Blog Post

How Do Personal Injury Victims Qualify For Medicare?

John Darer • Sep 02, 2020

With Few Exceptions, Must Be Receiving SSDI for 24 months

Medicare qualification with a disability
With few exceptions, if you are under age 65, you must be receiving Social Security Disability Income (SSDI) for 24 consecutive months in order to qualify for Medicare.

How the Social Security Administration Decides If You Are Disabled

To qualify for Social Security disability benefits, generally you must first have worked long enough in jobs that are covered by Social Security. In other words you have paid Social Security taxes. Not every job is covered by Social Security. For example some state, county and municipal employees, who are covered by state-funded pension plans rather than Social Security, and railroad employees, who are covered by a separate pension system that came into being in the 1930s.

You must have a medical condition that meets Social Security's definition of disability. 

What is the Definition of Disability under Social Security Rules?:

The Social Security Disability Benefits is for total disability

You cannot do work that you did before;  
The Social Security Administration decides that you cannot adjust to other work because of your medical condition(s); and 
Your disability has lasted or is expected to last for at least one year or to result in death.

The Social Security Disability Decision Tree
According to the Social Security Administration, it uses a step-by-step process involving five questions. They are:

1. Are you working?
If you are working in 2020 and your earnings average more than $1,260 a month, you generally cannot be considered disabled.

If you are not working, your application goes to the Disability Determination Services (DDS) office that will make the decision about your medical condition. The DDS then uses Steps 2-5 below to make the decision.

2. Is your condition "severe"?
Your condition must significantly limit your ability to do basic work such as lifting, standing, walking, sitting, and remembering – for at least 12 months. If it does not, the Disability Determination Services will find that you are not disabled.

If your condition does interfere with basic work-related activities, go to Step 3.

3. Is your condition found in the list of disabling conditions?
For each of the major body systems, Disability Determination Services maintains a list of medical conditions that it considers so severe that it prevents a person from completing substantial gainful activity. If your condition is not on the list, they have to decide if it is as severe as a medical condition that is on the list. If it is, they will find that you are disabled. If it is not, they then go to Step 4.

There are two initiatives designed to expedite processing of new disability claims:

Compassionate Allowances: Certain cases that usually qualify for disability can be allowed as soon as the diagnosis is confirmed. Examples include acute leukemia, Lou Gehrig’s disease (ALS), and pancreatic cancer.

Quick Disability Determinations:  Disability Determination Services use sophisticated computer screening to identify cases with a high probability of allowance.

For more information about our disability claims process, visit the Benefits For People With Disabilities website.

4. Can you do the work you did previously?
At this step, we decide if your medical impairment(s) prevents you from performing any of your past work. It is doesn’t, we’ll decide you don’t have a qualifying disability. If it does, we proceed to Step 5.

5. Can you do any other type of work?
If you can’t do the work you did in the past, we look to see if there is other work you could do despite your impairment(s).

Disability Determination Services considers your medical conditions and your age, education, past work experience, and any transferable skills you may have. If you can’t do other work, as part of its process of deciding if you meet its definition of disability. If you can do other work, they will decide that you don’t have a qualifying disability and your claim will be denied.


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