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Medicare and Medicaid for those with Disabilities

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Medicare if you have a disability and are under 65

If you are under 65 and have a disability you  may qualify for Medicare. You will usually need to receive Social Security Disability Income (SSDI) for 24 months before becoming eligible for Medicare.  Exceptions are made for those with end stage renal disease or Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig’s Disease.  To qualify for SSDI you must meet the standards for disability set by the Social Security Administration and you or your spouse must have paid Social Security taxes while employed.

Social Security Protection If You Become Disabled from the Social Security Administration can help you determine whether or not you are eligible for Social Security Disability Income (SSDI).  

If you qualify for Medicare our Medicare information page may be of interest to you.

Medicaid if you have a disability or a child with a disability

Supplemental Security Income (SSI)  disability benefits are for adults or children who have a disability and meet income, resource and living arrangement requirements. Although the standards for determining if you have a disability are the same as for Social Security Disability Income (SSDI), you do not have to have paid Social Security taxes to qualify for SSI.  Once you qualify for SSI, you are also eligible for Medicaid.

Wisconsin Supplemental Security Income:  Additional information from the Wisconsin Department of Health Services, including information on qualifying for Supplemental Security Income.

The Medicaid Purchase Plan offers people with disabilities who are working or interested in working the opportunity to buy health care coverage through the Wisconsin Medicaid Program. Depending on an individual’s income, a premium payment may be required for this health care coverage. This information is also available in Hmong and Spanish.

The Katie Beckett Program allows certain children with long-term disabilities or complex medical needs, living at home with their families, to obtain a Wisconsin Medicaid card. Children who are not eligible for other Medicaid programs because the income or assets of their parents are too high may be eligible for Medicaid through the Katie Beckett Program.

Additional information about Medicaid is available.

If you have further questions about your eligibility for SSDI or SSI or if you want to apply for Medicare, call the Social Security Administration. The toll-free telephone number is: 1-800-772-1213. The TTY-TDD number for the hearing and speech impaired is 1-800-325-0778. 

More Information

Navigating Medicare and Medicaid, 2005: A Resource Guide for People with Disabilities, Their Families and Advocates: This guide from the Kaiser Family Foundation provides information on eligibility, benefits, and appeal rights as well as information on interaction between Medicare and Medicaid for those who are eligible for both programs.

Keeping Medicare and Medicaid When You Work, 2005: A Resource Guide for People with Disabilities, Their Families, and Their Advocates: Also from the Kaiser Family Foundation, this guide explains what happens to your income and health benefits if you have a disability and would like to return to work.

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Last Revised: April 26, 2013