while my ssi disability is on appeal what about medicare

The good news, the SSA will not ask you to repay the value of the Medicare or Medicaid

benefits paid out while your case was on appeal—should your appeal not be successful. The SSA is not required to waive the monetary repayment of disability benefits paid while you were appealing your termination of benefits.

Full Answer

What happens if I don’t appeal my Social Security disability benefits?

Not requesting a continuing of benefits while on appeal will result in losing your disability benefits within two months after the SSA sent you the notice of cessation. The SSA calls this a grace period. Social Security will ask you to repay the SSDI or SSI cash benefits you received if you are not successful in your appeal.

How long does it take to appeal a social security decision?

Appeal A Decision. If you were recently denied Social Security benefits or Supplemental Security Income (SSI), you may request an appeal. Generally, you have 60 days after you receive the notice of our decision to ask for any type of appeal.

Do I have Medicare if I get Social Security disability?

If you get Social Security Disability Income (SSDI), you probably have Medicare or are in a 24-month waiting period before it starts. You have options in either case.

How do I check the status of my SSI appeal?

Whether you filed your appeal online, by mail, or in an office, you can check the status of your disability and SSI Reconsideration using your personal my Social Security account. A my Social Security account is an easy, convenient, and secure way to do business with us. If you don’t have one, you can create one today.

How does SSI work with Medicare?

It is possible to get both Medicare and Medicaid. States pay the Medicare premiums for people who receive SSI benefits if they are also eligible for Medicaid. If you get SSI and have Medicare, you will also be eligible for Extra Help with Medicare Prescription Drug Coverage without filing a separate application.

What happens when you appeal a Social Security decision?

—Regardless of the issue(s) you are appealing, your local office will send your request for hearing to one of our hearing offices for action. You will receive information from the hearing office about the hearing process, and the hearing office will send you a notice when we have scheduled your hearing.

What does it mean when Social Security says reconsideration?

Reconsideration is the second step in the Social Security Disability application process and is the first step in the appeal process. If your initial application is denied, you must file for reconsideration within 60 days of receiving the notice of decision from the Social Security office.

How long does SSI redetermination appeal take?

A reconsideration appeal can usually be decided in as little as four weeks or as long as twelve weeks; whereas an application for disability can take as long as six months (usually, if it takes this long it is due to difficulties in procuring medical records from various doctors and other medical providers).

What are the chances of winning Social Security appeal?

Unfortunately, your odds are even lower for getting your benefits approved on the first appeal—about 12%. If you move on to the next level of appeal, which involves a hearing before an administrative law judge (ALJ), your chances for approval increase significantly—more than 55%.

What happens if you lose an appeal?

If you win the appeal, your opponent could seek to appeal the appeal. If you win the appeal, the case might be sent back for a new trial leading to further expense. Losing the appeal may mean paying the other side's legal costs.

What is the difference between a reconsideration and an appeal?

If you're asking for a reconsideration, you're not appealing. It's sort of a new claim, a reopened claim, whatever you want to call it. You've got to say, “I disagree” and now there's a form that you have to use.

Who makes the final decision on Social Security disability?

The Disability Examiner is the one who writes up the decision about your SSDI benefits, and she is charged with deciding if a consultative medical examination is necessary.

How far does SSI back pay go?

Retroactive benefits might go back to the date you first suffered a disability—or up to a year before the day you applied for benefits. For SSI, back pay goes back to the date of your original application for benefits.

How long after I receive my award letter will I get my money?

Typically, claimants can expect to receive Social Security disability award letters within one to two months from the date they're approved, but in many instances, the wait may be significantly shorter, or longer. The timing of award letters depends on what stage of the process you're at—initial application or appeal.

How long does appeal process take?

An appellate court may issue its opinion, or decision, in as little as a month or as long as a year or more. The average time period is 6 months, but there is no time limit. Length of time does not indicate what kind of decision the court will reach.

How many times can you appeal Social Security?

