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.

Post from: Social Security Disability Blog

24 Month Waiting Period for Medicare Benefits in Approved SSDI Cases Causes Hardship

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

Post from: Social Security Disability Blog

SSI recipient having trouble with Medicaid

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. I found a website that might be a good resource for you: www.agingcarefl.org/caregiver/alzheimers/financial. Here is another website that discusses QMB programs in Maryland (so the income and asset numbers may be different from those in Florida) – www.peoples-law.org/health/gov-ben/qmb.htm.

I will see if I can find out more and supplement this answer.

–Jonathan

Post from: Social Security Disability Blog

Qualified Medicare Beneficiary program