Medicare vs. Medicaid: What’s the Difference?

Medicare vs. Medicaid: What’s the Difference?

Do you feel confused when people start talking about the difference between Medicare and Medicaid?

If so, you are not alone. One study found that only 4% of Americans could correctly explain the basic terms of their health insurance policy.

The thought of navigating the world of health insurance on your own may seem overwhelming. This is especially true as you approach your “Golden Years” and the reality of Medicare vs. Medicaid stares you in the face.

In this post, we will look at the difference between Medicaid and Medicare so you can make an informed decision. 

Understanding Medicare

Medicare is the primary health insurance provider for Americans over 65.

It can also provide coverage for those under 65 who receive Social Security Disability Insurance benefits.

Medicare is composed of 4 major parts. Here’s a brief rundown of each one.

Medicare Part A

Part A is what most people think of when they hear the term “Medicare.”

It covers hospitalization for those over 65 as long as they (or their spouse) worked and paid Medicare taxes for at least 10 years.

For most enrollees, this aspect of Medicare is free. However, you still have to pay deductibles and co-pays for certain services.

Medicare Part B

If you are eligible for Part A, you are also eligible for the health insurance benefits offered by Medicare Part B.

Part B offers coverage for services and equipment that are medically necessary. These include doctor’s visits, x-rays, lab work, and outpatient procedures.

This aspect of Medicare is not free. The monthly premiums are usually deducted from your Social Security payments.

Medicare Part C

Many who enroll in Medicare Parts A and B also sign up for supplemental coverage through Part C.

Also called “Medicare Advantage,” Part C works much like a PPO or HMO plan you likely had during your working years. It may also include dental and vision plans.

Medicare Part D

The final piece of the Medicare puzzle is Part D, which covers the cost of prescription drugs.

It includes a combination of monthly premiums and co-pays with a yearly deductible.

Understanding Medicaid

While everyone qualifies for Medicare once they reach 65—regardless of income—Medicaid is open to low-income families of all ages.

Each state has unique (and strict) requirements for Medicaid eligibility.

If you do qualify, you typically pay nothing for most healthcare services. Supplements are available for dental, vision, and prescription drug coverage.

Medicaid may also be used for long-term care funding for those who have no other way to pay for it.

Medicaid planning attorney can provide guidance and help you understand exactly what you might qualify for.

Medicare vs. Medicaid: Which Is Right For You?

In the decision of Medicare vs. Medicaid, your options depend on your personal situation and finances.

Which aspects of Medicare will you need after you turn 65? Will you qualify for Medicaid at that time, or might you already qualify for it?

The good news is you do not have to figure it out on your own.  If you are working hard to figure out the difference between the two programs, or if you qualify, we may be able to help.  Additionally, consider our Social Security disability advocacy, and estate planning services.  There is a good chance you are going to need these.

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Do SSI Lawyers Really Help With Your Disability Claim?

If you find yourself in need of assistance for a social security disability case, it is important to get help from an expert.

Many people make the error of representing themselves. While you may know your rights, it is always advantageous to reach out to one, or several social security disability law firms to increase your overall chance of success.

Follow the tips below to learn more about the importance of hiring the right SSI lawyer for your situation.

SSI Lawyers Increase Your Chance of Success

When you need a payout for your social security disability case, the last thing you want to deal with is personal doubt and uncertainty at each step of your claim. Hiring a competent disability lawyer will help you wipe away a lot of this doubt since you will have professional advocates on the case for you.

A great team of SSI advocates will work to clarify any questions the SSA has about your medical condition, employment status, medication and treatment, and any other concerns that arise. They will be there every step of the way working on your behalf to convince the Social Security Administration (SSA) that your claim is appropriate and should be granted.

A Great Team of SSI Lawyers Can Speak For Your and Explain the Details of Your Case

Knowing the law is one thing, but you also need a professional that can articulate it on your behalf.

When you start shopping around for various SSI lawyers, gauge how each one of them explains your situation to you. You want a lawyer that will explain everything about your claim, and the work they will do for you clearly, and also answers all your questions.

Remember, your lawyer will argue on your behalf that your condition meets the standards of a disability as defined by the SSA. They will further prove that your state hinders your ability to work and earn a living. It is vital that you can communicate with your lawyer if you ever expect them to be able to convey your situation accurately and compellingly for you.

SSI Attorneys Ease the Application Process

With social security disability cases, you are always subject to lulls in claim turnaround time. One of the best things you can do to get your claim approved as fast as possible is to retain a good SSI lawyer. Hiring a lawyer improves your chance of getting accepted in the first wave of the application process – which can help you get your claim approved in months rather than fighting for years over why it was not accepted in the first place.

