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Paralegal Owned and Operated Company
Member, National Association of Disability Representatives
The Disability Claims Digest
Volume 3                                                                                                          Copyright 2007
In This Issue
Visit our Disability Forum
Who is Eligible for Social Security Disability?
What Travel Expenses are Reimbursed by Social Security?
Direct Deposit -and- What Can be Garnished from My Benefits?
Medicare Monthly Premiums
Breaking News from Social Security
What is the difference between Medicaid, Medicare and Medigap?
Medicare Part D: The Prescription Plan
Medicare, Disability Pensions, Government Health Insurance and Social Security Disability
Why Does Social Security hold up SSI back benefits?
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Our Disability Forum
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Who is Eligible for Social Security Disability?

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What travel expenses are reimbursed by Social Security?
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Direct Deposit of Your Benefits
What Can be Garnished From Your Benefits?

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Medicare Monthly Premiums
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Medicare Part A is free when you turn 65 or you are awarded SSDI
and if you paid Medicare taxes while you were working.

The base Medicare
Part B monthly premium, as of 12/07, will be $96.40 per month.

The following links provide more detailed information:

Medicare Premiums

Medicare Part B Premium Depending on Income Level
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Welcome to the third edition of our Disability Claims Digest. 

In this edition, we will be discussing Medicaid and Medicare as it pertains to a disabled individual who is collecting Social Security disability or Supplemental Security Income.

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We will also be discussing the basics of Medicare D, the prescription plan.

SSI back benefits are not paid out in lump sum.  Many claimants are not aware of this at the time of the award and we discuss this in detail.

Lastly, many people who work for governmental entities and who receive a pension disability and governmental health insurance do not fully understand how these benefits may be affected if their Social Security disability claim is awarded.  Once Social Security disability benefits and Medicare coverage begins, there are several important factors that we address which you will not want to miss.

Many of the topics that we will discuss in our monthly digests are frequently asked questions by our clients, and we hope that the information we are sharing will help to clarify some of these complicated issues.

We warmly welcome the referral of anyone that you know who may need help with their Social Security disability claim.  If you have any questions or need help with the processing of your  disability claim or with applying for Medicaid, Medicare or welfare benefits, please do not hesitate to contact us.  We are here to help.

You can reach us at:



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Breaking News from
the Social Security Administration...

Breaking News


Social Security will be expediting claims filed by our Veterans of war so that they and their families receive benefits expeditiously.
Social Security has updated its listing for digestive disorders and chronic liver disease which will help the adjudicators and judges to properly evaluate and determine claims for individuals with these conditions.


What is the difference between Medicaid, Medicare and Medigap?

Medicare logo rectangle

As to Medicare:

SSDI (Title II) benefits are awarded with Medicare.

Medicare is a federal program of Hospital and Medical Insurance that is available to eligible individuals over 65 or persons with a disability who have received Social Security Disability for at least 24 months.

In order to be eligible for SSDI, a person with a disability must prove that they have severe medical/mental impairments that prevent them from being able to work for at least 12 months or longer.  A person must be eligible to receive SSDI.  An eligible person is a disabled worker, a disabled widow or widower between the ages of 50 and 60 and disabled children over 18 years of age whose disability began before the age of 22.

To be eligible for Medicare Part A a person must be:

* 65 or older and a person or their spouse paid into Social Security or Railroad Retirement Board for 34 or more quarters when working

*Be under 65, be blind or disabled and have received SSDI benefits for at least 24 months

*Be under 65 but have end-stage renal disease

*A person or their spouse had Medicare covered government employment.

To be eligible for Medicare Part B a person must be enrolled in Part A.  Enrollment in Part B is optional.  If a person who is just awarded disability benefits does not enroll immediately at the time of the award, a penalty is imposed which is added to the monthly premium and is based upon the amount of the delay.

Part A covers hospitalization, skilled nursing facility, home care and hospice expenses.  There are deductibles and co-payments that a person must pay.

Part B covers physician services, outpatient hospital services, durable medical equipment/supplies, ambulance, dialysis costs, home health, x-ray, lab tests, outpatient physical therapy, vaccines.  It does not cover prescription drug costs, routine office visits and wellness visits, eye exams, eyeglasses, hearing exams, hearing aids, long term care, transportation and dental care.
There is an annual deductible and copayment responsibilities as well as a monthly premium.

