Medicare Blog

what are 2 exceptions to getting medicare without a 2 year waiting period?

by Carson Pfeffer Published 2 years ago Updated 1 year ago

There are two exceptions to this rule: those with permanent kidney failure (known as end-stage renal disease, or ESRD

Chronic Kidney Disease

A condition characterized by a gradual loss of kidney function.

) and amyotrophic lateral sclerosis (ALS) aren't subject to the two-year waiting period.

There are two exceptions to this rule: those with permanent kidney failure (known as end-stage renal disease, or ESRD) and amyotrophic lateral sclerosis (ALS) aren't subject to the two-year waiting period.

Full Answer

What is the end of the Medicare disability waiting period?

The Ending the Medicare Disability Waiting Period Act of 2009, sponsored by Senator Jeff Bingaman (S. 700) and Rep. Gene Green (H.R. 1708) phases out Medicare’s two-year waiting period over a 10 year span. The phase out initially reduces the wait to 18 months, and then reduces it by 2 months every year over 10 years.

Is there a waiting period for Medicare after 65?

The waiting period is waived if you have amyotrophic lateral sclerosis (ALS) or end stage renal disease (ESRD). There is no Medicare waiting period if you’re over 65. You can apply for other types of coverage during the waiting period. People who receive Social Security Disability Insurance (SSDI) are eligible for Medicare.

Will my husband have to wait another year for Medicare coverage?

Unfortunately, you're right, your husband will have to wait at least another year for Medicare coverage. There are two exceptions to this rule: those with permanent kidney failure (known as end-stage renal disease, or ESRD) and amyotrophic lateral sclerosis (ALS) aren't subject to the two-year waiting period.

When will I be automatically enrolled in Medicare?

In most cases, you’ll be automatically enrolled in Medicare after a two-year waiting period. Your Medicare coverage will begin the first day of your 25th month of receiving benefits. However, if you have either ALS or ESRD, you can receive Medicare coverage without the 2-year waiting period.

Why does Medicare have a two year waiting period?

The original purposes of the 24month waiting period were to limit costs to the Medicare trust funds at a time when many workers might have other health insurance coverage and to ensure that Medicare protection is extended only to persons whose disabilities are severe and long lasting.

What are the 3 requirements for a member to be eligible for a Medicare?

You're 65 or older.You are a U.S. citizen or a permanent legal resident who has lived in the United States for at least five years and.You are receiving Social Security or railroad retirement benefits or have worked long enough to be eligible for those benefits but are not yet collecting them.More items...•

Does Medicare have a waiting period?

It lasts for 7 months, starting 3 months before you turn 65, and ending 3 months after the month you turn 65. My birthday is on the first of the month. If you miss your 7-month Initial Enrollment Period, you may have to wait to sign up and pay a monthly late enrollment penalty for as long as you have Part B coverage.

What would make you ineligible for Medicare?

Did not work in employment covered by Social Security/Medicare. Do not have 40 quarters in Social Security/Medicare-covered employment. Do not qualify through the work history of a current, former, or deceased spouse.

Can I get Medicare without Social Security?

Even if you don't qualify for Social Security, you can sign up for Medicare at 65 as long you are a U.S. citizen or lawful permanent resident.

How do you pay for Medicare Part B if you are not collecting Social Security?

If you have Medicare Part B but you are not receiving Social Security or Railroad Retirement Board benefits yet, you will get a bill called a “Notice of Medicare Premium Payment Due” (CMS-500). You will need to make arrangements to pay this bill every month.

Does Medicare coverage start the month you turn 65?

Your one-time Medigap Open Enrollment Period starts on the first day of the month you turn 65 and have Medicare Part B. Signing up for Medigap during Open Enrollment means the insurance company cannot deny you coverage based on your health.

Can my wife get Medicare if I on disability?

Does Medicare cover people's spouses? Medicare offers federal health insurance coverage for those aged 65 years and over, as well as those with a permanent disability. Medicare does not cover spouses specifically. However, some spouses qualify based on the work record of their spouse or a former spouse.

Can I get Medicare at age 62?

En español | No, you can't qualify for Medicare before age 65 unless you have a disabling medical condition.

Can you be denied Medicare Part B?

