How The Waiting Period Works
The Social Security Administration counts each month in which you are entitled to receive an SSDI payment toward the 24-month Medicare qualifying period.
There is also a waiting period for SSDI payments to begin, lasting five full calendar months after the month in which the SSA determines that your disability began . That means, in most cases, you become eligible for Medicare 29 months after what Social Security terms the onset of your disability.
Remember, though, that your onset date can be well before you filed for SSDI or were approved to collect it . In fact, Social Security can pay up to 12 months of retroactive benefits if it determines, based on the medical evidence, that your disability predated your application.
And those months when you were medically entitled to SSDI but had not yet been approved to receive it count toward the Medicare waiting period. Say you applied for SSDI on Sept. 10, 2021, eight months after a chronic illness sidelined you from your job. Social Security approves your claim in February 2022 and denotes Jan. 10, 2021, as the start date of your disability.
Your benefit entitlement, then, began in July 2021, the sixth calendar month after your onset date. You would get seven months of retroactive payments and become eligible for Medicare in July 2023, 17 months after you got a decision from the SSA.
Signing Up For A Medicare Plan
Your 7-month IEP is the best time to sign up for a Medicare plan. All of these plans are provided by private insurance companies working under the guidance of the Centers for Medicare & Medicaid Services . Your options are:
- Medicare Part C, more commonly known as Medicare Advantage, combines your Parts A and B benefits in a single plan that’s similar to the group health insurance many people have through an employer. Medicare Advantage plans must provide the same benefits you get with Original Medicare, but most offer additional coverage as well, with prescription drug coverage being the most common. Please note that, even if your Advantage plan has a monthly premium, you are still responsible for the Part B premium.
- Medicare Part D provides prescription drug coverage. You may join a standalone Part D prescription drug plan or a Medicare Advantage Prescription Drug plan . Medicare beneficiaries must maintain prescription drug coverage . If you do not have creditable coverage elsewhere AND you don’t sign up for a Part D plan, you may owe lifelong late enrollment penalties. Learn more here.
There is also Medicare Supplemental Insurance, more commonly known as Medigap, which helps cover some of your out-of-pocket Medicare costs. The best time to sign up for a Medicare Supplement plan is during your Medicare Open Enrollment Period , because you cannot be denied coverage or charged a higher rate, even if you have preexisting conditions.
Top 5 Things You Need To Know About Medicare Enrollment
1. People are eligible for Medicare for different reasons.
Some are eligible when they turn 65. People under 65 are eligible if they have received Social Security Disability Insurance or certain Railroad Retirement Board disability benefits for at least 24 months. If they have amyotrophic lateral sclerosis , theres no waiting period for Medicare. Some people with End Stage Renal Disease may be eligible for Medicare. Its important to know the different ways that people qualify for Medicare so you can help current and former employees and their dependents anticipate their eligibility for Medicare so they can make timely and appropriate decisions about their enrollment.
2. Some people get Medicare Part A and Part B automatically and some people need to sign up for them.
People living in the United States and U.S. Territories who are already collecting Social Securityeither disability or retirementare automatically enrolled into Part A and Part B when theyre first eligible. These people will get a packet of information a few months before they turn 65 or receive their 25th month of Social Security Disability or Railroad Retirement Board benefits. At that time, they can choose to keep or decline Part B, but cant decline Part A unless they withdraw their original application for Social Security and pay back all Social Security cash benefits.
3. Enrolling in Medicare can only happen at certain times.
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How Long Do People On Disability Have To Wait To Become Eligible For Medicare
Once you have collected SSDI payments for two years, you will become eligible for Medicare. You wont even have to sign upMedicare will automatically enroll you in Part A and Part B and mail your Medicare card to you shortly before your coverage begins.
Thankfully, your 24-month waiting period doesnt have to be all at once. For example, if you qualify for SSDI, lose eligibility, then re-qualify for SSDI, each month you collect checks counts toward the total 24-month waiting period.
Similarly, if you apply for SSDI and are denied disability benefits, you can appeal the decision. If you appeal and the decision is reversed, your 24-month waiting period will be backdated to when your disability benefits should have started. The result: your wait for Medicare will be shorter than two years.
How Do I Enroll In Medicare
Automatic Enrollment Period
A person receiving SSDI for the required time period is automatically enrolled in Medicare Part A and Medicare Part B . Beneficiaries should receive a Medicare card in the mail a few months before they become eligible. This will notify beneficiaries of their automatic enrollment in Medicare Part A and Medicare Part B. If you do not receive this card, you should contact the Social Security office as you approach Medicare eligibility. Medicare Part A is usually premium-free for everyone. If you have worked fewer than 40 quarters, the premium is based on the number of quarters worked. For Medicare Part B there is a monthly premium which is usually deducted from your Social Security check. The monthly Part B premium can change annually. A person has the option to turn down Medicare Part B. If you are a beneficiary or your spouse is actively working for an employer that is providing an employer group health plan , you may be able to continue the EGHP coverage if you or your spouses employer has 100 or more employees. In this situation you will be able to delay enrollment in Medicare Part B. If you are going to delay your enrollment in Medicare Part B, you should meet with a Social Security representative or call 1-800-772-1213 or 1-800-325-0778 .
