October 25, 2014

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 represents Social Security disability claimants in Georgia. In practice for over 23 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.

Comments

  1. Marlene Campo says:

    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.

  2. 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?

  3. 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.

  4. SHOULD I START INS. PAYMENTS FOR MEDICARE UNTIL THE TWO YEARS ARE UP?

  5. Priscilla says:

    I was on SSI from Jan2009 until Aug2009.At that time my disabilty came through.Do the months I was on SSI count toward my 24 months ?

  6. I am on SSDI. I have lung cancer. CT’s and MRI’s are not cheap. I had my right lung removed March 2010. I have been given only a 25% chance of being alive 5 years from the date of my surgery. I am on oxygen and other meds. 24/7. I have to see my physician on a monthly basis because of the meds. that are prescribed to me. The stress of the bill collectors and appts. is enough to drive a person into madness. I believe that the government is waiting to see if people DIE first before they get Medicare. I qualify for nothing in the private insurance industry because of this 24 month waiting period. I am married and my husband earns a decent wage. We are not wealthy at all. In our household there is too much income for me to qualify for Medicaid. I know of a couple that has been married for 55 years. The couple had to Divorce just so that the wife who was bed-ridden could qualify for in home care. Now, lets all sing “Proud to be an American”.

  7. Joseph Applegate says:

    I filed for SSDI in july of 2010 and won the case first try and th SSA ruled that I have been disabled since Dec. 2009 and couted that as my trial period and paid a lump sum from april 2010 to my regular payments started in Sept of 2010. will I get medicare baed on my diability onset in Dec. 2009, or other terms will I get Medicare in Dec 2011 (24 months since onset of disability) is there any thing I have to do to start it? I am spending mony faster than I can replace it on doctors bills… my lump sum is gone and I am getting calls on the 190K of bills I have now and am considering bankuptcy.

  8. My question is my two year period will be up next month for my Medicare what do I need too do?

  9. Kelli Harris says:

    I am currently on SSDI and will be eligible for Medicare in June or July of 2012. Will someone be in contact with me as the date gets closer as to what I need to do or do I need to contact someone? Thank you. K. Harris

  10. My husband had a major stroke in June, 2011. He is bedridden and totally disabled, he is receiving his disability but will not be eligible for Medicare until June 2013. Meantime, he’s bedridden, not receiving any PT, OT and his left hip and his left knee have completed froze up and only with surgery will they ever have a chance of being right again. We picked up Cobra Insurance when his policy for BCBS of Alabama ran out and they won’t pay for any home health care. Cost me $440.00 a month. Of course, it’s kinda hard to take him to the doctor because he can’t sit in a wheelchair because instead of sending him to a re-hab, Blue Cross and Blue Shield of Alabama said he didnt’ meet the criteria to go to a reahab facility and they sent him home. He got some PT, OT and a nurse’s visit but no CNA care. What a bunch of BS. It’s quite cruel for and my husband deserves better than this.

  11. Elizabeth says:

    I have just been qualify for disability. I have to wait 24 months for Medicare because I am $20 a month over for M’caid. Now what needs to happen is stop complaining about the baby boomers. The government needs to stop giving our money away to countries who hate America and make the federal government’s IOU s good where they borrowed from Medicare Social Security. These two programs are not the federal government’s piggy bank. These two programs are not electives to the American People. They are mandatory deductions. The government needs to put on their big boys and girls pants on and stop worrying about their cushy Elective jobs and start serving the American People as in job descriptions and their election promises. As your Employer and fix this and drop the 24 month waiting period for at least the terminally ill. For my self I personally will not see an onocologist or have another test because it is not in my budget. You are all being over PAID.

  12. margie sexton says:

    my entitlement was amended to nov 2011. when will i qualfy for medicare

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