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SSI & SSDI FAQs »

Medicare and Medicaid

1. When does the disabled patient’s eligibility for Medicaid or Medicare benefits start?

Eligibility for Medicaid begins on the date the SSA determined the claimant was disabled.  So for the two years immediately subsequent to the claimant’s first day of being disabled the claimant’s medical bills will be paid by Medicaid. (Example, John Doe applies for disability (SSDI and SSI) on 1/5/06 saying he was disabled 12 months prior on 1/5/05.  On 1/5/07 the SSA determines John Doe was disable as of 1/5/05 as he alleged.  John’s Medical bill between 1/5/05 and 1/507 are billable reimbursable under Medicaid.  After 1/5/07 John Doe’s bills are payable through Medicare.)

On the second anniversary of the Claimant’s first date of disability as determined by the SSA (or upon reaching full retirement age whichever is first) the claimant becomes eligible for Medicare.

For further information on Medicaid, Medicare and supplemental insurance issues we invite you to visit www.insureflorida.info.

2. After being found disabled how long must I wait for my Medicare Card?

You cannot get your Medicare card until after you have been disabled for two years and five months. If you have already been disabled for two years and five months, you should keep track of your medical bills so that these may be submitted later to Social Security if you win.

3. How long must I wait for Medicaid?

There is no waiting period for Medicaid, but you have to be very poor to qualify for it. You also have to apply specifically for it, unlike Medicare. If you have filed a claim for Supplemental Security Income (SSI) you can probably qualify for Medicaid if you win. You will not likely qualify for Medicaid unless, and until, you win. If you have filed a claim for Medicaid in the past, keep all of your medical bills in your legal file so that you may later take them to the Department of Social Services to get them paid if you win your Social Security case. If you have applied for Social Security Income (SSI), you should now apply for Medicaid. You can only get Medicaid for three months prior to your first claim for Medicaid.

4. Where do I apply for Medicaid?

You apply for Medicaid at the County Department of Social Services (not Social Security).  They will turn you down, but if we win your Social Security case they will later change this decision and award you back Medicaid benefits.

If you get your health care through Medicaid, you are also enrolled in the Medipass program. YOU NEED TO KNOW THIS!

5. If a new law is changing how Medipass works?

Each year, you get notice from Medicaid of an “open enrollment period.”  After October 1, when you get your open enrollment notice, you will need to contact Medicaid if you want to stay in Medipass.  If you don’t contact them, Medicaid will automatically switch you out of Medipass and into a health plan (HMO).

6. What will happen if I am switched to an HMO?

Medipass is a program run by the state. HMOs are run by insurance companies. If you are switched from Medipass to an HMO, you may not be able to see your doctors, and coverage for some of you medications may be denied or delayed. HMOs can also limit the services you get, even if your doctor wants you to get them.

7. What should I do about enrollment?

Watch you mail for a notice from Medicaid telling you about your open enrollment period and this change.  If you want to stay in Medipass, you must contact Medicaid Options (the State’s Medicaid enrollment broker) at 1-888-367-6554.  Be sure to act right away once you receive your open enrollment notice.  Your open enrollment period is only 30 days long.

NOTE: We don’t know yet how Medicaid will notify you of this change, but as information becomes available, it will be posted online at: www.floridachain.org/medipass.htm

8. Can I get back into Medipass if I get switched to an HMO?

Maybe, but Medicaid has not said how it will handle this yet either. If you find out that you were switched to an HMO but wanted to stay in Medipass, call Medicaid Options right away. Ask if you can be switched back to Medipass.

9. Whom can I contact to ask questions?

Call Medicaid Options at 1-88-367-6554 on Mon-Fri from 8 AM – 7PM. TDD users only, call 1-800-653-9803.