There is really no limit to the number of times you can apply for benefits or appeal your disability claim. However, there are a variety of other factors to consider when deciding whether to apply or appeal a denied claim. For many applicants who have received a claim denial, an appeal is the best course of action.

How far does SSI back pay go?

Retroactive benefits might go back to the date you first suffered a disability—or up to a year before the day you applied for benefits. For SSI, back pay goes back to the date of your original application for benefits.

Who makes the final decision on Social Security disability?

The Disability Examiner is the one who writes up the decision about your SSDI benefits, and she is charged with deciding if a consultative medical examination is necessary.

How many times can you appeal Social Security?

There is really no limit to the number of times you can apply for benefits or appeal your disability claim. However, there are a variety of other factors to consider when deciding whether to apply or appeal a denied claim. For many applicants who have received a claim denial, an appeal is the best course of action.

Can a fully favorable decision be reversed?

Can A Fully Favorable Decision Be Reversed? The Appeals Council can review any decision made by an ALJ—favorable or unfavorable. While rare, the Appeals Council can find the ALJ made an error and reverse a fully favorable decision.

How long does it take to appeal a Medicare termination?

While you may have 60 days to appeal the termination of benefits, to continue getting your benefits while on appeal, the time limit is 10 days ...

How long does it take for a disability to disappear?

Generally speaking, your disability status disappears in the month SSA sends you the cessation notice. Not requesting a continuing of benefits while on appeal will result in losing your disability benefits within two months after the SSA sent you the notice of cessation. The SSA calls this a grace period.

What is SSA Form 795?

SSA Form 795, Benefit Continuation Election Statement, is the form you need to fill out to continue receiving benefits while on appeal.

What happens if you change your SSI benefits?

If your circumstances change while the cessation is on appeal—more monthly income, gaining additional non-exempt SSI assets, or even family giving donations or room and board—your SSI benefits may be suspended or changed in accordance with your new status.

Can I receive disability benefits while on appeal?

In some cases, if the SSA stopped payment of your disability benefits because they allege your condition (s) improved, you may be able to continue receiving your disability benefits while your case is on appeal. There are, however, different rules for DIB and SSI benefits.

Can you appeal a disability claim if you are not successful?

If you were not successful at the hearing level in getting your benefits reinstated, and you wish to appeal to the Appeal’s Council, the SSA will not allow you to continue receiving disability benefits. If the Appeals Council, however, sends your case back down for a new hearing, your benefits will continue without you having ...

Can you get suspended from SSDI if you work while on appeal?

If you work while on appeal, during a trial work period, and those earnings rise higher than what social security considers substantial gainful activity ($1,180 for 2018)—your SSDI benefits can be suspended.

How to appeal Social Security denied?

If we recently denied your Social Security benefits or Supplemental Security Income (SSI), you may request an appeal. Generally, you have 60 days after you receive the notice of our decision to ask for any type of appeal. There are four levels of appeal: 1 Reconsideration. 2 Hearing by an administrative law judge. 3 Review by the Appeals Council. 4 Federal Court review (please see the bottom of page for information on the Federal Court Review Process).

What are non medical reasons for disability?

Non-medical reasons may include a denial due to income, resources, overpayments, or living arrangements. Request Non-Medical Reconsideration. Check the Status of Your Reconsideration. Whether you filed your appeal online, by mail, or in an office, you can check the status of your disability and SSI Reconsideration using your personal my Social ...

What to do if you disagree with a decision made at the reconsideration level?

If you disagree with the determination we made at the reconsideration level, you may ask for a hearing. An administrative law judge who had no part in the original determination or the reconsideration of your case conducts the hearing. You may request a hearing online.

How do I check my disability hearing status?

Whether you filed your request for a hearing online, by mail, or in an office, you can check the status of your disability and SSI hearing using your personal my Social Security account. A my Social Security account is an easy, convenient, and secure way to do business with us. If you don’t have one, you can create one today.

What is reconsideration in insurance?

