Am I eligible for government assistance?
At some point, you may consider benefits from private and public disability programs. Efforts have been made to streamline processes, but applying for benefits-and ensuring eligibility-can be complicated and time-consuming. Two things to remember. First, do not throw away any potentially relevant paperwork you receive from an employer, an insurer, a government agency, or an advocate on your behalf. Second, keep copies of everything that you submit. Some programs to consider include: Social Security Disability Insurance (SSDI), Supplemental Security Income (SSI), Medicare, State Health Insurance Counseling and Assistance Programs (SHIP), and Medicaid.
What are the main benefit programs for people with disabilities?
There are a variety of government programs that provide cash on a monthly basis for people with disabilities who have difficulty making ends meet. Restrictions abound and the monthly amount is often barely sufficient to cover anything beyond the most basic expenses; however, efforts are under way in some states to implement more comprehensive cost-of-living analyses in order to improve benefit amounts. A federal government agency, The Social Security Administration (SSA), offers a comprehensive and user-friendly information on the full range of disability benefits it provides; it is available online at†www.ssa.gov/dibplan/. The medical requirements for disability payments are the same for all federal programs and a person's disability is determined by the same process. In general, you may be considered disabled under Social Security rules if:
- you cannot do the work that you did before
- the SSA decides that you cannot adjust to other work because of your medical conditions(s);
- your disability lasts or is expected to last for at least one year or to result in death.
One way to determine if a person is potentially eligible for any of the government's programs for disabled people is to check out the Benefit Eligibility Screening Tool (BEST), operated by Social Security Online at http://best.ssa.gov/. (Note: The BEST tool can be cumbersome to access and navigate itself. Often a follow-up phone call with a government official is necessary to clarify results obtained through BEST.)
Social Security Disability Insurance (SSDI)
The SSDI program is geared primarily toward those under age 65 who had fairly substantial "on the books" employment records before leaving work because of a disability. The amount of the monthly benefit it provides is based on work history. The federal government's Social Security Administration (SSA) administers the program.
For more information on the specifics of SSDI, visit the SSA's Web site at†www.ssa.gov. The agency also operates a toll-free telephone number, 1-800-772-1213. That number is also the one to call to apply for SSDI benefits. The claims representative will ask specific questions about the disability and discuss the required documents that must accompany an application. (Probably the most important document is a letter of diagnosis from a physician; other required documents may include a birth certificate or social security card.)
Note: It can take a few months for SSDI to kick in. During that period, applicants may be eligible for SSI (Supplemental Security Income) benefits from the government.
In terms of health insurance, SSDI beneficiaries are automatically eligible for Medicare after collecting SSDI benefits for 24 months. They may also be eligible for Medicaid-which provides similar, but not the exact same, services-but they must submit a separate Medicaid application. For further information, visit†www.cms.hhs.gov, the Web site of the Centers for Medicare and Medicaid Services (CMS).
SSI (Supplemental Security Income)
The government's SSI (Supplemental Security Income) program also provides a monthly cash stipend to people with disabilities who need help meeting their basic needs for shelter, food, and clothing. It differs from SSDI in that it is based on financial need only and generally applies to those who have extremely limited "on the books" work history. (Note: SSI is also available to individuals who are waiting for their SSDI to start.)
Many people with disabilities consider SSI a double-edged sword. On the one hand, it provides a guaranteed (although not remotely generous) monthly benefit; however, in order to be eligible, one must have very few assets. For instance, under current rules a single person living alone cannot have total assets worth more than $2,000 (not including the home lived in and the land it is on) and cannot have unearned income of more than $638 a month. With such restrictions, it's small wonder that in order to maintain eligibility many people have no choice but to refuse to accept payment for "on the books" work or spend much of their time volunteering.
For more specific information on SSI, including eligibility requirements, read the Electronic Booklet on SSI at†http://www.socialsecurity.gov/pubs/11000.html or call 1-800-772-1213.
What are healthcare specific programs?