Special Enrollment
For more details and further information, please call SHIIP at 1-855-408-1212 Monday through Friday from 8am to 5pm.
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How Long Should You Wait Before You Apply For Disability
Wait times differ across the country, but you should expect to wait at least six months. According to the SSA, the shortest wait times for 2021 are in: In certain parts of the US, wait times can be as high as a year or more. Tacoma, Washington, for example, has a current claim-processing time of 497 days.
What If Im Getting Social Security Benefits Because Of Als Or Esrd
Individuals who have ALS are automatically enrolled sooner than other Social Security benefits recipients. If you are disabled due to ALS, your Medicare Part A and Part B coverage will begin the very first month you start receiving Social Security disability benefits.
If you receive Social Security benefits because you have ESRD, your Medicare enrollment is not automatic, though you can still get it while under the age of 65.
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If You Are Applying For Social Security Disability When Does Medicare Start
file for Social Security Disability benefits and are approvedSocial Security DisabilityHowever, in most cases, individuals who have been approved for Social Security Disability do not actually have to wait two years to receive medicareNorth CarolinaNY TimesLA TimesFor assistance on a disability application or Appeal in NC, Most popular topics on SSDRC.com
How To Get Disability Insurance And Maximize Benefits
Published: by Financial Samurai
If you ever get disabled, your active income generating abilities may be in jeopardy. As a result, its wise to have disability insurance to cover you when you can no longer work. Bad things happen all the time.
During the pandemic, my myopia got worse. Further, if I spend longer than an hour on my laptop or phone at a time, I experience eye fatigue, dryness, and pressure. As a result, I can no longer pound out a post in two hours straight. I need to take breaks.
If my eyesight continues to worsen, I may have to evolve to just recording mostly podcasts. Or I might hire someone to transcribe and edit all my posts. If things get really bad, I might step away altogether and hire freelance writers and invite guest posters on Financial Samurai.
For those of you who are still 100% healthy, cherish your ability to work! Sooner or later, your health will fade. You may encounter bad luck as well. It will become harder to maintain your same work intensity as you age. Pre-mortem planning is a must.
I understood this sad reality after experiencing so many physical ailments during my banking career before age 25. As a result, I saved and invested as aggressively as possible to build passive income. I needed a financial safety net. At the time, I didnt understand the benefits of disability insurance.
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How Long Does It Take To Get Medicare After Being Approved For Disability
Asked by: Levi Nolan
You have to wait two years after you are entitled to disability benefits to get Medicare unless you fit into an exception. All Social Security disability insurance recipients can receive Medicare coverage two years after the first month they are eligible for their monthly disability benefits.
How Do I Become Eligible For Medicare If I Am Under Age 65 And Disabled
Before you can receive Medicare you must apply, be approved and have received Social Security Disability Insurance for a period of time. You can apply for disability benefits at your local Social Security office, apply online at www.socialsecurity.gov or call toll free 1-800-772-1213 or 1-800-325-0778 to make an appointment to file an application.
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How Long Does It Take To Get Medicare After Receiving Ssdi
Qualifying for Medicare When Receiving Disability Benefits. Medicare coverage kicks in for most SSDI recipients two years after the first month they are eligible for their monthly disability benefits. However, this doesnt automatically mean that every person approved for SSDI must wait two years to get their Medicare coverage.
Social Security Disability And Medicare
Being a recipient of Social Security Disability benefits is one of the qualifications that can make you eligible to receive Medicare coverage before the age of 65 years. However, to receive SSDI, you must have worked and paid Social Security taxes for some time.
Social security also has strict guidelines on the conditions that can be classified as a disability and make you eligible to receive SSDI benefits. These conditions include:
- Musculoskeletal disorders including amputation, chronic joint pain, and spinal disorders
- Impaired hearing, sight, or speech
- Respiratory disorders including asthma, chronic obstructive pulmonary disease , and cystic fibrosis
- Neurological disorders, including ALS, Parkinsons, epilepsy, multiple sclerosis, and traumatic brain injuries
- Mental health disorders including dementia and schizophrenia
- Cardiovascular illnesses including heart disease and heart failure
- Digestive disorders including liver and bowel disorders
- Chronic kidney disease
- Disorders of the blood including anemia, sickle cell disease, and bone marrow disorders
- Congenital disorders such as Down syndrome
- Auto-Immune diseases, including lupus, HIV, and inflammatory arthritis
If you qualify for SSDI benefits under any of these conditions you will be automatically enrolled for Original Medicare coverage after 24 months.
