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Did You Choose the Correct Onset Date for Your Social Security Disability Claim?

What onset date should you use for your Social Security disability claim? Choosing the earliest possible onset date can benefit you in many ways – you may qualify for additional months of past due benefits – which can put hundreds or thousands of dollars in your pocket.

The earlier your onset date, the earlier you qualify for Medicare. When you are awarded SSDI, you become eligible for Medicare two years after the date you first become eligible for disability payment. So choosing an earlier onset date can qualify you for Medicare that much earlier.

In some cases, an early onset date can qualify you for SSDI when at first glance you only qualified for SSI. Remember that to qualify for SSDI, your disability must begin – your onset date – before your date last insured for SSDI. So an earlier onset date may put you back into SSDI status. Continue reading →

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.

SSI recipient having trouble with Medicaid

My nephew has SSI and is having problems with his medical bills being paid. Medicare said he has Medicade and Welfare said no, he has Medicare so no one is paying his medical bill and his bill are getting higher. Who is to pay? They said to get in touch with SSI. Why? –Betty

Jonathan responds: Betty, if your nephew is getting SSI, he is automatically eligible for Medicaid, not Medicare. Medicaid should be paying the bills. I would suggest that you call your local Social Security office as well as the State Medicaid office. Realize that Medicaid is a State operated program that receives funding from the federal government so you will need to call both the State Medicaid office as well as your local SSI (Social Security Administration) office. Sometimes, your federal Senator or Congressional representative can be very helpful in cutting through the red tape.

–Jonathan

Qualified Medicare Beneficiary program

I am the responsible payee for my 43 year old permanently disabled son. He receives social security disablilty benefits of $776. monthy and $42.00 food stamps. The State of Florida pays his Medicare premium of $88.50. monthly.[I don’t know what department of Florida pays it-don’t know how to find that.]

My question is I called Medicare and they informed me of a program called QMB [Qualified Medicare Beneficiary]. Is there such a program in the state of Florida? Also, Why can’t my son qualify for SSI. He is single, lives in his own appartment and IS diagnosed with spina bifida, AADD and bipolar. His psychiotrist informed me that because of his cost share through Medicard is $525 monthly, he will have to pay the difference of $49. a visit. He doesn’t have it!

Can you give me a direction to go to for help for him. He really needs the help as, according to his urologist, his condition will worsen as he ages and might requite surgery in the future. I would greatly appreciate any help you can give me. I have spent days on the phone trying to get answers. I keep getting sent to another agency to no avail.Thank you.

Jonathan Ginsberg responds: Cynthia, I know very little about Qualified Medicare beneficiary programs. My understanding is that this program pays the Medicare Part B premiums for individuals whose monthly income falls below a certain level.

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