A federal law, the Consolidated Omnibus Budget Reconciliation Act (COBRA), stipulates that when an employee loses coverage under an employer-sponsored health plan, he or she must be allowed to elect to continue coverage under that plan for a set period of time on a self-pay basis. COBRA applies most frequently in instances when an employee is laid off (for reasons other than "gross misconduct") or his or her hours are reduced. The law also applies to the employee's dependents in the event of divorce, the employee's death, or certain other situations.
Generally, employers are required to offer access to their health care plan for 18 months after the employee is terminated or his or her hours are reduced. That period is extended to 29 months for an individual who is determined to be disabled under the Social Security Administration (SSA) guidelines. See†http://www.ssa.gov/disabilityresearch/wi/medicare.htm#cobra for more information about the specific guidelines.
The government-administered Medicare program provides health care services for people aged 65 and older-and for many people with disabilities who are younger than 65. For specific information and to determine eligibility, visit†www.cms.hhs.gov, the Web site operated by the Centers for Medicare and Medicaid Services (CMS), or call 1-800-MEDICARE (1-800-633-4227).
The Medicare Prescription Drug Improvement and Modernization Act of 2003 (MMA), signed into law in December 2003, provides the first-ever prescription drug benefit under Medicare. For more information on the MMA, visit†http://www.cms.hhs.gov/MMAUpdate/01_Overview.asp#TopOfPage.
SSDI beneficiaries are automatically eligible for Medicare after collecting SSDI benefits for 24 months. They may also be eligible for Medicaid-which provides similar, but not the exact same, services-but they must submit a separate Medicaid application. For further information, visitwww.cms.hhs.gov.
State Health Insurance Counseling and Assistance Programs (SHIP Programs)
For Medicare recipients, every state has a program designed to help find the most appropriate insurance options for your specific situation. Visithttp://www.medicare.gov/contacts/static/allStateContacts.asp for more information about what is available in your state.
Medicaid is a joint federal-state program that provides health care services primarily to low-income people. Among those potentially eligible for coverage are people with disabilities and those who receive federally assisted income maintenance payments, such as Supplemental Security Income (SSI). Because state governments kick in a substantial portion of Medicaid budgets, benefits vary widely around the country. Nearly all programs help pay for prescription drugs.
For specific information and to determine eligibility, visit†www.cms.hhs.gov, the Web site operated by the Centers for Medicare and Medicaid Services (CMS), or look up a telephone number online for the Medicaid administration in your area:†http://www.cms.hhs.gov/RegionalOffices/.
SSDI beneficiaries may be eligible for Medicaid-which provides similar, but not the exact same, services as does Medicare-but they must submit a separate Medicaid application. For further information, visit†www.cms.hhs.gov.
Note: Until July 2001, CMS was known as the Health Care Financing Administration (HCFA). Although the name has changed, the agency's services and programs have not.
What is the Ticket to Work and Work Incentives Act of 1999?
Passed by Congress and signed into law by then-President Clinton, the "Ticket to Work" legislation was designed to eliminate restrictions that did not allow disabled people to work, even part-time, without losing crucial medical benefits such as Medicare or Medicaid. Often the amount earned by working would not even equal the value of the lost benefits. As a result, people with disabilities have long had one of the highest unemployment rates in the country-about 70 percent in 2000. For more specific information on Ticket to Work, visit†http://www.cms.hhs.gov/TWWIA/.
Are there Employer-offered Disability Plans?
Many employers offer short-term and/or long-term disability plans that employees can choose to put money into while they are working. After leaving work because of disability (and keep in mind that different plans have different eligibility requirements as to what constitutes disability), qualified employees receive a portion of their salary while they remain disabled.
Private-sector plans usually begin paying out within a period of months after disability begins. That compares favorably with most government disability programs, which can take a year or more to approve a disability claim and begin disbursing payment. Some private plans pay a set amount regardless of what an insured patient receives from Social Security, while other plans may offset the benefits they pay by whatever disability payments the insured may receive from Social Security.