1.3 Other Related Benefits Flashcards
Question: “What is the relationship between SSDI and Medicare?”
Answer: “SSDI recipients are eligible for Medicare after a 24-month waiting period.”
Explanation: “The 24-month period begins the month disability benefits are payable. Exceptions exist for conditions like End-Stage Renal Disease (ESRD).”
Source: SSA Medicare Eligibility Guidelines.
Question: “How does SSI relate to Medicaid?”
Answer: “SSI recipients are automatically eligible for Medicaid in most states.”
Explanation: “Some states require a separate Medicaid application, but SSI recipients generally qualify due to financial need.”
Source: SSA Medicaid Eligibility Guidelines.
“Can a claimant receive both SSDI and SSI?”
Answer: “Yes, a claimant can receive both SSDI and SSI if their SSDI payment is below the SSI federal benefit rate (FBR) and they meet SSI’s income and resource limits.”
Explanation: “For example, an SSDI recipient earning $500 per month may receive additional SSI benefits to reach the $914 FBR for individuals.”
Source: SSA Medicaid Eligibility Guidelines.
“What happens to SSI eligibility when a recipient qualifies for SSDI?”
Answer: “SSI payments may be reduced or terminated if SSDI payments push total income above the SSI resource limits.”
Explanation: “Dual eligibility is often transitional, especially when SSDI benefits increase due to cost-of-living adjustments (COLA).”
“How does Medicaid interact with SSI and SSDI?”
Answer:
“SSI: Automatic Medicaid eligibility in most states.”
“SSDI: Medicare eligibility after the 24-month waiting period.”
Explanation: “Medicaid is state-managed but federally funded and typically linked to low-income status.”
Case Scenario: Anna, an SSDI recipient, has been receiving benefits for two years due to a severe back injury. She is now eligible for Medicare. Anna is unsure whether Medicare covers her ongoing physical therapy sessions.
Question: Does Medicare cover physical therapy for SSDI recipients?
Answer: Yes, Medicare covers physical therapy services if they are medically necessary.
Legal Explanation: SSDI recipients become eligible for Medicare after a 24-month waiting period. Medicare Part B covers medically necessary outpatient therapy, including physical therapy, provided by certified providers.
Case Scenario: Paul receives $300 per month in SSI benefits and qualifies for Medicaid in his state. He begins working part-time and earns $1,200 per month, which exceeds the SSI income threshold.
Question: Does Paul lose his Medicaid coverage if his SSI payments stop?
Answer: No, Paul may qualify for continued Medicaid coverage under Section 1619(b).
Legal Explanation: Section 1619(b) allows SSI recipients to retain Medicaid coverage if they earn above SSI limits but remain disabled and need Medicaid to work. Paul must meet his state’s specific income threshold for continued coverage.
