Federal & State Health Insurance
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DISCLAIMER: This is a brief overview and a starting point. Please do your due diligence going forward — this is only what I have learned.
Social Security Disability Insurance (SSDI) Benefits
Eligibility Requirements (Quick Reference)
Your medical condition meets their definition of disability
You can't do the work you did in the past
You can’t do other work because of your medical impairment(s)
You haven’t been able to work for a year or more
Benefits:
Usually continue until you can work again on a regular basis
Return to Work Incentive: for 9 months after returning to work, you will continue to receive your SSDI check.
Note:
The application process is lengthy and very detailed.
If you are fortunate enough to have Long Term Disability (LTD) insurance, they will help you file for SSDI.
But: whatever SSDI awards you will offset what LTD actually pays you.
For Example, if the LTD award is $1,000/month and the SSDI award is $300, you will now receive $700 from LTD and $300 from SSDI -- resulting in the original award value of $1,000/month. (It's nice to know this upfront)
If you're getting Social Security disability benefits:
You will automatically get Medicare after you have received disability benefits for 24 months.
Medicare coverage is the same as for people who qualify based on age.
Coverage includes hospitals, nursing homes, home health, physicians, and community-based services.
Standard Part B monthly premium is $174.70 in 2024
For more information: Medicare.gov 2024 Medicare Costs -Fact Sheet
Medicaid is A Joint
Federal-State Program:
A part of the Social Security Amendments of 1965
Federal Medicaid law sets broad requirements
Mandates coverage of some populations and benefits
Requires uniformity in the enrollment and renewal procedures
Each state specifies how it will structure its Medicaid program
Federal Medicaid Oversight
The government highlights generic characteristics of all state Medicaid programs
Reports data to increase public transparency about program outcomes.
Provides a listing of each states' Medicaid Profile
Medicaid.gov
New York State Medicaid Eligibility
2024 Individual net assets must be less than $1,732/month or $42,312 annually for joint-married.
New York State Medicaid - see website for details and services
Medicaid TBI Waiver Program
Helps TBI survivors live in the community by waiving fees for important services. Such as:
• Service Coordination • Independent Living Skills Training • Structured Day Programs
• Substance Abuse Programs • Positive Behavioral Interventions and Supports • Respite Care • Community Integration Counseling • Home and Community Support Services
• Environmental Modifications • Community Transitional Services
• Waiver Transportation Assistive Technology (special medical equipment and supplies)
Eligibility Requirements in New York State
(please check the rules in your state)
You must be a Medicaid recipient
Choose to live in the community rather than in a nursing facility
Be between 18 and 64 years old at the time you apply for waiver services
A primary diagnosis of TBI or similar deficits such as stroke or anoxia (oxygen supply loss)
Be assessed to need nursing home level of care
Have an approved plan outlining the available services for you to live safely in the community
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