Part C (also known as Medicare Advantage Plans) are actually HMO and PPO type policies.  You must be enrolled in Parts A and B in order to be eligible for Part C. They require you to treat in-network with their participating hospitals and physicians.  There are some Medicare Advantage plans which are available with optional coverages which include items such as eyeglasses. Additional premiums do apply for Part C.

For more information concerning Part C visit:

To visit Medicare's official website click this link:



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As to Medicaid

SSI (Title XVI) benefits are awarded with Medicaid.

Medicaid is known as Medical Assistance.  It is a free public health insurance program.  It is not Welfare.  In fact, most people on Medicaid do not receive welfare in the form of cash assistance.  Anyone is able to apply but not everyone is eligible.  To be eligible for Medicaid, a person must meet the citizenship/alienage requirements, fit into one of the groups the Medicaid covers and meet the income and resource requirements.

Medicaid is free to persons with disabilities.

A person who is approved for Supplemental Security Income automatically gets Medicaid.  As long as a person is eligible to be paid just $1.00 of SSI benefits per month, that person will continue to receive Medicaid.

To be eligible for Medicaid, a person must have the following:

*Less then $2,000 in cash per person
*Less then $3,000 in cash per couple
*Have no substantial income, assets or investments

Social Security will not count the following when determining if a person is eligible for SSI:

*House a person lives in
*Household goods and personal affects
*A wedding or engagement ring
*A car
*An irrevocable burial account
*The cash surrender value of a whole life insurance policy over $15,000
*Retroactive SSI or SSDI benefits for up to nine months after you receive them
*Grants, scholarships, fellowships or gifts set aside to pay educational expenses for nine months after receipt.

The same criteria will apply if a person applies for Medicaid through their local Social Services office, independent of Social Security.

For more information concerning SSI, please visit Medicaid's official website:



As to Medigap:

Medigap is an optional coverage plan.

There are supplemental Medicare insurance policies available which are referred to as Medigap.  These policies are offered by private insurance companies and can be purchased in addition to Medicare Parts A and B.  By doing so, many of the costs that are not covered by Medicare Parts A and B will be covered.

For more information about selecting a Medigap policy, please click here:

Medicare D:
The Prescription Plan

It is important to understand that if you want prescription coverage, you must sign up for Medicare D, because this is an optional coverage.

If you applied for Title II benefits and won your claim, you will be entitled to receive Medicare 29 months from the date Social Security determined that you were disabled. 

Approximately one month prior to your becoming eligible,  you will receive a Medicare package in the mail.

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You will be asked by Medicare to advise them what medical coverage that you want to receive.  Part A is automatically provided to you.  But, it is at this time that you will also need to let Medicare know if you want any of the optional plans including Medicare Parts B, C and/or D.

As soon as you are awarded Social Security disability, it would be very helpful for you to request a Medicare D booklet from Medicare.  This booklet will list all of the many prescription plans being offered to you.  There are approximately 60-80 different plans.  You will need to determine which plan is the best plan for your needs by evaluating the following things:

*Which plans include all of your medicines?  (the list of covered medicines is called a formulary plan.)

*What will amount of your copayment responsibility be?  (the amount you will pay out of pocket for each prescription at the time of purchase)

*What is the amount of your yearly deductible? (the amount of money that you must pay out of pocket before coverage kicks in)

*What is the amount of the premium that you will be charged per month for the prescription coverage?

Once you have evaluated all of these things, you will then be able to decide which prescription plan is best for your needs and you will need to apply for the Medicare D coverage.

For more information, please review the official Medicare website:

Medicare Part D Information

If you are unable to pay the required Medicare D prescription plan premium and need financial assistance, you can complete the following application:

Application for Help with
Medicare D Premium
What Happens When All Factors are in Play:
Disability Pensions,
 Employer Government Issued Health Insurance
and Social Security Disability

Maze of confusion

A question recently came up concerning a person who is disabled and is receiving both a disability pension and governmental health insurance benefits through her employer's policy along with Social Security disability benefits and Medicare.

