage.

However, these plans also provide caps on annual out-of-pocket expenses and limit copays.

Medicare Part D is the Medicare standard program’s drug coverage plan with no limited network of providers. Although provided through private insurers, Part D does not extend to dental, hearing, or vision coverage, and there is no cap on out-of-pocket expenses.

Medicaid

Although Medicaid is subject to changes in eligibility and services from state to state, Medicaid provides Medicaid both medical care and long-term care for those who qualify. Unlike Medicare, Medicaid is a “needs-based” program with eligibility requirements based on the applicant’s income and available financial resources.

The income eligibility limits vary in different states, but the generally applicable income limit is $2,742 per month, with a limit on available assets set in 2023 at $2,000. You must refer to your state’s current financial eligibility criteria for the specific rules that affect you.

Sackett and Associates Disability Lawyers Have Your Medicare and Medicaid Answers

Attorney Harvey Sackett is one of the most experienced disability lawyers anywhere in the country, having won thousands of disabled clients the benefits they deserved. With more than 40 years of disability law experience, Sackett and Associates have fought tenaciously for people with disabilities since 1980.

No matter where you live in the United States, from California to Maine, from Florida to Washington, Sacket and Associates will prepare, file, and fight for your Social Security Disability (SSD) or Supplemental Security Income (SSI) benefits and get you the Medicare and Medicaid coverage to which you are entitled.