24 Month Waiting Period for Medicare Benefits in Approved SSDI Cases Causes Hardship
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.
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Jonathan Ginsberg
Comments on 24 Month Waiting Period for Medicare Benefits in Approved SSDI Cases Causes Hardship
I am very aware of the hardships caused by the 24 month waiting period as I was a non-attorny Claimant's Representative beginning in 1980 and I am just now retiring or perhaps I should say quitting.
However, the long wait (sometimes 3 years or more) it takes for a Case to be approved for disability (in many cases) in fact most cases result in the Claimant qualifying for Medicare by the time the claimant knows they are approved. However, that waiting period still applies and prevents claimants from getting back Doctor and Hospital bills approved during the 2 years of the "waiting period".
I am certainly in favor of the 2 year waiting period after the date the claimant is adjudicated as disabled to be eliminated.
Hi Jonathan
I am awaiting my administrative law judge hearing. Thankfully, my case is finally coming up within the week after a year and a half wait.
Last spring, I read about HR 1708/S 700, a bill proposed to phase out the Medicare waiting period for people on Social Security Disability. However, in an internet search tonight, I can find no more information about it it's status. I see that Obama first co-sponsored the bill in 2007. I assume it must have not passed that time. I am wondering if the same thing has happend this time? If so, it's a dirty, shame.
Do you know anymore about the status of this bill?
I am a disabled person that has recieved my ssdi benifits since july of 2004. Up until August of 2009 I never had to pay the premiums for my medicare. The social security dept. takes 100.00 a month out of my check which is barely enough to keep me going. I am homeless brcause i cant afford to pay rent with the remaining 750.00 i recieve. Why am I now having a co-pay with my medical bills and have to pay the premium for my medicare. Please help me understand.