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Medicare, Medicaid, Social Security Disability

compiled by doctordee
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If you are uninsured, you need to check with any facility you are planning on using to see if they have a program for "needy" patients (without insurance). Some are good and others are greedy and won't treat you without cash up front. It's not a good thing to be uninsured in American medicine.
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The links below are to government sites, but the web has many URLs for Medicare, disability, etc.

Social Security Disability

What you need is to look at the current form that SS uses to determine disability. Look at the questions they ask. Most of this is common sense. I don't have the current form but the concept is unchanged.

It is about the impact of disease on function. Chronic fatigue; chronic and severe pain in __; Chronic nausea; Unable to concentrate for more than ___ minutes; mobility impaired; Prognosis is that things will not get better; Lots of etc. plus mountains of documentation.
Stage IV LMS or metastatic LMS is immediate grounds for disability.

It is not about finances.

Social Security Administration Office of Disability
http://www.ssa.gov/disability/

Disability Direct: Information on Disabilities for Americans
http://www.disability.gov/

HOW DISABILITY DECISIONS ARE MADE

To allow or disallow -- that is the question. How do we decide who is disabled for Social Security purposes and who is not?
It's a complex process, but the answers can be found in the "Blue Book." The "Blue Book" provides disability definitions
and medical criteria for evaluating Social Security disability claims.

A lot of factors go into making a medical decision, and we invite you to check out all the guidelines here.
http://www.ssa.gov/disability/professionals/bluebook/


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MEDICARE

Medicare is the same in every state. What is different is the type of medigap insurance that may be available. That gap can be pretty significant. The Federal Government has standardized Medigap plans, so that Plan B in one state is exactly the same as Plan B in any state. However two companies in the same state can offer the same plan for very different rates.

And remember: Medicare does not cover prescriptions.
The criteria for medicare, is either:

Age 65: U.S. citizens are automatically covered. (Actually the law was changed and it is up to a few months more than age 65 on a transitional scale they set up).

Disability: You apply to Social Security for disability status. Once that is granted, medicare comes with it. The good news is that disability can be retroactive. I think that there is a two year wait from the time that disability is determined to have occurred to the time that medicare comes on, but I can't remember exactly.

The Official U.S. Government Site for People with Medicare
http://www.medicare.gov

THE PATIENTS' BILL OF RIGHTS IN MEDICARE AND MEDICAID
http://www.hhs.gov/news/press/1999pres/990412.html

Medicare Consumer Information
http://hcfa.hhs.gov/medicare/mcarcnsm.htm

The web page at
http://www.medicare.gov/Publications/Search/View/ViewPubList.asp?Language=English#Medicare+Basics
has links to a collection of government publications on Medicare

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Medicaid

Medicaid is not a state program, but is a Federal program that is administered by state governments. It is usually operated as a part of the state welfare system but it is controlled by Federal Regulations. If the requirements are met honestly (therein lies a problem), eligibility generally requires that you have almost no assets or income of any kind.

Medicaid is different in every state. The criterion for Medicaid is extreme poverty-low income. One goes to the State office in their area and applies.

THE PATIENTS' BILL OF RIGHTS IN MEDICARE AND MEDICAID
http://www.hhs.gov/news/press/1999pres/990412.html

Medicaid
http://hcfa.hhs.gov/medicaid/medicaid.htm


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last update December 2001



The information on this site is not a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting with your doctor. Please consult your doctor with any questions or concerns you may have regarding your condition. Copyright 2001-2007 LMSWEBSITE