Social Security Disability Lawyer Blog

For disabled folks who struggle to pay hospital bills, Medicare and Medicaid can help cut back the costs of hospital stays, physician visits, and necessary prescription drugs. A disabled person's eligibility for either program is dependent on the type of disability benefits that they receive.

Medicare is a program run by the federal government that provides health insurance for citizens over the age of 65. In addition to the over 65 set, Medicare covers those that have been receiving Social Security disability benefits (under title II) for two years or more.

Beneficiaries are automatically enrolled in Medicare (Part A only, which covers hospitalization; most beneficiaries will need to sign up for further coverage during the enrollment period) 24 months after their date of entitlement. The date of entitlement is five months after the established date of onset. In simpler terms, disabled beneficiaries are eligible for Medicare 29 months after the determined start date of the disability. Those with specific conditions, including renal failure, kidney transplant, ALS, or Lou Gehrig's disease, may be eligible for Medicare much sooner.

Medicare coverage is complex, but is generally broken down into four categories of coverage:

Part A - Hospital Insurance. A basic insurance that covers hospital stays as well as some hospice and home medical care.
Part B - Medical Insurance. A more comprehensive insurance, requires an additional monthly fee and covers hospital stays, physician visits, laboratory services, home medical care, surgical services.
Part C - Medicare Advantage. Private insurance plans through Medicare contracted companies. Plans are wide ranging and can cover a variation of the services and care covered by Part A or Part B.
Part D - Prescription Drug Plans. Private prescription drug plans, approved by Medicare, that assist with the costs of medications.

Those who receive supplemental security income under title 16, on the other hand, could be eligible for Medicaid. Medicaid is a state and local run program that helps patients with medical expenditures. Eligibility is based on several factors, but a limited income is one of the main prerequisites. Medicaid pays some or all of the medical expenses for qualifying individuals.

Some individuals receive both disability benefits under title II as well as supplemental security income under title 16. In these instances, it is best to consult the Social Security Administration to determine whether you qualify for Medicaid or Medicare.

Crohn's Disease is a chronic inflammatory disorder affecting the gastrointestinal (GI) tract. While the disease typically affects the lower small intestine, it can cause inflammation in any part of the GI tract. Claimants with Crohn's Disease can suffer from diarrhea, abdominal pain, rectal bleeding, and weight loss, among other symptoms. The disease currently has no known cure, and treatment can sometimes require multiple surgeries.

Obtaining Social Security disability benefits for Crohn's Disease can be frustrating, mostly because the disability listing is very technical. Claimants must prove, using appropriate medical documentation and physician reports, that their disorder is preventing them from being able to hold down gainful employment. Unfortunately, the symptoms associated with Crohn's Disease are similar to symptoms associated with less severe ailments, like Irritable Bowel Syndrome (IBS), making it hard for doctors to diagnose properly.

If a claimant's Crohn's Disease interferes with the ability to work, though, it is definitely still possible to be approved for benefits. The listing requires that a diagnosis of Crohn's Disease be accompanied by medical evidence, including endoscopy, imaging, biopsy, or operative findings. Patients should also exhibit the following:

• Recurring (at least twice, 60 days apart, within a 6-month period) obstruction of inflamed areas in the small intestine or colon, resulting in the need for hospitalization.
OR
• Despite following the prescribed treatment plan, the claimant still experiences two or more of these debilitating symptoms, on two separate physician visits, 60 days apart, within a 6-month period:
o Anemia (hemoglobin less than 10.0 g/dL)
o Serum albumin of 3.0 g/dL or less
o Abdominal pain accompanied by a physical mass or cramping that does not respond to pain medication
o A draining abscess or fistula caused by an infected perineum, accompanied by pain that does not respond to pain medication
o Unintentional weight loss of 10% or more
o Inability to absorb proper nutrition without medical intervention

Since the requirements are so specific, claimants may want to speak with their physician or an experienced disability attorney before submitting their claim.

One frequently asked question regarding Social Security disability benefits is whether they can expire, leaving still disabled claimants with no way to remain financially solvent. Fortunately, once a claimant is approved for disability benefits, their benefits will continue until they are deemed no longer disabled. Benefits do not have a time limit.

Claim examiners do, however, conduct case reviews regularly. Examiners are looking to ensure that beneficiaries still meet the Social Security Administration's (SSA) definition of disabled for their impairment category. If the beneficiary no longer meets the disability listing requirements, benefits will be discontinued. There is a process to dispute the SSA's determination to revoke benefits, and beneficiaries can appeal to continue receiving benefits while they are disputing the review. In other words, the SSA will not simply revoke benefits without warning.

As for whether or not there is a limit on how long after leaving work a claimant can wait before filing for disability benefits, there is no official limit on that either. When filing for disability, claimants must have at least 20 work credits within the ten years leading up to a disability. If a worker earned the maximum four work credits per year, he/she can wait up to five years from the point of discontinuing work to apply for benefits.

However, a claimant could also receive benefits if he/she can prove that a disability forced him/her out of a job ten years ago, and they had 20 work credits leading up to that disability. The process becomes more difficult, but if a claimant can gather the requisite medical documentation and sufficiently prove the disability started ten years ago, no SSA guidelines would prevent their claim from being approved. In this case, the claimant would greatly benefit from working with a disability attorney. The burden of proving a disability in the past is often not something a claimant is prepared to handle without an intimate understanding of Social Security laws and regulations.

Many claimants are surprised to discover how deeply a disability examiner investigates into their lives. Examiners will often look into a claimant's daily activities, talk to family and friends, and scrutinize personal records. As one might suspect, alcohol and/or drug abuse is one finding that can significantly change the dynamic of your case.

Substance abuse does not necessarily preclude applicants from receiving benefits, but it can certainly hamper a claimant's case. Since drug and alcohol abuse are not listed on the Social Security Administration's (SSA) List of Impairments, sufferers must have a disability apart from their substance abuse. The key factor when considering drug/alcohol abuse in a disability case is whether the abuse is material to the case. When abuse is material to a disability case, the case can easily be denied. If it is immaterial, that means that the substance abuse is not a major factor in the claimant's disability and thus, their claim is more likely to be approved.

Substance abuse may be material to the case when...

• The claimant's disability was sparked by substance abuse
• Any disability would clear up without substance abuse
• Abuse of alcohol or drugs is constant, with no periods of sobriety

Substance abuse may be considered immaterial when...

• Claimant would be disabled even without the substance abuse
• During periods of sobriety the claimant is still disabled
• Substance abuse is secondary to a completely separate disabling condition

Drug and alcohol abuse can be discovered in a variety of ways, including notes (recent or not) from the claimant's medical files. If your physician made a note on one of your charts about admitted or suspected substance abuse, this note can easily come to light during your case. Have your disability attorney review your medical files alongside you to avoid any unwelcome bombshells.