Oftentimes seniors with disabilities qualify for health and financial assistance programs, but don’t know about them. Or they’re not sure about the eligibility requirements and enrollment process. Let’s go over the key programs for seniors with disabilities so that you have the information you need to get the benefits you deserve.
Note on the types of recognized disabilities
The term disability entails a wide range of conditions and illnesses. In general, benefits programs recognize three main types:
- Physical disabilities (such as quadriplegia, brain injuries, etc.)
- Intellectual or developmental disabilities (such as cerebral palsy, autism, Down syndrome, etc.)
- Serious behavioral disorders or mental illness (such as schizophrenia or bipolar disorder)
Seniors with any of these disabilities will likely qualify for different government-sponsored benefits programs. In addition, some programs may have specific requirements based on age or ability to work.
4 main benefits programs: SSI, SSDI, Medicare and Medicaid
Let’s get started by going over the four main benefits programs, including SSI, SSDI, Medicare and Medicaid. These programs are highly connected. Qualifying for one may automatically qualify you for another.
For seniors with disabilities, the most significant benefits programs start with SSI and SSDI. Below, we’ll go into the details.
SSI and SSDI
The two most common benefits programs for seniors with disabilities are SSI and SSDI. As a disabled senior, you’ll want to apply to one (or both) of these programs to receive financial assistance. Note that these programs are intended for long-term or lifelong disabilities and don’t cover short-term disability.
Each program has its own focus but overall SSI is intended for low-income seniors and those with disabilities, while SSDI is for disabled seniors who have a qualifying work history. Depending on your financial situation, you’ll want to apply for the right program for you. If you have a disability and limited income, SSI is best. If you have a disability and work credits, SSDI is best.
Why do SSI and SSDI matter?
SSI and SSDI are qualifying programs for Medicaid and Medicare, respectively. It’s an important step for getting financial assistance and then getting enrolled in health insurance. SSI recipients automatically qualify for Medicaid, while SSDI recipients automatically qualify for Medicare after 24 months of receiving benefits.
Supplemental Security Income (SSI)
SSI is for low-income people who are aged, disabled or blind. It’s intended to give financial assistance to those living on limited resources. It’s funded by general tax revenues. Here’s some key information about SSI:
- Benefits begin during the 1st full month after the claim is filed.
- Average monthly payment is $783 (2020).
- Those who get SSI benefits will automatically qualify for Medicaid.
Social Security Disability Insurance (SSDI)
In contrast, SSDI is for disabled people who have a qualifying work history (at least 5-10 past years). It’s funded by Social Security tax. Here’s some important information about SSDI:
- Benefits begin during the 6th full month of disability after your claim is approved.
- Average monthly payment is $1,258 a month (2020).
- Those who get SSDI benefits will automatically qualify for Medicare after a 24-month waiting period from the start of SSDI (no wait for ALS or ESRD patients).
Can I apply to both SSI and SSDI benefits?
It’s possible to be eligible for both SSI and SSDI benefits. For example, you may have limited resources and qualifying work history. Generally speaking, the average SSDI payment is higher, but you may apply to both if you qualify.
How do I apply for these benefits?
For SSI benefits, you can apply online if you’re an adult with a disability. However, other applicants aren’t eligible for online applications and must go to the Social Security offices or call to apply.
For SSDI benefits, you can apply online at any age. Or if you prefer, you can go to the Social Security office or call to apply.
What happens if my application is rejected?
The majority of applications for SSI and SSDI benefits are denied. (Here are some signs that you will be approved.) You can always appeal the decision, though this process can take time. If you believe you’ve been unfairly denied, you might also consider contacting a Social Security Disability lawyer. You must appeal within 60 days of the decision letter.
Is COVID affecting claims and processing time?
Yes, COVID is affecting claims because Social Security offices are closed to walk-in visits. Some urgent situations are eligible for in-person appointments. However, most times you can apply online or via phone. You can get the most recent COVID updates here.
Overall, the average processing time is 3-5 months, though there is currently a backlog due to COVID delays.
Who can receive Medicare benefits?
Medicare covers seniors over the age of 65, as well as those with disabilities (even if younger). If you’re a senior with a disability, you’re likely covered by this government-sponsored health program. To be sure, you can check your specific situation using the Medicare eligibility tool.