You will also get another set of eyes on your initial disability application.

You Will Get Paid What You Deserve

In most cases, you can expect your social security lawyer to take up to 25% of your payout (up to $6k). This rate is the maximum rate an SSI lawyer can charge to assist you as an advocate. But there are some ways that firms can slip other fees by you. Even though it seems like everyone charges the same thing, you can still find there is a difference at the end of the day (in your bank account) if you don’t shop around.

Get the Professional Help You Need

We have years of experience and would love to hear from you. We’re passionate about helping you to know more about your claim – you can see this by visiting our blog.

But we can also show you by meaningfully connecting with you beyond this article. Contact us and get advice and help on your disability claim today!

Contact Lilac City Law For Disability Help Today

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What to Look for in a Great Disability Lawyer

Have you submitted a disability benefits claim and are waiting to hear whether or not it’s been approved? Unfortunately, the odds are stacked against you. Only 23% of Social Security Disability Insurance (SSDI) claims are approved at the initial application stage. Sometimes, even less if you did not use a disability lawyer.

Of course, you can always appeal a denial of disability, but even then, you’re facing an uphill battle. The total number of approvals, whether initially or upon appeal, is only about 34% of all claims filed.

Is there a way to improve your chances of receiving disability benefits? Luckily, the answer is yes. You can hire a disability lawyer to help you navigate this complex process.

A Successful Disability Lawyer Has Medical Knowledge

Social Security Disability Insurance (SSDI) cases are particularly tricky because they require an in-depth understanding of medical conditions that can interfere with a person’s ability to perform their job duties. Therefore, the lawyer that you choose must be experienced in the specialty of disability law.

You are most likely not going to get the results you are looking for if you hire your tax lawyer to tackle your disability case. Look for a law firm whose lawyers have experience litigating medical-related cases. Ask them how many disability cases they have handled and if they have dealt with your particular disability before. 

A Successful Disability Lawyer Understands the Law

This statement should go without saying, but the complexity of disability cases means that a lawyer must know the Social Security system’s requirements inside and out.

In all disability situations, your lawyer will be seeking to demonstrate one, or all, of the following:

  • your medical condition meets the criteria of a condition that is among those described by the Social Security Administration (aka a “disability listing“)
  • you cannot perform your previous work in accordance with Social Security’s “grid” system, which classifies exertion associated with job duties
  • you cannot work even a sedentary position
  • you have limitations that aren’t covered by the grid but impact your ability to perform a job

An Experienced Disability Lawyer Will Be Choosy About Cases

Lawyers who specialize in disability claim appeals cannot charge clients an upfront fee or retainer.

Instead, they receive compensation on contingency. Once your appeal has been approved, and you have been awarded a sum of back pay from the Social Security Administration, your lawyer’s fees will be deducted.

Not having to pay any amount upfront is a massive bonus for clients who may already be struggling financially due to their disability. It means you can afford excellent representation – and you can be awarded your disability benefits even within our challenging disability system!

It also means that if a lawyer takes on your case, they are also taking on the risk of not achieving a favorable outcome. It is in everyone’s interest to work hard for you.

A Great Disability Advocate in Lilac City Law

Our disability team has the know-how and expertise to help you fight and win your disability appeal. For a free, no-obligation consultation, contact us today.

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Is Sleep Apnea a Disability?

Is Sleep Apnea a Disability?

Is sleep apnea a disability?

Sometimes the guidelines regarding whether you qualify for SSI or SSDI can be confusing.

Some disabilities, Sleep Apnea, for instance, are not always straight to the point.

Is Sleep Apnea a Disability?

Sleep Apnea happens to be one of those disabilities that can fall into different categories.  In particular, the aspects surrounding severity and cause.  Either or both of these could be relevant to your disability case, even minus the apnea.

Sleep apnea is a disorder that causes momentary loss of your ability to breathe properly or to use respiratory muscles while you are asleep. This can happen from ten to thirty seconds at a time and can happen many times throughout the night. 

Sleep apnea often causes those who suffer from it to lose countless hours of sleep and wake in the morning still feeling tired. This may seem minor; however, can cause serious hazards if it goes undiagnosed. Not only will sleep apnea affect your mood, memory, and alertness, but you are also at greater risk of falling asleep at awkward or even dangerous times, such as while in conversation or while driving.

Moreover, chronic sleep apnea is often a contributing factor to high blood pressure, heart attacks, stroke, and heart disease.

