TONI SAYS: Guidelines when cancer qualifies you for Medicaid

By Toni King

Toni: I am a 58-year-old female and in October of 2020, I was diagnosed with stage IIIA metastatic breast cancer. A non-profit Cancer program in Houston qualified me under Medicaid (Breast/Ovarian cancer program through the State of Texas) because I was unemployed, and I was referred to MD Anderson for treatment. I have undergone chemotherapy and mastectomy and will be starting radiation next week.

My question: If I can qualify for medical disability through Social Security and I am placed on Medicare, what will happen with my Medicaid benefits? At present, I am not paying anything for my cancer treatments.

I have contacted Medicaid and Social Security and have not been able to get a straight answer. Friends tell me I am crazy not to get my Social Security Disability because I need the income. Social Security has said I am eligible for disability (based on work credits) and the amount I can collect will be $1,535.

Thank you for any advice you may have!

— Trish

Waller, TX

Hi there, Trish: Many people think that qualifying for Social Security Disability can be the answer when you cannot work due to a serious illness. Your friends do not know the Medicaid or Medicare rules and can steer you in the wrong direction!

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.

You are just beginning your radiation treatments at MD Anderson and do not have to pay for anything because you have been blessed by qualifying for Medicaid. 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 MD Anderson, any healthcare provider or facility. Now, your troubles will really begin!

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 25th month.

My advice is to wait and 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 worrying 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, go and 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.

Confused about Medicare Zoom webinar is Thursday April 28 at 4:00 PM. Visit to sign up for the Toni Says online webinar event.

Toni King, author of the new Medicare Survival Guide® is on sale at Email questions or to schedule a “Confused about Medicare Workshop” for your professional organization or church to [email protected].