When you a have a debilitating or disabling medical condition, having health insurance is critical. Maybe critical for your survival if you don’t have the resources to pay for all the needed treatments, therapies, medications and more. The good news is that if you receive Social Security Disability Insurance (SSDI), you will automatically qualify for Medicare benefits. However, you will likely have to wait to access said benefits. The way Medicare typically works is the program primarily serves people 65 and older. It is also available for younger adults who have a disability. The majority of SSDI recipients may qualify for Medicare 24 months after they become eligible for disability benefits. This waiting period is waived for people with amyotrophic lateral sclerosis (ALS) or end-stage renal disease.
Why is there a delay in benefits that I need right now? Well, it is purely economic. In 1972, Congress voted to expand Medicare to cover people with disabilities. This expansion included the two-year delay to help mitigate the cost of adding those beneficiaries, and to avoid replacing coverage some disabled workers would be able to get from their former employers through COBRA.
How Does the Waiting Period Work?
The Social Security Administration counts each month in which you are entitled to receive an SSDI payment toward the 24-month Medicare qualifying period.
There is also a waiting period for SSDI payments to begin, lasting five full calendar months after the month in which the Social Security Administration determines that your disability began (viewed as when you became unable to work due to your medical condition). So, what that really means, in most cases, you become eligible for Medicare 29 months after what Social Security terms the “onset” of your disability.
Remember that your onset date can be well before you filed for SSDI or were approved to collect it. This is a process that typically takes several months and can go much longer if it involves appealing a denial of benefits. Social Security can pay up to 12 months of retroactive benefits if it determines, based on the medical evidence, that your disability predated your application. Plus, those months when you were medically entitled to SSDI but had not yet been approved to receive it count toward the Medicare waiting period.
Aside from the waiting period, Medicare functions for people with disabilities much as it does for eligible older adults. You likely won’t have to pay for Medicare Part A if you paid Medicare taxes while you were working. You will have monthly premiums for Part B and for Part D if you choose to enroll in one. These costs may be deducted from your SSDI benefit.
What if you go back to work?
Medicare coverage based on receiving SSDI will end if benefits stop because your condition improves to the point that Social Security no longer considers you disabled. The Social Security Administration will do periodic reviews to determine your continuing medical eligibility for benefits.