MedicareTypes of Health Care Assistance Programs, Part 4

Medicare

This government program is available to children with certain disabilities and to dependent adult children whose parents are currently receiving Medicare.
Who qualifies for Medicare:
  • Children with amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease) and end-stage renal disease (ESRD or kidney failure) can qualify for Medicare coverage soon after they have been determined to have a permanent disability.
  • Dependent adult children who developed a permanent and severe disability before the age of 22 and whose parents currently receive Medicare are eligible to also receive Medicare benefits. A two-year waiting period for these benefits begins when the child turns 18 years of age. If the parent receiving Medicare benefits dies, the child will continue to receive benefits.

To get more information on Medicare eligibility and benefits, contact Medicare:
Call 1-800-633-4227
Visit www.medicare.gov

If You Do Not Qualify for Health Care Assistance And Cannot Afford Insurance

Perhaps you are unable to meet the eligibility requirements for government health care assistance programs. You find the monthly cost of private insurance too expensive, but you want it and need it. A possible solution is to consider ways to create financial capacity to pay the insurance premiums.

As an option, speak with a financial professional or counselor to find out how you might modify your life style or increase your income to afford monthly insurance payments. Also, take a look at the money management tools presented in Managing Your Finances, such as creating a spending plan and tracking how you spend your money.

Non-Medical Benefits

Two federal benefit programs provide non-medical assistance income to children and young adults with disabilities: Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI).

Determining your child’s eligibility for SSI and SSDI and applying for benefits can be lengthy processes. You will be asked many questions about your child’s disability, which you will have to support with medical records and written statements from teachers and others who have known your child over a period of time.

For a more detailed presentation on who is eligible and how to apply for benefits for each of these programs, contact the Social Security Administration:

Call 1-800-772-1213 (Voice) or 1-800-325-0778 (TTY). Ask for the contact information of your local office.
Visit www.ssa.gov/ssi or www.ssa.gov/disability.

Supplemental Security Income (SSI)

This federal program provides people with disabilities who have little or no income with cash assistance for basic needs such as food and shelter. Eligibility for SSI can begin at birth and last until 18 years of age (or, if a student, until the age of 22). Eligibility is also based on:

  • Financial need.
  • The Social Security Administration’s definition of “disability for children.”

To continue coverage beyond 18 years of age, your child must meet the Social Security Administration’s requirements for need and definition of “disability for adults.” Individuals who receive SSI may not have more than $2,000 in assets such as cash, investments, vehicles, and personal property. Some states have stricter asset requirements, meaning individuals may own less than $2,000 in assets.

Anyone who qualifies for SSI automatically qualifies for Medicaid; however, Medicaid enrollment is not automatic in all states. Check with your county’s Office of Public Assistance or Social Services for information on SSI enrollment.

Social Security Disability Insurance (SSDI)

This federal program provides income to people with disabilities who are unable to work. Your child may be eligible if your child:

  • Is over the age of 18 and:
    • You, the parents, have paid into the Social Security System though payroll taxes.
    • Your child meets the Social Security Administration’s “definition of disability.” 
    • Your child’s disability occurred before the age of 22.
  • Paid into the Social Security System through payroll taxes.

The SSDI benefit amount is based on the length of the work period, either yours or your child’s, and the total amount of income earned.

State Mandated Insurance Programs

As part of the 2010 Health Care Reform, states are now able to offer subsidized premiums to individuals previously denied insurance because of pre-existing conditions. These programs are called high-risk insurance pools. As of this publication’s writing, states are in the process of ramping up on this program, which will be offered until 2014 (National Conference of State Legislatures,. "Coverage of Uninsurable Pre-existing Conditions: State and Federal High-Risk Pools" November 5, 2010.) Individuals are responsible for paying part of the monthly premium.

For more information on the high-risk insurance pool offered in your state, visit www.StateHealthFacts.org and search on “high risk pool eligibility."

 

"You learn a lot over the years. Back when my daughter was first diagnosed, I thought we should pay for everything because we could. I thought ‘programs’ were for truly needy people. I simply had no idea of the costs we would incur. I wish we had applied for programs we were eligible for in the very beginning.”

—Carol Bakies, mother of Sarah

 

DOWNLOAD .PDF OF THIS PAGE

Next Section: The Issue of Medical Privacy