Public Health Benefits for the Injured or Disabled

A permanent injury or disability may require long-term medical care. The expense of medical treatment combined with not being able to work can be financially devastating for people who do not have private insurance, depleting their savings and even leading to bankruptcy. Two government programs, Medicare and Medicaid, may be able to help with the cost of medical care for people who are not able to work because of an injury or disability.

Medicare Benefits

Medicare is a health insurance program for people over the age of 65, or for people with disabilities under the age of 65. Medicare has two programs, Medicare Part A and Medicare Part B. Medicare Part A is hospital insurance. It is usually provided free to people who meet the age or disability requirements because most people pay Medicare taxes while they are working. Medicare Part A benefits help pay for stays in a hospital, nursing facility, or hospice, and some home health services.

Medicare Part B is a medical insurance program that people can choose to enroll in at the age of 65. In 2018, the standard Part B insurance costs $134.00 per month (or higher depending on income). Medicare Part B helps pay for medically necessary doctor’s care, home health services, outpatient hospital care and physical therapists.

Medicare Eligibility Requirements

People under the age of 65 with an injury or disability are eligible for Medicare Part A insurance if they have been collecting Social Security or Railroad Retirement Board disability payments for 24 months, or if they are a kidney dialysis or kidney transplant patient. People who meet the conditions to get Part A insurance can also choose to buy Part B insurance. (For more specific information on what Medicare covers, visit www.medicare.gov/Coverage/Home.asp.)

Social Security disability payments are only available to people with a long-term, total disability. A disability is based on whether or not you are able to work. If you cannot do the work you did before or adjust to new work because of an injury or medical condition, and the condition has lasted or is expected to last for at least a year or result in death, then it meets the standard for a long-term, total disability. The Railroad Retirement Board disability payments also require a “permanent disability” that results in an inability to work. Because Medicare eligibility for people under age 65 requires a serious and long-term disability, it is not usually revoked once granted.

To find out if you are eligible for Medicare, visit www.medicare.gov . Under the “Search Tools,” follow the link that says “Find out if you are eligible for Medicare and when you can enroll.” The website will take you through a series of questions to determine your eligibility, and if you are eligible will instruct you on how to enroll in the program. You may also do this over the phone by contacting the Social Security Administration between 7 a.m. and 7 p.m. Monday through Friday at 1-800-772-1213.

Medicaid Benefits and Eligibility Requirements

Medicaid is a program designed to assist people and families with low incomes. It pays money directly to health care providers and may require a co-pay. Medicaid benefits vary from state to state, but must include hospital services, vaccinations, prenatal care, family planning services, rural clinics, pediatric service and screenings, and laboratory and x-ray services. Unlike Medicare benefits, Medicaid benefits end within a month if the recipient’s financial situation improves.

Medicaid varies from state to state, and each state defines what makes a person eligible for Medicaid. In general, families that qualify for Aid to Families with Dependent Children, children under the age of 6 and pregnant women in low-income families (at or below 133 percent of the Federal Poverty Level; roughly $26,600 for a family of four) qualify for Medicaid. To find out about elegibility requirements and to apply for Medicaid, contact your county Social Security office. To find the office nearest you, visit the Social Security Office Locator. To learn more about Medicaid statistics in each of the 50 states, check out www.kff.org/mfs/index.jsp. Click here to find the Medicaid program in your state. For more help on disability insurance law, go to www.law.freeadvice.com/insurance_law/disability_insurance/.