Texas Disability Benefits and Medicare

Medicare is federally funded health insurance for disabled people and those 65 and older. To qualify for Medicare due to disability, you first have to qualify for Social Security Disability Insurance (SSDI). You’re eligible for Medicare after 24 months on SSDI. Along with being eligible for Medicare, you’re also eligible for programs that supplement Medicare, and these are also regulated at the state level. Texas residents on disability have numerous supplemental options that have been approved by their state department of insurance.

Social Security Disability

Texas residents have access to SSDI, which pays a monthly benefit to you once you’ve been disabled for five months or more. Social Security has a strict definition of disability; you must be unable to work your regular job, unable to do other work and the disability has to be expected to last a year or more or be a terminal illness. Depending on your income, you may also qualify for Supplemental Security Income, which is an additional monthly benefit and may qualify you for food stamps and housing assistance.

Medicare

Once you’ve been on SSDI for two years, you qualify for Parts A and B of Medicare. Medicare Part A will cover you if you’re hospitalized, if you’re in need of skilled nursing care and if you need hospice care. Part A has no monthly premiums. Part B covers your other health costs, like doctor visits, lab tests and durable medical equipment, including wheelchairs or other equipment you may need due to your disability.

Texas Supplemental Plans

Texas residents with Medicare due to disability have an open enrollment period to enroll in a Medigap plan. These plans are secondary to Medicare and help cover the out-of-pocket costs associated with original Medicare. Texas requires companies to offer Plan A, which is the most basic Medigap plan. Several companies do, although the premiums can be quite high ($1,800 to $16,000, depending on your age and the company you choose). If you purchase a Medigap, you also need a Part D plan, which is Medicare’s prescription plan. These are offered through private companies and also have a monthly premium.

Medicare Advantage Plans

Medicare Advantage plans also help cover Medicare’s out-of-pocket costs. These plans typically have a provider network that you need to use. A monthly premium applies, and there are co-pays. Medicare Advantage plans typically include your Part D prescription coverage and may include benefits not offered by Medicare, like routine dental and vision coverage. Medicare Advantage plans are regional; every county in Texas has options available to its residents, and some plans are offered statewide.