You may refuse Part B without penalty if you have creditable coverage, but you have to do it before your coverage start date. Follow the directions on the back of your Medicare card if you want to refuse Part B.

What happens if you don't enroll in Medicare Part A at 65?

The Part A penalty is 10% added to your monthly premium. You generally pay this extra amount for twice the number of years that you were eligible for Part A but not enrolled. For example, suppose that: You were eligible for Medicare in 2020, but you didn't sign up until 2022.

Which of the following is an eligibility requirement for all Social Security disability Income benefits?

Be unable to work because you have a medical condition that is expected to last at least one year or result in death. Not have a partial or short-term disability. Meet SSA's definition of a disability. Be younger than your full retirement age.

How long do you have to wait to get Medicare if you have SSDI?

Most SSDI recipients need to wait 24 months before Medicare coverage begins. However, there are exceptions. For some life-threatening conditions, the waiting period is waived and coverage begins sooner. You won’t need to wait the full 2 years if you have ASL or ESRD.

How long do you have to be on Medicare to get disability?

Takeaway. You’ll be automatically enrolled in Medicare once you’ve received Social Security disability benefits for 24 months. The waiting period is waived if you have amyotrophic lateral sclerosis (ALS) or end stage renal disease (ESRD). There is no Medicare waiting period if you’re over 65. You can apply for other types ...

How long is Medicare coverage?

Medicare coverage is available to people under age 65 who receive Social Security disability benefits. Most people are automatically enrolled after a 2-year waiting period. If you have ESRD or ALS, the 2-year waiting period will be waived. You can take advantage of programs such as Medicaid, COBRA, or the Health Insurance Marketplace ...

How long do you have to wait to get dialysis?

You’ll likely need dialysis treatments when you have ESRD, and you may be considered for a kidney transplant. You don’t need to wait the full 2 years to receive Medicare coverage if you have ESRD. Your Medicare coverage will begin the first day of the fourth month of your dialysis treatment.

When does Medicare start paying for dialysis?

Your Medicare coverage will begin the first day of the fourth month of your dialysis treatment. You can get coverage as soon as your first month of treatment if you complete a Medicare-approved training program to do your own at-home dialysis treatment.

When can I apply for medicare if I am 64?

This means that if you apply for SSDI benefits and are approved when you’re 64, your Medicare benefits will begin at 65, just like they would have if you didn’t receive SSDI.

Is there a waiting period for Medicare?

There is no Medicare waiting period if you’re over 65. You can apply for other types of coverage during the waiting period. People who receive Social Security Disability Insurance (SSDI) are eligible for Medicare. In most cases, you’ll be automatically enrolled in Medicare after a two-year waiting period. Your Medicare coverage will begin the first ...

How long is the waiting period for Medicare?

Many people think that they will get Medicare upon receiving disability benefits and are caught by surprise when they learn there is a two year waiting period. This waiting period can seem to be arbitrary and unfair. There are rare exceptions to the waiting period- if you have End Stage Renal Disease or Lou Gehrig’s Disease- ...

How long does it take to get Medicare after being approved for Social Security?

Author Attorney Lloyd Bemis: After you have been approved for Social Security Disability Insurance, there is usually a two year waiting period before you will be eligible to receive Medicare. Many people think that they will get Medicare upon receiving Social Security Disability benefits and are caught by surprise when they learn there is ...

Why did the American Medical Association oppose Obamacare?

The American Medical Association opposed his plan on the grounds that it was “socialized medicine”. If today’s heated debate over Obamacare is any indication, healthcare has long been a controversial issue in America. Under private insurance, people over the age of 65 found it difficult to find a plan that would work for them. Private insurers don’t want to take on customers who are chronically ill or have low incomes. Lyndon B. Johnson championed Truman’s ideas and Medicare began with the Social Security Amendments of 1965. Harry S. Truman and his wife were the first to be enrolled in the new Medicare program.

How long do you have to wait to file for disability?

The two-year waiting period begins on the first month you are eligible for benefits, not from your date of disability or when you actually start receiving benefits. Because many disability applicants do not actually begin receiving disability benefits on the day they become eligible, it may be less than two years between when you get your first ...

How many people do not survive the 2 year wait?

