What to Know About Disability Benefits and Healthcare Access – Disability Attorneys of Michigan

Living with a disability presents unique challenges, and one of the most pressing concerns many individuals face is how to access affordable healthcare. Fortunately, specific programs are designed to support those with disabilities, including Social Security Disability Insurance (SSDI), Supplemental Security Income (SSI), Medicare, and Medicaid. At Disability Attorneys of Michigan, we understand the complexities of navigating these programs, and we’re here to help guide you through the process.

Qualifying for SSDI Benefits

Social Security Disability Insurance (SSDI) is a federal program that provides monthly benefits to individuals who cannot work due to a disability. Unlike SSI, which is based on financial need, SSDI is based on your work history and the amount you’ve paid into the Social Security system through FICA, or payroll, taxes. To qualify for SSDI, the following criteria must be met:

Work Credits: You must have worked a certain number of years and paid into Social Security to earn work credits. The number of credits required depends on your age at the time of disability, but generally, you need 40 credits, with 20 of them earned in the last 10 years.

Medical Condition: Your disability must meet the Social Security Administration’s (SSA) definition of disability. It must prevent you from doing substantial work and is expected to last for at least 12 months or result in death.

If you meet these criteria, you may be eligible for SSDI benefits. Once you qualify, you can also access healthcare coverage through Medicare.

SSDI and Medicare: A Lifeline for Healthcare

When you qualify for SSDI, you automatically become eligible for Medicare after a 24-month waiting period. Medicare is a federal health insurance program for individuals 65 or older. However, people younger than age 65 with specific disabilities, permanent kidney failure, or amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease, may also be eligible for Medicare. The program helps with healthcare costs but does not cover all medical expenses or the cost of most long-term care.

Once you qualify for Medicare, the Social Security Administration (SSA) automatically enrolls you in Original Medicare, which includes Part A (hospital insurance) and Part B (medical insurance). Here’s what each part covers:

Medicare Part A helps cover hospital inpatient care, including critical access hospitals and skilled nursing facilities (but not custodial or long-term care). Part A also covers some home health care, hospice care, and inpatient care in religious non-medical health care institutions.

Medicare Part B helps cover medically necessary doctor services, outpatient care, home health services, durable medical equipment, mental health services, limited outpatient prescription drugs, and many preventative services.

Medicare does not cover everything, so you may consider other options to help cover additional healthcare costs. If you choose to have Original Medicare, you can buy a Medicare Supplement Insurance (Medigap) policy from a private insurance company. Medigap helps cover some of the costs that Medicare does not, such as copayments, coinsurance, and deductibles.

Alternatively, you can choose a Medicare Advantage plan, a bundled option typically offered by private insurance companies. Medicare Advantage plans often include Part A, Part B, and usually Part D (prescription drug coverage) in one plan, simplifying the process and potentially reducing out-of-pocket costs.

Medicare is designed to help reduce the financial burden of healthcare for those with disabilities. Still, it is essential to understand the various parts of Medicare and the associated costs, including premiums, deductibles, and co-pays.

Qualifying for SSI

Supplemental Security Income (SSI) is a needs-based program that provides financial assistance to individuals with disabilities who have limited income and resources. Unlike SSDI, SSI does not have a work history requirement; eligibility is based on your financial situation and inability to work. To qualify for SSI, you must meet these key requirements:

Disability: You must have a qualifying disability defined by the Social Security Administration. This includes physical and mental impairments significantly limiting your ability to perform basic work-related activities.

Income and Resources: Your income and resources must remain below a certain threshold. The SSA considers your sources of income, including earnings, pensions, and other benefits. Resources include assets such as bank accounts, land that you do not live on, and savings. In 2025, the resource limit for SSI is $2,000 for individuals and $3,000 for couples.

Citizenship: You must be a U.S. citizen or a qualified non-citizen.

If you qualify for SSI, you will receive monthly payments intended to cover basic living expenses, including food, clothing, and shelter. Additionally, SSI recipients are often eligible for Medicaid.

SSI and Medicaid: Health Coverage for Low-Income Individuals with Disabilities

If you qualify for SSI, you may automatically be eligible for Medicaid, a state and federal program that provides health coverage to low-income individuals, including those with disabilities. Unlike Medicare, which is primarily available to individuals who qualify for SSDI, Medicaid is specifically designed for people with limited income and resources, including those receiving SSI benefits.

Medicaid provides comprehensive healthcare services, including:

Hospital and doctor visits: Covers most of the costs associated with medical visits, hospital stays, and outpatient services.

Prescriptions: Covers prescription medications.

Specialized care: Medicaid also covers long-term care, including nursing home care and home and community-based services.

Each state administers its own Medicaid program, so the benefits and eligibility requirements may vary. However, you will likely be eligible for Medicaid if you receive SSI benefits, and the application process is often streamlined.

We Help Secure the Benefits and Care You May Be Entitled to by Law

Navigating healthcare with a disability can be complex, but understanding the programs available, such as SSDI, SSI, Medicare, and Medicaid, is the first step toward securing the support you need. At Disability Attorneys of Michigan, we help individuals with disabilities access the benefits they deserve. If you have questions about eligibility or need assistance with an application or appealing a denial, reach out for personalized guidance.

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