Medicare for seniors with disabilities over 65 doesn’t have any special requirements for enrolling. However, there are a few stipulations if you’re younger than 65 and disabled. You must have received:
- Social Security Disability Insurance benefits for 24 months
- OR have End Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS) (no benefit period requirement)
Remember: there is no low-income requirement for Medicare and seniors can’t be denied coverage because of an underlying condition or illness. Even if seniors need long-term care, they should not be denied Medicare.
What do Medicare benefits include?
Medicare benefits involve three different areas that cover a wide range of health services, including:
- Part A: Covers hospitalization costs.
- Part B: Covers physician services, lab and x-ray services, medical equipment, and outpatient services.
- Part D: Covers or assists with the cost of prescription drugs, including some shots and vaccines.
Medicare also provides some nursing home, home health, physical therapy and community-based services, which may be important for a senior with a disability.
In addition, Medicare offers a privately-supplemented plan, called Part C. This plan covers a paid Medicare Advantage Plan (such as an HMO or PPO), which is offered by private companies and covers a wider range of services, including vision, hearing and dental.
How do I get Medicare Part D benefits?
Medicare Part D, which covers prescription drugs, is essential for disabled seniors who take regular medications. As we mentioned, Part D has similar requirements to Medicare as a whole. It’s available for seniors over the age of 65 or those with a disability (even if younger) who have received Social Security Disability Insurance for 24 months.
Tip: It’s important to note that you must enroll in Part D to get benefits. This is an overarching theme of getting benefits. For every benefit you qualify for, you must go through the enrollment process in order to receive it.
What doesn’t Medicare cover?
Not everything is covered by Medicare. In particular, here are a few medical areas that Medicare doesn’t pay for:
- Custodial care
- Dental care and dentures
- Eye exams
- Hearing aids and exams
- Routine foot care
If you’re using Medicare as a senior with a disability, it’s important to have a plan for these other medical areas.
Medicaid may also assist seniors with disabilities. It’s a wide-reaching program intended for low-income people, including children and seniors. This program may include seniors who have had disabilities since birth or those with disabling conditions acquired through illness, injury or trauma.
Why would I want Medicaid if I already have Medicare?
As a senior with a disability, you may also want Medicaid if you qualify. That’s because Medicaid can help pay for Medicare premiums, as well as long-term care at home, in the community and in nursing homes. It also covers other important health services such as vision, hearing and dental.
If you’re a low-income senior with a disability, Medicaid could be essential to lowering your health care costs in the long term. Millions of Americans qualify for both Medicare and Medicaid.
How do I qualify for Medicaid?
For seniors with disabilities, there are several “pathways” to getting this benefit:
- You currently receive Supplemental Security Income (SSI).
- You qualify under state-defined limits, which may be more lenient than federal ones.
- Income cap: those under the state-set income limit, usually around 3 times the SSI amount.
- Spend down: even if you’re over the income cap, you may be eligible if you spend excessively on medical bills. This is done by a state-set limit calculated by “spending down” or subtracting medical bills from income.
- Other limits: Seniors receiving home and community-based services (HCBS) services can be eligible under state definition.
What do Medicaid benefits include?
Medicaid is a full-range health insurance program. Through Medicaid, states are obligated to provide inpatient and outpatient hospital services, physician services, laboratory and x-ray services. For seniors, they must provide nursing care, home health and rural health services too. Finally, they also must have family planning, midwife and pediatric care.
In addition to these services, Medicaid may also offer optional benefits. This will depend on your state of residency. Some typical optional benefits include prescription drugs, case management, physical and speech therapy, foot care, vision, dental, hearing and hospice care.
Is Medicaid a federal or state program?
This is a great question that often generates confusion. Medicaid is implemented at the state level, which means it will vary according to policies enacted in your state of residence. There are mandatory benefits, as listed above, but then states have certain liberties to implement health programs and revise eligibility requirements.
Tip: Medicaid programs often have different names at the state level. (For example, Massachusetts Medicaid is called MassHealth.) Be sure you understand what your state’s program is. You can find a list of Medicaid program names by state here.
Other Medicaid or Medicare-related benefits programs
In addition, there are a few other benefit programs that seniors with disabilities could benefit from. These programs are related to Medicaid or Medicare, which means they may vary by your state of residency.
1. Home and Community-Based Services (HCBS) Waivers
These waivers are designed to provide long-term assistance for seniors outside of nursing homes.
Like the name suggests, these services are granted at home, in assisted living facilities or in adult day care. The idea is to offer alternative ways to develop skills and enrich senior communities, as well as provide basic services such as respite care and transportation.