There are two types of sleep apnea:

Obstructive: When your airways are being blocked. Airways can be blocked when the body is relaxed by your throat muscles, tongue, tonsils, uvula or fatty tissue.

Central: This is a more rare form of sleep apnea and is caused by the central nervous system and when the proper signals aren’t sent from your brain to the muscles in control of your breathing.

How Will I Know if My Sleep Apnea Qualifies?

When you apply for social security, your disability will be evaluated under a five-step process to determine if you are eligible or not. An examiner will work with a physician and at the hearing, a decision will be made.

  1. The first step is to meet the nonmedical thresholds.  You cannot even be considered to receive benefits if you do not meet these criteria. Basically, if you make more than a certain amount of money in employed work, you will not be approved.
  2. Second, the SSA via a medical professional will determine if your sleep apnea is considered severe, or otherwise detrimental to your ability to do employment type activity. Your attorney can help with this part as you may need to gather all medical evidence as well as fill out any questionnaires
  3. Third, your sleep apnea will be evaluated to see if you land under social security’s “listing of impairments”. There are fourteen separate categories, and sleeping disorders typically land in the third “respiratory system impairments.”
  4. Fourth your work history will be looked into, and it will be determined if you can perform at any of your previous jobs.
  5. Finally, your age, work experience, and education will be considered to see if any other jobs would be available to you.

In Brief Summary..

Is sleep apnea a disability? Technically yes, but how it affects you on a day to day basis is every bit as important (perhaps more so) than the diagnosis in the first place.  

If you believe you have sleep apnea, or you have been diagnosed with sleep apnea and are applying for Social Security disability benefits, contact us for help today. 

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SSI Lawyers Fees, How Much Will You Pay?

SSI Lawyers Fees, How Much Will You Pay?

When you are filing for Social Security, it is recommended that you start connecting with SSI and SSDI lawyers to assist you in the process.

Just having the connection and being informed will help increase your odds of being approved on your first go-round. 

However, if you have already applied and been denied, then it not just important to hire and SSI Lawyer, it is critical!

The costs for SSI lawyers can be a concern for many seeking help.  Costs are often cited as the biggest fear of people in this situation, but the good news is that fees are designed so that the cost of a great SSI Lawyer isn’t your barrier to ultimate success.

Read below to see how you can hire a great SSI Lawyer, risk-free!

How SSI Lawyers Can Help

As a brief primer, we should cover what Social security lawyers will do to help you once you retain their services. You will receive support, and even hands-on work on your application to social security as well as meeting required deadlines and collecting enough evidence to successfully represent you so that you may be approved to receive your benefits.  In short, retaining a good lawyer will make sure your claim and appeal get done… and done well!

Contingency Fee

SSI lawyers charge a contingency fee for representing you in your Social Security claim.  When you first meet your Social Security lawyer, you will go over a contingency fee agreement. Once this is signed, it will allow the Social Security Administration to pay your attorney from your past-due benefits, when they have been approved.

SSI lawyers only get paid for representing you if you win your appeal, and they will only receive payment from your back pay.

Keep in mind that although you are not paying for the lawyers’ services out of pocket, there are other costs involved that might require your payment. A disability attorney needs to have access to and collect all kinds of records including medical, work and school. This process can be pricey, and some attorneys will require you to be the one responsible for your lawyers’ access to them. Any mailing or copying charges could also be your responsibility. It is a good idea when meeting your attorney to ask what costs you will be responsible for and whether those costs are expected to be covered at the time or after you begin receiving benefits.

Back Pay

Lawyers’ fees are paid through your back pay. This is the money you would be receiving if you were to get benefits during the time you were disabled but not yet approved for benefits. Social security lawyers get a maximum of twenty-five percent of the back pay you are awarded up to a maximum of six thousand dollars. In the rare case you are not awarded back pay, your lawyer might then submit a fee petition. This could allow your lawyer to still receive a fee for their services. This does not mean you necessarily have to pay out of pocket. However, the fee would then typically come out of your awarded amount.

Again, make sure you go over this with any prospective SSI Lawyer you intend to work with.

Exceptions

There are a few situations where Social Security Lawyers may ask for more than the typical max of six thousand from your back pay and submit a fee petition. These conditions typically require for you to :

  1. Hire a new, different attorney than who you started with, or fire your previous attorney. This particular case can be confusing. If the first lawyer you worked with did a significant amount of work and did not waive their fee, then the two lawyers will have to share the percentage of your back pay. This may end in your current lawyer asking for a higher fee to make up the difference.
  2. You are still denied benefits after the appeal hearing and need to further your case to federal court.