A reconsideration is a complete review of your claim by someone who did not take part in the first determination. We will look at all the evidence submitted used in the original determination, plus any new evidence.

Can a Social Security appeal be denied?

The Appeals Council looks at all requests for review, but it may deny a request if it finds the hearing decision is in accordance with social security law and regulations. If the Appeals Council decides to review your case, it will either decide your case itself or return it to an administrative law judge for further review. If you disagree with the hearing decision, you may request a review by Social Security’s Appeals Council online.

How to check on my Social Security disability appeal?

To check the status of your appeal, create or log in to your personal my Social Security account.

How long does it take to appeal SSI?

The notice will tell you how to appeal. If you file an appeal within 10 days of the date you receive your notice, your SSI benefits may continue at the same amount until we make a determination on your appeal. The notice will tell you if you are entitled to continued benefits.

How long do you have to appeal a disability termination?

If you appeal a disability cessation and you want to keep receiving benefits until we make a determination, you must make a written request for benefit continuation within 10 days after the date you receive the written notice . You are entitled to a hearing with a disability hearing officer.

How to request reconsideration of disability?

If you disagree with the initial determination, you may request reconsideration by writing to us or by completing a Form SSA‑561-U2 (Re quest for Reconsideration) or a Form SSA-789 (Request for Reconsideration - Disability Cessation). Go to www.ssa.gov to complete an online request for a reconsideration on a disability claim or non-disability issue.

What do you look for when you ask for an appeal?

When you ask for an appeal, we will look at the entire determination or decision, even those parts that were in your favor.

What happens after you file for SSI?

After you file an application for SSI, we will mail you a written initial determination. This is your first “initial determination”, but each time we make a determination about your eligibility or payment amount after that is also an initial determination.

Can you appeal SSI?

You can appeal most determinations and decisions we make about whether you can get Supplemental Security Income (SSI) or if we make changes to your benefit amount. That means you can ask us to look at your case again.

How long does it take to get Medicare if denied SSDI?

The result: your wait for Medicare will be shorter than two years.

How much does Medicare cost on disability?

If you qualify for SSDI, you'll typically qualify for premium-free Medicare Part A based on your work record. Part B requires a monthly premium ($144.60 in 2020), automatically deducted from your Social Security check. You can technically opt out of Part B if you don’t want to pay the premiums. Just know that without Part B, you’ll forego extensive medical coverage. It’s usually not a good idea to opt out of Part B unless you have other health insurance—like from an employer.

How long do you have to collect SSDI to get Medicare?

Once you have collected SSDI payments for two years , you will become eligible for Medicare. You won’t even have to sign up—Medicare will automatically enroll you in Part A and Part B and mail your Medicare card to you shortly before your coverage begins.

What is ESRD in Medicare?

ESRD, also known as permanent kidney failure, is a disease in which the kidneys no longer work. Typically, people with ESRD need regular dialysis or a kidney transplant (or both) to survive. Because of this immediate need, Medicare waives the waiting period. 2

What to do if your income is too high for medicaid?

If your income is too high to qualify for Medicaid, try a Medicare Savings Program (MSP), which generally has higher limits for income. As a bonus, if you qualify for an MSP, you automatically qualify for Extra Help, which subsidizes your Part D costs. Contact your state’s Medicaid office for more information.

What conditions are considered to be eligible for Medicare?

Even though most people on Social Security Disability Insurance must wait for Medicare coverage to begin, two conditions might ensure immediate eligibility: end-stage renal disease (ESRD) and Lou Gehrig’s disease (ALS).

How long does a disability last?

The government has a strict definition of disability. For instance, the disability must be expected to last at least one year. Your work history will also be considered—usually, you must have worked for about 10 years but possibly less depending on your age.

What happens if you appeal a disability claim?

If your appeal is denied at the hearing level and you wish to appeal to the Appeals Council, you will no longer continue to receive disability benefits. However, if the Appeals Council remands your case for a new hearing, your benefits will continue with no action on your part.