HCBS Waivers are popular programs and often have enrollment caps and waiting lists. It’s important to get enrollment information for your specific state to avoid getting left out.
2. Self-Directed Care / Cash and Counseling
This Medicaid program is intended to give greater flexibility to families by letting seniors and caregivers decide on their care. Basically, recipients get funds and then are able to select their own care providers, including their own family members.
This is a huge benefit for family caregivers, even spouses, who would like to be paid for the assistance they provide. Overall, self-directed care is designed for greater control during long-term caregiving.
3. State Health Insurance Assistance Programs (SHIPs)
SHIPs are state-specific advocacy centers that provide local assistance and counseling for Medicare-eligible people. The mission of SHIPs is to make Medicare more transparent and help guide families through the process. Some services they provide include:
- Information and clarification about Medicare benefits, coverage and insurers.
- Help cover out-of-pocket Medicare costs.
- Advocate for your rights under Medicare.
While SHIPs are mostly informational, they can aid with the Medicare process for seniors and their families.
Other benefits programs for seniors with disabilities
In addition to the benefits programs above, there are others found at the state level. Depending on your medical situation, you may qualify for these programs.
1. Personal Assistance Services (PAS)
This program is intended to help seniors age-in-place by offering home care services for adults with severe disabilities so they can continue to live at home. If a disabled senior wants to avoid placement in a long-term care facility, PAS is a great option. PAS services may include custodial care such as bathing, toileting and eating, as well as home services such as meals, housekeeping, laundry and shopping.
2. Program of All-inclusive Care for the Elderly (PACE)
PACE isn’t available in every community, but it’s an excellent option for seniors with disabilities, especially those who are elderly or otherwise frail. This program involves an interdisciplinary team of health workers to provide seniors with comprehensive and coordinated care. It’s a care package program that’s an alternative to nursing home care. Seniors who opt for this program will be able to remain in the community instead. Most PACE patients are dual-eligible Medicare and Medicaid participants.
3. Adult Day Care
Adult day care is another potential benefit for seniors with disabilities. This program, which varies from state-to-state, offers community programming during day hours. It’s a way to provide a supervised environment that’s also socially-enriching for seniors. Adult day care even provides certain services, such as haircuts. It’s an affordable option that works well for many families. Adult day care is typically offered for any seniors who have partial or full mobility.
4. Respite Care
Respite care isn’t focused directly at seniors with disabilities, but rather their caregivers. The idea is to give caregivers a well-deserved break. Respite care comes in several forms, such as emergency, overnight, holiday or short-term. Some respite care is provided in-home, while others take place in a facility. It’s a great option to renew the caregiver-patient relationship. It’s also typically covered by Medicare.
5. VA Benefits
Finally, if you’re a senior veteran, you may also qualify for VA benefits and healthcare. Many veteran seniors aren’t aware of the wide array of health benefits they could receive. Eligibility requirements involve a military service period, which depends on when you served.
In addition, if your disability is tied to military service, you may also receive VA disability compensation. You should talk to a VA benefits expert in order to get the many VA benefits you may qualify for.
Conclusion: applying for benefits
These are the main benefits programs for seniors with disabilities. Remember that to get benefits, you’ll need to go through the enrollment process for each one. Depending on the program, this process can take months, so it’s important to plan early.
At the same time, many of these programs will vary greatly depending on the state of your residence. You must get local information about any state-specific requirements. In fact, many seniors find that they qualify for more programming based on widened requirements at the state level. Be sure to look up your state’s information.
Moreover, you’ll want to get started early on the application and enrollment process because many programs are impacted by COVID. For example, many local offices are closed, though applications can still be processed online or via phone. There are also some delays in processing time to keep in mind.
Ultimately, seniors with disabilities deserve to get the benefits they qualify for. If you need more information about senior rights and health care, MyCaringPlan has a wealth of information to share.
- People with disabilities, MacPac, https://www.macpac.gov/subtopic/people-with-disabilities/
- SSI vs. SSDI: What Are These Benefits and How Do They Differ?, NCOA, https://www.ncoa.org/blog/ssi-vs-ssdi-what-are-these-benefits-how-they-differ
- What’s the difference between SSDI and SSI?, AARP, https://www.aarp.org/retirement/social-security/questions-answers/ssdi-ssi-how-each-works.html
- Three Big Differences Between SSI and SSDI, Special Needs Answers, https://specialneedsanswers.com/three-big-differences-between-ssi-and-ssdi-14866