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Does Medicare Pay For Non
If the VA authorizes services in a non-VA hospital, but doesn’t pay for all of the services you get during your hospital stay, then Medicare may pay for the Medicare-covered part of the services that the VA does not pay for. Example: John, a veteran, goes to a non-VA hospital for a service that is authorized by the VA.
Why Do You Have To Wait 2 Years For Medicare
Medicare was originally intended for those over 65, and when Medicare was expanded to include persons with disabilities, a very expensive expansion, the two-year waiting period was added as a cost-saving measure. … About a third of disability recipients receive Medicaid coverage during the waiting period.
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How Long Does It Take To Get Ssdi Benefits After I Am Approved
Congratulations! Your social security disability benefits claim was approved. If you are like most of my Louisiana disability clients after your SSDI claim has been approved you want to know WHEN WILL I GET THE DISABILITY BENEFITS I HAVE BEEN AWARDED?
It will usually take a few months for your benefits to start AFTER YOU RECEIVE A FAVORABLE WRITTEN DECISION.
Medicare Benefits For People With Disabilities
Whether you qualify for Medicare based on age or a disability, Medicare Part A and Part B coverage stays the same. Medicare beneficiaries have the same benefits and can access the same services. The same coinsurance and copayments also apply to Medicare beneficiaries under 65. Heres a brief rundown of what each covers:
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Enrolling In Medicare Advantage
Anyone eligible for Medicare can enroll in a Medicare Advantage plan. Once you get your Medicare ID card and effective date, you can apply for any plan sold in your area.
If you choose Medicare Advantage, you may have to pay a separate premium to your insurance company in addition to your Part B premium. Most people have access to a $0 premium, $0 deductible Medicare Advantage plan.
If you are concerned about out-of-pocket spending with Original Medicare, a Medicare Advantage plan might be a good option. All Medicare Advantage plans have an annual out-of-pocket maximum. This means that once you reach your plans limit, the insurance company pays 100% of your costs.
While the government maximum is $7,550 in 2021, the average out-of-pocket maximum among Medicare Advantage plans is about $4,900.
Some people with disabilities qualify for a Medicare Advantage Special Needs Plan . These plans always include Part D coverage. They usually have $0 premiums and $0 deductibles, and include extra benefits such as dental, vision, and care coordination to help you manage your condition. Benefits are specifically tailored to help keep costs low.
What To Do If Your Income Is Too High For Medicaid
If your income is too high to qualify for Medicaid, try a Medicare Savings Program , which generally has higher limits for income. As a bonus, if you qualify for an MSP, you automatically qualify for Extra Help, which subsidizes your Part D costs. Contact your states Medicaid office for more information.
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Getting Medicare Enrollment Assistance
If you have questions about or need help with Medicare eligibility or enrollment due to disability, you will want to talk with Social Security office. You can also go to your local State Health Insurance Assistance Program office for Medicare counseling.
If you get approved for disability benefits but arent yet eligible for Medicare yet , you can reach out your local state human services agency to see if Medicaid may be an option for you.11
Footnotes
Medicare With Als Or Esrd
There are two exceptions to the 2-year waiting period. If you have amyotrophic lateral sclerosis , also known as Lou Gehrigs Disease, youll be enrolled in coverage in the first month you receive SSDI.
If you have end stage renal disease , your Medicare coverage normally begins after youve received 3 months of dialysis treatment.
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Qualifying For Medicare When Receiving Disability Benefits
Medicare coverage kicks in for most SSDI recipients two years after the first month they are eligible for their monthly disability benefits. However, this doesnt automatically mean that every person approved for SSDI must wait two years to get their Medicare coverage. The two-year Medicare waiting period generally gets calculated from the date of your SSDI entitlement . Normally, this is the date your disability began plus the five-month SSDI waiting period.
However, things get a little tricky depending on your disability onset date. Depending on how far back you became disabled, you may have met a good portion of the waiting period by the time you are approved for benefits. But, because Social Security only allows a maximum of 12 months of retroactive benefits, plus the 5-month waiting period for benefits, the earliest that you can become eligible for Medicare is one year after you apply for Social Security disability.
But, if you recently become disabled and were approved with an entitlement date of August 2018, you would not become eligible to receive Medicare benefits until August 2020. There are exceptions to this rule if your disabling diagnosis is End Stage Renal Disease or Amyotrophic lateral sclerosis . People with these conditions receive expedited Medicare coverage.
Medicare Coverage For Working People With Disabilities
If you have a disability and are working, your Medicare coverage can fall into one of three plans.
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