Illinois Valley Traumatic Brain Injury Support Group

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What Is A Brain Injury?

How Many People Have TBI?

What Are The Causes Of Brain Injury?

What Are The Types Of Brain Injury?

What Are Possible Impairments?

Commonly Asked Questions

Is There Any Treatment?

What Is The Prognosis?

What Research Is Being Done?

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Financial Resources

The consequences of brain injury may be
financially devastating. Acute medical and
inpatient rehabilitation services often deplete
work-related and private health insurance funds.
Many people with brain injury are unable to
return to work due to the extent of their injuries.
This leaves them needing long-term medical and
social services but lacking the income to pay for
such assistance.

Government financial support for people with
brain injury include the income programs of
Social Security Disability Insurance (SSDI) and
Supplemental Security Income (SSI), and two
health insurance programs, Medicaid and
Medicare.

All programs should be immediately investigated to determine eligibility requirements and application deadlines.

SOCIAL SECURITY DISABILITY INSURANCE
(SSDI)
SSDI is a federal insurance program is designed
to provide basic protection to individuals against
income loss due to disability. If you have been
employed for a period of time, then you may be
eligible to receive disability benefits through SSDI
which can help cover some medical costs.
Monthly payments are based on the individual’s
lifetime average earnings covered by Social
Security.

SUPPLEMENTAL SECURITY INCOME (SSI)

SSI is a federal “needs” program administered by
the Social Security Administration (SSA). This
covers people who have not worked prior to their
injury or who have not worked long enough or
recently enough before their injury occurred to be
covered by SSDI. Monthly payments for SSI are
based on the person’s income, assets and the state
where the person resides.
If you have questions about SSI or SSDI please
contact the Social Security Administration at
(800) 772-1213

MEDICARE

Medicare is a federal insurance program for
people 65 years of age or older, and some people
with disabilities. Medicare Part A pays for part of
inpatient hospital care, Medicare-certified skilled
nursing facilities, home health care and hospice
care. There is no premium for this coverage, but
there is a deductible, as well as co-payments.

Medicare Part B covers physician services,
outpatient hospital care and lab services. The
monthly premium for Part B coverage may be
billed quarterly or deducted from the person’s
Social Security check.

If you are disabled and under age 65 and have
been receiving SSDI for at least two years, you
may be eligible for some Medicare coverage.

MEDICAID

Medicaid is a state and federally funded program
designed to provide medical assistance to people
with low incomes. Medicaid is need-based and
financial eligibility is determined by a person’s
income and assets.
In determining eligibility, the state uses the
spending down process which requires a person
with income in excess of the poverty line to spend
this extra income on medical care. The state will
only allow people to receive Medicaid when their
income is at or below the poverty line. Medicaid
is administered by the Illinois Department of
Public Aid.

APPEALS PROCESS

If a person is determined ineligible for any government financial support, investigate the appeals process immediately by contacting the appropriate government agency. You have a limited time to begin the appeals process from the date of the decision notice.

WORKERS COMPENSATION

People injured while performing job duties or contracting a work-related illness may be eligible for workers’ compensation. The employer must pay for reasonable medical treatment. Notify your employer immediately if you are injured while on the job.

VETERAN’S DISABILITY COMPENSATION

Soldiers and veterans who are injured may be eligible for disability compensation in which they receive monthly payments based on the effects of the injury and the extent to which they are injured. Disabilities are rated at a percentage and the monthly payments are based on that percentage.

Soldiers and veterans are encouraged to contact their local Office of Veteran Affairs for more information.

Know Your Financial Situation

Talk with the insurance carrier, managed care organization, or other health care payer to find out how much it will pay; for what services and under what conditions. Ask about deductibles and co-payments. Get a copy of your policy or plan and re-read it. Find out the extent of your financial obligations. Ask about the long-term implications of decisions you make today. Get regular (at least monthly) updates about where you stand financially with the payer and program. Find out about public or other private benefits you may be eligible for and apply promptly.