What happens if you appeal Social Security?

If your appeal is unsuccessful at any level, Social Security will ask you to repay the SSDI or SSI cash benefits paid to you while your appeal was pending (but you can ask for a waiver--see below). Social Security will not ask you to repay the value of any Medicare or Medicaid benefits that continued while your appeal was pending.

How long does it take to get a reconsideration for Medicare?

Request for Reconsideration. To receive continuing benefits, you must file a request for reconsideration (appeal) within 10 days of receiving your notice of cessation along with your request for continuing cash benefits, Medicare, or both.

How long do you have to file a request for reconsideration?

If your request for reconsideration is denied, you must file a request for hearing and another request for continuing benefits within 10 days after you receive your notice of reconsideration. You may elect continuing benefits with your hearing request even if you did not elect continuing benefits with your request for reconsideration.

When do you get a cessation notice for SSDI?

EXAMPLE: You receive an SSDI cessation notice on July 15 because you failed to attend, without good cause, a medical exam scheduled by Social Security on May 15. Your disability ceased in May, and your benefits continue until the end of July. You have the same 10 days after receipt of your notice to elect continuing benefits.

When does disability cease?

The general rule is that your disability ceases in the month that the cessation notice is mailed to you. If you don't request a continuation of benefits, your SSDI or SSI benefits will continue during the disability cessation month and the following 2 months (the "grace period"). EXAMPLE: On July 15, you receive an SSDI cessation notice (because ...

What is SSA Form 795?

The form to file to request continuing benefits if SSA Form 795, Benefit Continuation Election Statement.

How to appeal unemployment benefits?

If you’d like to ask that benefits be continued while the agency’s finding is being appealed, you must file within 10 days of the date cited on the agency’s notice of decision . Be aware that you may be liable for repayment of those temporarily continued payments if your appeal is unsuccessful.

How long does it take to get a reconsideration from SSA?

Requests that terminated benefits be continued pending reconsideration must be filed within 15 days of the date on the notice. Other requests must be filed within 60 days. If there are extenuating circumstances, an additional 60-day extension may be granted for reconsideration requests.

What to do if reconsideration isn't successful?

If the reconsideration process isn’t successful, you can request a hearing using a form provided by SSA. The hearing is conducted before an administrative law judge, and you may introduce witnesses and supplemental medical evidence and may cross-examine SSA witnesses. If possible, you should be represented by legal counsel.

How long do you have to file an appeal for unemployment?

If you’d like to ask that benefits be continued while the agency’s finding is being appealed, you must file within 10 days of the date cited on the agency’s notice of decision. Be aware that you may be liable for repayment of those temporarily continued payments if your appeal is unsuccessful.

Can you appeal SSA decision?

The SSA’s final decision may be further appealed in federal district court, and if you continue to be denied benefits, additional appeals may be appropriate. The appeal process can become very complicated, and in some cases, legal counsel is advisable.

Who conducts a hearing for Medicaid?

The hearing, which should be recorded, is conducted by an impartial party who may or may not be an attorney. It’s less formal than a court trial, and you may either represent yourself or choose to use an attorney or other advocate. You can offer evidence, call witnesses and testify yourself. You can also question the Medicaid agency’s witnesses.

Is Medicaid a federal or state initiative?

Medicaid is a joint federal/ state initiative, with each state defining and managing its own plan in accordance with national requirements. Though eligibility requirements vary by state, certain aspects of the appeals process are uniform across the U.S.:

What to do if Social Security denies your appeal?

If the SSA denies your appeal, the next step is to request a hearing with an Administrative Law Judge (ALJ). At an ALJ hearing, you meet face to face with a judge whose job is to adjudicate Social Security disability appeals. The ALJ has unilateral authority to overturn the SSA’s denial of your benefits, so it is important to show up to your hearing prepared to make a thorough, compelling case.

What If My Appeal Is Unsuccessful?

