A common problem that claimants face when they become sick and are no longer able to work is that they will lose their health insurance benefits. It is all too easy to accumulate thousands of dollars in medical bills to treat disabling conditions. I am often asked in my practice whether or not Social Security Benefits, if awarded, will take care of those outstanding medical bills. The answer is: maybe.
Whether or not you have insurance through your disability benefits that will cover old medical bills depends on a number of factors.
The Type of Disability Benefit
Depending on the type of disability benefit you receive, you will be eligible for either Medicaid or Medicare. Under Supplemental Security Income (SSI) you are eligible for Medicaid Benefits. In Tennessee, these are TennCare benefits.
If you are eligible for Disability Insurance Benefits, then you will qualify for Medicare. It is also possible, depending on the amount of income you receive each month from your benefits and other financial resources, that you could qualify for both Medicaid and Medicare simultaneously.
- SSI/Medicaid – if you are found to be eligible for SSI Benefits, the entitlement to Medicaid is back-dated to the month you were first eligible for an SSI check. This means that if you file for benefits under SSI in January of 2012 and are then found to be disabled back to January of 2012, you will have insurance through Medicaid retroactive to January of 2012. This could mean that the bills that you had accumulated between January of 2012 and the date you were awarded benefits, might be paid by Medicaid.
- Disability Insurance Benefits/Medicare – unlike benefits under SSI and Medicaid, with SSDI and Medicare there is a two-year wait period before your Medicare eligibility kicks in. This means that if you file a claim alleging disability as of January 1, 2012 and you file that claim on January 1, 2012 you will be eligible for Medicare Benefits as of June of 2014. This is because you become eligible for a disability check 5 full calendar months after you are disabled and you must then wait 24 months from your benefit eligibility before the Medicare benefits start. This will typically mean that for someone who has only a disability insurance claim, the medical bills for the time that they are waiting have a lesser chance of being paid because they have to establish disability for a longer time than those applying just for SSI Benefits.
Tennessee Residents and TennCare
At Donati Law, our lawyers provide services primarily to clients in Tennessee, Mississippi and Arkansas. Each state has its own Medicaid program with its own rule about what is or is not covered. Out of Tennessee, Mississippi and Arkansas, Tennessee generally has a more generous Medicaid program under TennCare.
With regard to TennCare and disabled individuals, the State of Tennessee has elected to give Medicaid/TennCare Benefits to certain individuals who receive disability insurance benefits. As detailed above, the state is not required to give individuals with disability insurance benefits coverage under their Medicaid programs; instead, the Federal Government is supposed to care for them under Medicare.
However, as mentioned above, this creates a harsh result for many disabled individuals who accumulate huge medical bills while their claim is pending, and they have no way to repay them because their insurance is not back-dated to when their disability started.
Eligibility for TennCare
In Tennessee, individuals who receive Social Security Disability Insurance benefits may apply with the Department of Human Services (DHS) to ask for coverage under TennCare.
The test for TennCare eligibility centers on:
- how large a claimant’s monthly benefits are under SSDI, and
- what other sources of income and support they have.
Individuals with relatively modest monthly benefits under SSDI may be found eligible for TennCare benefits. In these situations, TennCare may well be back-dated to the date the claimant was initially eligible for benefits just like for individuals that are eligible for SSI. So, for SSI recipients whose Medicare eligibility has not yet kicked in, it is usually worthwhile to inquire with the State Department of Human Services as to whether or not they may also be eligible for TennCare benefits.