I Have Cancer and Am on Medicaid, Should I Apply for Social Security Disability?

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If you’re unable to work due to a serious illness, you may think that Social Security Disability will be the answer to all your troubles. However, it can often be less simple than that. Here’s how a cancer diagnosis complicated one reader’s Medicaid and Social Security benefits.

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Dear Toni,

“I am 58 years old and recently received a diagnosis of stage 3A metastatic breast cancer. A non-profit cancer program helped me qualify for Medicaid due to my unemployment status, and I was referred to receive treatment. I have already undergone chemotherapy and a mastectomy, and I am scheduled to begin radiation therapy next week.

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My current concern revolves around the potential implications if I qualify for medical disability through Social Security and transition to Medicare. How will this affect my existing Medicaid benefits, which currently cover the costs of my cancer treatments? Despite reaching out to both Medicaid and Social Security, I have yet to receive a clear answer on this matter.

My friends have emphasized the importance of applying for Social Security Disability due to the financial support it provides. According to Social Security, I am eligible for disability benefits based on my work credits, with an estimated monthly amount of $1,535. I would greatly appreciate any insights or advice you may have on navigating this complex situation.”

-Trish

woman with cancer walking with nurse and IV

To qualify for Medicaid, one must meet certain income requirements, and if you make $1 too much—and I repeat, $1 too much—then you can lose your Medicaid benefits.

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What is Medicaid?

Medicaid is a federally funded program that provides health insurance for qualifying low-income individuals. It can cover a wide range of individuals, including the elderly and disabled. According to the Social Security Administration, thirty-five states (and the District of Columbia) provide Medicaid eligibility to people eligible for Supplemental Security Income (SSI ) benefits. In fact, within these states, the SSI application is also the Medicaid application, and Medicaid eligibility starts at the same time as SSI eligibility.

To qualify for Medicaid, a recipient must:

Have been eligible for an SSI cash payment for at least one month.
Be disabled.
Meet the other eligibility rules, including the resources test.
Need Medicaid to work.
Have gross earned income that is insufficient to replace SSI, Medicaid, and any publicly funded attendant care.

For further information on Medicaid, go to: http://www.cms.hhs.gov.

Trish, you are just beginning your radiation treatments and do not have to pay for anything because you have been blessed by qualifying for Medicaid. However, you could risk your Medicaid eligibility by applying for Social Security Disability.

The $1,535 Social Security Disability check will be too much income to keep you qualified for your Medicaid benefits, and you could lose your precious Medicaid benefits.

Once you lose those benefits, you will have to pay 100% for your cancer treatment because Medicaid will not be paying the hospital!

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⚠️ When someone qualifies for Social Security Disability, it will take 24 months for you to begin qualifying for Medicare and Medicare will begin on the 25^th month. ⚠️

How much is too much?

Trish and others in her position might be wondering how much is too much. Specifically, what is Medicaid’s income limit? Good news—I have just the information for you! It’s important to note that all of your income counts toward the Medicaid’s income limit.

This includes:

Retirement or pension income
Alimony
Social Security
Social Security Disability Income
Cash
Stock
Bonds
Vacation properties

With that being said, I’m sure you’re now wondering what the actual income limit is in 2025! Keep reading to find out.

Nursing Home Medicaid / HCBS Waivers

For single applicants: $2,000. According to Medicaid Planning Assistance, New York is a notable exception. They allow up to $32,396. For more information about state-specific Medicaid asset limits, click here.

For married couples: Up to $3,000 or $4,000 when both spouses are applying for Nursing Home Medicaid.

Regular Medicaid

For single applicants: It’s the same amount as the one above—$2,000! Additionally, New York also allows up to $32,396 when applying for regular Medicaid.

For married couples: Up to $3,000 as a couple.

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What should Trish (and other readers in her position) do?

Trish, I hope you’re still reading because I have some advice for you that you need to hear. While I understand where your friends are coming from, I would wait to apply for Social Security Disability until after you have finished all your treatments and are released with a clean bill of health. I would not want you to put the mental and financial burden on yourself and your family because you are worried about how to get your cancer treatment, and most of all, how to pay for the treatments.

If you are not receiving any more cancer treatments when you are 62, then apply for early Social Security benefits, not Social Security Disability. At 62, one receives 75% of their Social Security amount. You will not receive 100% of your Social Security benefit until you reach your full retirement age (FRA).

At 65…

Apply for Original Medicare online and enroll in a Medicare Supplement with a Medicare Part D plan or enroll in a Medicare Advantage plan. One should always confirm that their cancer facility and/or medical providers accept the Medicare Advantage plan they are enrolling in. With Original Medicare, the Medicare recipient can make as much money as needed and not lose medical benefits. Not like losing Medicaid and your medical benefits because of making too much money!

More Medicare Resources

If you or any other readers have any questions, simply call the Toni Says Medicare hotline at 832-519-8664 or email [email protected]. Toni’s new “Confused about Medicare” video series is available at www.tonisays.com. And remember, readers—with Medicare, what you don’t know WILL hurt you.