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Medicare Disability Coverage Guide

Medicare Disability Coverage Guide

Disability Benefits

Did you know that you have a 1-in-4 chance of becoming disabled if you work in the United States between age 20 and reaching full retirement age?

It is a staggering statistic.

There is a connection between Social Security Disability Income and Medicare too.

There is a connection between Social Security Disability Income and Medicare too.


Supplemental Security Income (SSI) is administered by the Social Security Administration but is paid for by the U.S. Treasury general fund. SSI is a monthly payment made to Americans, children, and adults, who have a low income and little resources and are also either age 65 or older, blind or disabled.

Many Americans who qualify for SSI may also be eligible to receive Social Security benefits. If you qualify for SSI, you most likely will automatically qualify for medical assistance through AHCCCS, Arizona’s Medicaid. This will help with the cost of hospital visits, doctor/medical bills, prescription drug costs, and other health-related expenses.

On top of that, you may also be eligible to receive a supplemental payment from Social Security as well as food/nutrition assistance.

To qualify for SSI, you must be:

  • Disabled
  • Blind
  • Or at least age 65
  • And have limited income and resources

You must also:

  • Be either a U.S. citizen or national, or a qualified alien.
  • Reside in one of the 50 States, the District of Columbia, or the Northern Mariana Islands. and
  • Not be absent from the U.S. for a full calendar month or 30 or more consecutive days.

If you need assistance determining if you qualify for SSI, please contact your local Social Security office.

Next, I will explain the details about disability coverage in general, and then will tie this into Medicare disability coverage toward the end of this article.


Who can get SSDI?

If you cannot work because you have a medical condition that is expected to last at least one year (or may result in death), then Social Security will pay an SSDI benefit. Federal law mandates an extremely strict definition of a disability. Social Security does not give money to those with a partial disability nor a short-term disability. You may need to investigate other programs if this is the case for you.

Earnings requirements for SSDI.

This is where things get a little complicated. To receive disability benefits, you have to meet two different earnings tests:

  • 1Recent work test (based on your age at the time you became disabled; and
  • 2Duration of work test that shows you worked long enough under Social Security.

Some blind workers only need to meet just the duration of work test.

Review the table below that shows the rules for how much work you need for the recent work test. The rules are based on a “calendar quarter” in which you turned (or will turn) a certain age. The calendar quarters are as follows:

Quarter One: January 1 – March 31

Quarter Two: April 1 – June 30

Quarter Three: July 1 – September 30

Quarter Four: October 1 – December 31

If you became disabled… If you became disabled…
In or before the quarter you turn age 24 1.5 years of work during the three-year period ending with the quarter your disability began.
In the quarter after you turn age 24 but before the quarter you turn age 31 Work during half the time for the period beginning with the quarter after you turned 21 and ending with the quarter you became disabled.
Example: If you become disabled in the quarter you turned age 27, then you would need three years of work out of the six-year period ending with the quarter you became disabled.
In the quarter you turn age 31 or later Work during five years out of the 10-year period ending with the quarter your disability began.

The following shows how many quarters of coverage you need to meet the duration of work test:

You may take the year you became disabled and subtract the year you attained age 22 to get the number of quarters of coverage necessary to meet the duration requirement. You must have a minimum of six quarters of coverage to meet the duration requirement. This minimum requirement for six quarters of coverage is also applicable for those who have not yet attained age 22 and may apply for disability based on their own earnings.

Here is a general idea (an estimate only):

If you become disabled… Then you generally need:
Before age 28 1.5 years of work
Age 30 2 years
Age 34 3 years
Age 38 4 years
Age 42 5 years
Age 44 5.5 years
Age 46 6 years
Age 48 6.5 years
Age 50 7 years
Age 52 7.5 years
Age 54 8 years
Age 56 8.5 years
Age 58 9 years
Age 60 9.5 years

How to apply for disability benefits:

There are two ways you can apply for SSDI.

  • 1Apply online at  www.socialsecurity.gov
  • 2Call Social Security at 1-800-772-1213 to make an appointment to file a disability claim
    at your local Social Security office or over the phone. The interview lasts about an hour.

When should you apply and what information do you need?

The best time to apply for SSDI benefits is as soon as you become disabled. The application process can take several months to be processed.

It will also take you quite a bit of time/energy to gather all the necessary information, such as:

  • Your Social Security number
  • Your birth certificate (or baptismal certificate)
  • Names, addresses and phone numbers of the doctors, caseworkers, hospitals, and clinics that took care of you, as well as the dates you visited them
  • Names and dosage of all your medications
  • Medical records from your doctors, therapists, hospitals, clinics, and caseworkers that you already have in your possession
  • Lab and test results
  • A summary of where you worked and the kind of work you did
  • A copy of your most recent W-2 or federal tax returns if you were self-employed

There are also several forms that need to be completed by both you and your doctors or other health care professionals.

You must also:

You will be automatically enrolled in Medicare coverage after you have received disability benefits for two years. If this does not happen, contact your local Social Security office, and ask them to assist you with the process.

Medicare is our federally administered health insurance program that provides health coverage for those over age 65 or who are disabled (on SSDI). Medicare basically covers 80% of your health-related expenses, so when you get enrolled in Medicare disability coverage, you will then want to talk with a licensed sales agent to help you learn more about Medicare Advantage plans and Medicare Supplement plans. These plans work to either pay the 20% that Medicare does not cover or replaces Medicare with an HMO or PPO type of health plan where you only pay co-pays for services.

Medicaid/AHCCCS and Medicare

In some cases, based on your income, you may qualify to have both Medicare and Medicaid (called AHCCCS in Arizona). In these cases, you may qualify for a special type of Medicare Advantage plan called a Dual Special Needs Plan. These plans are amazing because they work in conjunction with your Medicare and Medicaid/AHCCCS to provide you several extra benefits at no cost, like:

  • Free dental insurance
  • Free vision insurance
  • Free hearing aids
  • Over-the-counter mail order catalog, where you can order your OTC items all at no cost to you
  • Free gym membership
  • Chiropractic and acupuncture coverage

If you have these two cards, please contact us right away, and we can help you learn more about the extra benefits you may qualify for all at no cost.

  • Medicare Health Insurance
  • Arizona Health Care Cost Containment System

Where do I learn more?

If you have these two cards, please contact us right away, and we can help you learn more about the extra benefits you may qualify for all at no cost.

We’re here to help! Call us today.

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