If your appeal is ultimately unsuccessful, the SSA might demand that you repay the benefits you received while your appeal was pending . Should this happen, you can apply for a waiver, and the SSA might consider forgiving this money if it believes you submitted your appeal in good faith .

What Happens to My Benefits if the ALJ Denies My Claim at the Hearing?

If the ALJ denies your claim, you have another step in the appeals process, which is to take your case to the Appeals Council. But you will not receive benefits while your case is pending at this stage. If the Appeals Council reverses the ALJ’s decision (which is rare), your benefits will automatically start again.

How long do you have to appeal a cessation notice?

You can still collect SSDI benefits during your appeal if these benefits stop, but you have only 10 days to initiate the appeals process, and that includes filing the paperwork to keep receiving benefits ...

How long do you have to file an appeal to extend your unemployment benefits?

You can extend your continuation of benefits through your ALJ hearing, but you must file another request, and you must do it within 10 days (plus five for the mail) of receiving notice that your initial appeal was declined. Also, you can request to receive benefits until your hearing even if you did not elect to receive them while your first appeal was pending.

How long do you have to file an appeal for unemployment?

If you prefer to file a traditional appeal and not ask for benefits in the interim, you have 60 days to file.

How to contact Disability Advantage Group?

Our job is to get you the benefits you deserve. To schedule a free case evaluation, call us today at 865-566-0800.

How long does an SSI appeal take?

The SSI appeals process is not a quick process. It can often take 12-18 months to complete an appeal of your initial decision. This is one reason that many people give up too soon because they simply cannot wait that long to get help. For that reason, many will attempt to return to work because they need the money.

What percentage of disability appeals are approved?

In recent years, about 40% of appeals are approved at the hearing stage. This is much higher than those approved at the reconsideration level which is less than 10%. In most cases, your odds of getting approved during the appeal process is much higher if you have an attorney working on your case.

What to do if you are denied a disability claim?

If you go through the ALJ hearing and Appeals Council and still have your claim denied, all hope is not lost. You can still file a claim in Federal District court and ask that the court review your claim. There are a few outcomes that you can expect at this level. The District Court might send your case back to the SSA and ask them to reconsider the claim. They could also opt to go ahead and approve your claim or even dismiss your case. Once you get to this step, an attorney is almost always needed to file the case in Federal court. In reality, very few cases make it this far. Many attorneys are unwilling to continue with a disability claim this far because the odds of winning are extremely small unless there is new evidence that perhaps was not available or presented in the initial claim and appeals process.

How to request reconsideration of disability?

Most initial determinations are made by local Disability Determination Services (DDS). These are often state agencies that make the initial decision for the SSA. Your reconsideration request is asking the SSA to review and reconsider the decision made by this agency. This is sometimes successful, but not often.

What happens if you are unsuccessful in a federal appeals court?

If you are unsuccessful at the hearing, you can continue to appeal your case. Your next step would be to the Appeals Council and finally to Federal court if the Appeals Council review is unsuccessful. Very few cases actually make it to Federal District Court in reality. If your benefits are not approved at the hearing level, then many cases simply get dropped at that point.

How many appeals are approved?

In recent years, about 40% of appeals are approved at the hearing stage. This is much higher than those approved at the reconsideration level which is less than 10%. In most cases, your odds of getting approved during the appeal process is much higher if you have an attorney working on your case.

What happens if you miss a Social Security filing deadline?

If you miss a filing deadline, then your claim is likely to get dismissed right away. Even if you have a valid claim, missing a deadline will get it denied regardless of your arguments or the evidence.

Appeals Process

• You can appeal most determinations and decisions we make about whether you can get Supplemental Security Income (SSI) or if we make changes to your benefit amount. That means you can ask us to look at your case again. When you ask for an appeal, we will look at the entire determination or decision, even those parts that were in your favor.

See more on ssa.gov

How to Appeal Social Security Determinations and Decisions

Initial Determination

Reconsideration

Hearing

Appeals Council

Federal Court