She won her Social Security disability benefits one year ago.  At the time of the award, she opted to receive Medicare Part A and not Part B.  This decision was made because she believed that she already had complete medical coverage through her government issued health insurance plan and she felt that Medicare Part B would be duplicate coverage.

(Note: The cost for Medicare Part A is free but Medicare Part B is not.  See information concerning premiums in the box above to the left.)

It was just recently determined that this person's government issued health insurance entity had placed a sheet of paper in the back of her policy booklet which acted as an addendum.  The addendum required her to opt for the complete Medicare package, meaning Part A and
Part B at the time of the award of her Social Security disability claim.  The addendum further advised that if the full Medicare package was not purchased, that any medical services that fall under Part B will not be covered by the government health insurance policy.

This person underwent surgery over the past year and incurred approximately $100,000 in medical expenses.  These expenses were submitted to the government health insurance carrier but were denied because she had not purchased Medicare Part B at the time of her Social Security disability award.

This person now realizes that she has no choice but to sign up for Medicare Part B.  The open enrollment period occurs only once a year in the month of January.  She will be applying for Medicare Part B this January so that all future medical expenses that she incurs will be covered. 

Unfortunately, it appears that any open medical bills that she incurred over this past year will not be covered by her government health insurance because she had not signed up for full Medicare benefits at the time that her Social Security disability claim was awarded.

We want to bring this very important matter to your attention in the event that you are a teacher, a police officer or you work for any city, county, state, federal or other governmental employer whose insurance carrier may have the same or similar requirement.

If you are disabled and are receiving health insurance coverage as a part of your employee benefit, and you have applied for and are receiving a pension disability through your employer's carrier and you have been awarded SSDI benefits, please keep in mind that you may need to opt for the full Medicare plan to avoid any non-coverage issues.
Why does Social Security pay SSI awarded back benefits in installments?

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In 1996, Social Security implemented a rule concerning the payment of SSI back benefits to claimants.

Once an SSI claim is awarded and it is determined that the amount of the back benefits are substantial, Social Security will not release all of the funds at one time, as is done in the case of an SSDI award.  The funds are paid in installments of no more than three payments in six month intervals.

The reason why Social Security implemented this rule is that they found most SSI recipients were not able to properly manage their back benefit funds when they were paid out all at one time.  By implementing the installment payment rule, Social Security believes that the SSI recipients will be better able to support their own needs throughout the year in which these payments will be distributed.

There are two exceptions to this rule.  Social Security will pay out all of the funds at once upon the award of SSI:

*If you have a medical condition that is expected to result in your death within 12 months

You become ineligible for SSI benefits and are likely to remain ineligible for 12 months

*You are able to show outstanding debt for food, clothing, shelter or medically necessary services, supplies, equipment or medicine

*You are able to show that you need the funds for medically necessary services, supplies, equipment or medicine or for the purchase of a new home.

To view the actual rule concerning this issue, click the link below:

Code of Federal Regulation 416.545

The current federal rate for SSI monthly benefits is $630 per month.  That rate is increasing in December of 2007 to $637.

Keep in mind that several states pay a monthly supplement over and beyond the SSI amount.  Please click on the link below for the list of states that pay supplements:

From The President's
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It is our mission to help as many people as we can to make their way through the frustrating claims process.  We are here to help anyone who is on this journey.  In addition to excellent representation services, we provide all of our clients with guidance, words of comfort, compassion, encouragement and kindness.

We hope that you have found the information we have shared in our Digest to be of help to you.  If you know of anyone that may benefit from this information, please forward our newsletter along to them by using the link below.

Please accept our warmest wishes for a wonderful Thanksgiving holiday.

Until next time, take care and be well.
Sincerely yours,

Lisa S. Wagman, CP
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Social Security Disability Benefit Consultants is a subdivision of Premier Legal Services, LLC.  We are independent benefit consultants authorized by law to represent claimants before the Social Security Administration from the initial application to the Appeals Council level.  We are in no way affiliated with the Social Security Administration directly.

We do not provide any legal advice.  Our newsletter is a general service that provides legal information.  We are not a law firm.  The information contained in this newsletter is general legal information and should not be construed as legal advice to be applied to any specific factual information.  We do not endorse any content provided by any linked sites, nor do we assume any responsibility for the interpretation or application of any information originating from such content.