You may be aware that when you qualify for SSDI benefits you also become eligible for Medicare. However, your Medicare eligibility is not immediate – instead, Medicare coverage does not begin until 24 months after you first become eligible to receive an SSDI payment.
Here is an example: Tom applies for SSDI benefits in March, 2008, alleging an onset date of January 7, 2008. Tom’s case is denied administratively and he appears at a hearing in August, 2009 and the judge issues a favorable decision issued on September 2, 2009.
Tom will become eligible for SSDI benefits as of July, 2008. This is because SSDI imposes a five month waiting period on payment of benefits. January, 2008 does not count in this 5 month period because it is a partial month, so the waiting period includes February, March, April, May, and June, 2008. Tom’s eligibility, therefore, begins as of July, 2008. His Medicare, however, does not kick in until July, 2010. This is the 24 month Medicare delay.
Why is there a 24 month delay in starting Medicare? According to a recent article in the Dallas-Ft. Worth News:
When Congress extended Medicare coverage to people with permanent disabilities in 1972, it also established the waiting period. Lawmakers added the wait to hold down the cost of the new government benefit, avoid overlapping with private insurance and make sure Medicare would be available only to people whose disabilities were long-lasting.
However, as a number of public interest groups point out, the private insurance landscape has changed significantly since 1972. Far fewer disabled persons have coverage, meaning that disabled citizens who are deemed “disabled” by Social Security may have to forgo medical care and treatment for up to two years.
Of course, the primary obstacle in efforts to eliminate or reduce the 24 month waiting period is money. Eliminating the wait would cost the federal government $6.8 billion the first year and $110 billion through 2019, according to the Congressional Budget Office. With record deficits already in place it seems unlikely that Congress will take steps to add to the shortfall.
In Social Security disability cases, therefore, your onset date is critically important because it will determine your eligibility for Medicare. The further back in time you can push your onset the sooner you become eligible for Medicare.
Jonathan Ginsberg represents Social Security disability claimants in Georgia. In practice for over 29 years, Jonathan publishes a widely known disability blog, a podcast and several disability web sites. In 2004, Jonathan published a "how to" book about Social Security disability called the Disability Answer Guide. Jonathan lives with his wife and 2 children in Atlanta.