Understanding income rules and Medicaid

Dear Toni: In January, I was diagnosed with lung cancer at the age of 60. A non-profit cancer program in my state of Texas was able to help me qualify for Medicaid to begin receiving medical treatment since I have a very low income and am uninsured. Right now, I am not paying anything for my cancer treatments. My chemotherapy will begin next week with the possibility of receiving a lung transplant in the near future.

Friends tell me I am crazy not to apply for my Social Security Disability since I need the income. Social Security has verified that I am eligible for disability and the amount I can collect will be over $2,000 which is more monthly income than my state Medicaid program allows.

My mother advised me to contact you before I sign up for Social Security Disability and ask what I should do. If I lose my health insurance, my cancer treatment will stop. I would like to know what my best option is.

Cindy. Lubbock

Hi Cindy: I am so glad that your mother gave you my information and you contacted me because enrolling in Social Security Disability would have been a medical and emotional disaster for you and your mom would be very sad.

The main qualification for Medicaid is that you must meet the specific income requirements for the state that you live in. If you make $1 too much -- I repeat, only $1 -- then you will lose your Medicaid benefits. Once you lose your Medicaid benefits, you will have to pay 100% for your cancer treatment because Medicaid will not pay for your health care. Then your troubles will really begin!

Cindy, your friends did not realize that when one qualifies for Social Security Disability, it will take 24 months to qualify for Medicare and your Medicare will begin on the 25th month. (Chapter 1 of the Medicare Survival Guide Advanced edition explains how to enroll in Medicare the correct way.)

My advice is to wait and apply for Social Security Disability after all of your cancer treatments are finished and you are released with a clean bill of health. I would not want you to put the mental and financial burden on yourself or your family about how to pay for your health care.

If you are no longer receiving cancer treatments covered by Medicaid when you are 62, you could apply for your early Social Security benefits. At 62, one receives 75% of their Social Security amount. You would not receive 100% of your Social Security benefit until you reach your full retirement age (FRA).

Cindy, you may want to explore at 62 if your Social Security amount will be more if you qualify for Social Security Disability once you no longer have the health issues and need to be on Medicaid. At that time you can apply for an individual health plan before turning 65.

At 65, apply for Original Medicare online at www.ssa.gov. Explore your Medicare options of either Original Medicare and applying for either a Medicare Supplement with a stand-alone Medicare Part D plan or enroll in a Medicare Advantage Part D plan. One should always confirm that their cancer/hospital facility and/or medical providers accept the Medicare Advantage plan that they are enrolling in since the MAPD plans can be HMO or PPO.

With Original Medicare, the Medicare recipient can make as much money as needed and not lose medical benefits-- unlike losing Medicaid and the important medical benefits Cindy currently has because she may make too much income with a Social Security Disability monthly amount.

Cindy, your friends meant well, but they did not know the Medicaid or Medicare rules and steered you in the wrong direction!

Have a Medicare question, email [email protected] or call 832-519-8664.