If you have questions about your Social Security claim or need assistance filling out your claim, contact us today!

I’d Like To Talk to Lilac City Law About SSI Help & Go Over the Contingency Agreement
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Can You Win a Disability Claim for Meniere Disease in Spokane, WA?

Can You Win a Disability Claim for Meniere Disease in Spokane, WA?

If you have Meniere Disease and are finding it hard to work, you may qualify for Meniere Disease Disability Benefits.

In fact, depending on the severity of your symptoms and if you meet the SSA requirements, you may automatically qualify.

What Meniere Disease is

Meniere Disease is a disorder of the inner ear (vestibular labyrinth) which is the area that controls your balance and positional awareness.  If you have Meniere Disease, you do not constantly have symptoms, but rather attacks that come on quickly and without warning.  These attacks include extreme vertigo, hearing loss, and a full feeling in your ear.  Because of vertigo, you are at risk of falling and causing injuries.  With hearing loss, you may be unable to use the phone or verbally communicate because you cannot hear what is being said to you.  These attacks may happen in a short period of time, or they may be isolated incidents that happen every few years.  Most attacks are very debilitating and take several hours to recover from.

How to Automatically Qualify for Meniere Disease Disability Benefits

Meniere Disease is listed in the SSA blue book under SSA listing 2.07– disturbance of labyrinthine-vestibular function as a disability that automatically qualifies you for Social Security disability benefits.  However, to automatically qualify you must:

  1. Have both, disturbed function of vestibular labyrinth demonstrated by caloric or other vestibular tests; and hearing loss established by audiometry.
  2. Be earning less than $1180 per month (unable to engage in Substantial Gainful Activity)
  3. Have symptoms that last or are expected to last at least 12 consecutive months. Because Meniere Disease’s symptoms come and go, it is important to provide medical records from each time your symptoms occur from your primary doctor (or any other doctor that has treated your Meniere Disease) and your audiologist.

What to do if You Do Not Meet the Automatic Qualifications

Even if you do not meet the qualifications to receive Meniere Disease Benefits automatically, you should still apply for Social Security Disability.

SSA will create a residual capacity assessment (RFC) that will detail your ability to perform certain work-related activities.  Additionally, SSA will use the medical evidence that you submit and possibly ask you to see a doctor or audiologist hired by the SSA.

The RFC will look at your ability to perform basic work activities such as:

  • Walking, standing, sitting, lifting, pushing, pulling, reaching, carrying or handling
  • Seeing, hearing and speaking
  • Understanding/carrying out and remembering simple instructions
  • Responding appropriately to supervision, co-workers and usual work situations
  • Dealing with changes in a routine work setting

SSA should take into consideration side effects caused by the medications you take for your Meniere Disease.

For example, your medications may cause sleepiness and fatigue.  This could impact your ability to work around or with heavy machinery.  It may also affect your reliability and productivity.  If you can prove that your productivity is ~20% less than what it was before your Meniere Disease diagnosis, then you may be found disabled.

After your RFC is created, the SSA will use a formula to decide whether your RFC and your vocational factors put you in the disabled category.

You Can Get Help!

If you have Meniere Disease and are not sure if you should apply for Social Security Disability, please contact us.  We want to help!  If you have been denied, you should file an appeal, asap.  We will show you how.

Get Help With Meniere Disease Disability Claims!

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FAQ: How Much Can I Work & Still Be Eligible for Disability?

FAQ: How Long Will The Social Security Disability Process Take In Spokane?

This is not an easy question to answer, but it is one of the most important ones to consider when you contemplate your path to recovery. 

Here is our outstanding founding attorney, Randi L. Johnson, breaking down the answer:

 

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FAQ: What’s the Difference Between SSI & SSDI?

SSI vs SSDI - what's the difference?

Are you stuck trying to figure out the difference between SSI & SSDI? 

Here is our outstanding founding attorney, Randi L. Johnson, breaking down the answer:

 

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FAQ: How Long Will The Social Security Disability Process Take In Spokane?

FAQ: How Long Will The Social Security Disability Process Take In Spokane?

Initial Application, Reconsideration, Hearing Level, Appeals Council Level, Federal District Court Level…how long will it take to get your claim approved in Spokane, WA?  

Here is our outstanding founding attorney, Randi L. Johnson, breaking down the answer:

 

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FAQ: Should I Bring in ALL of My Medical Records for My Case?

SSI vs SSDI - what's the difference?

The answer to this one is all about communication and timing.   Is that vague – watch this short video and it will make more sense.

Here is our outstanding founding attorney, Randi L. Johnson, breaking down the answer:

 

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