It is a very upsetting fact that 4 percent of those in this situation do not survive the two year wait. Having health insurance produces better health- those who spend the two year waiting period without insurance have significantly higher health costs than those who managed to stay insured.

When did Medicare start?

Harry S. Truman wanted to establish a national healthcare system as early as 1935 .

Can you waive the waiting period for Lou Gehrig's disease?

Many of the efforts to end the waiting period also focus on expanding the list of exceptions. Currently only two conditions qualify to have the waiting period waived. Applicants suffering from End-Stage Renal Disease are allowed to bypass the waiting period as the condition requires dialysis and other expensive treatments. Applicants with Lou Gehrig’s disease may also have the waiting period waived as the disease can progress very quickly with irreversible effects.

How long is the waiting period 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.

How many people die while waiting for Medicare?

Indeed, about 4% of disability recipients die while waiting for Medicare coverage. Over the last several years, there have been legislative attempts to phase out the waiting period and/or to eliminate it immediately for those with life-threatening illnesses (in addition to ESRD and ALS).

Does Medicaid cover high medical expenses?

In three-quarters of the states, Medicaid has a "medically needy" program, so that individuals with high medical expenses but too much income to quali fy for the regular program can still qualify for Medicaid.

Do you get Cobra insurance if you have no income?

If you've ever used COBRA, however, you know that the premiums are very high, especially for someone who no longer has earnings from work. Things may be a little more hopeful on the Medicaid front for some people. About a third of disability recipients receive Medicaid coverage during the waiting period.

When will John be eligible for SSDI?

Because John was first entitled to benefits in June 1, 2016 he would still have to wait until June 2018 to be covered by Medicare, which would satisfy Medicare’s 24-month waiting period from the date John was first entitled to SSDI benefits.

How long does it take to get SSDI benefits?

The 24-month waiting period begins when an SSDI beneficiary is first entitled to benefits. Not only is there a Medicare waiting period, but also an SSDI waiting period which makes beneficiaries wait an additional five months before they are first entitled to benefits, from the date they are found disabled.

Can I get Medicare if I am disabled?

People who are found disabled by the Social Security Administration, and entitled to Social Security Disability Insurance (SSDI) benefits, automatically qualify for Medicare coverage, but there is a catch. Although many people will qualify for Medicare coverage immediately, some do not because Social Security has a waiting period ...

Does Social Security waive the waiting period for Medicare?

Some conditions and impairments are considered so severe and life-threatening that Social Security waives the waiting period for Medicare coverage for some people. The two types of impairments that automatically call for the waiving of the waiting period are: Amyotrophic Lateral Sclerosis (ALS), sometimes better know as Lou Gehrig’s ...

How long is the waiting period for SSDI?

They check the date of starting of your disability and then there is the 5-month waiting period of SSDI. For instance, if you become disabled in January 2020, after the waiting period of 5 months and if you did not get enrolled at the time of your disability you will get benefits by 2022. However, there is one exception to ...

What age does Medicare cover?

One such policy initiated by the government is Medicare Coverage. You must have heard about medicare coverage of people above 65 years of age (senior citizens). However, the government also provides Medicare coverage to those who come ...

How many parts does Medicare have?

It has four parts ABCD which covers most of the medical requirements but not all. Thus, it is very important to know beforehand the pros and cons of any such policy before taking it. Thus, beware. Medicare has many such types of policies according to the requirement of the customers.

When will someone with ALS get medicare?

If someone is diagnosed with ALS they will get medicare coverage within a month of their enrollment in SSDI. Also, check out this article about your muscles and how you can take care of them. End-Stage Renal Diseases (ESRD): ESRD is also a chronic condition related to the kidney.

Does Medicare depend on age?

Medicare coverage given by SSDI does not have any age criteria. The plan of your medicare coverage completely depends upon the type of disability and your financial conditions. Thus, clearly, Medicare coverage does not depend upon your age.

Do you have to fill out a disability form for SSDI?

You just have to fill the disability form by SSDI and if it gets approved you automatically get enrolled for medicare coverage benefits. All these medicare coverage plans have different numbers of parts and have their own rules.

Do you have to get Medicare separately for SSDI?

You will be get automatically enrolled for the Medicare Coverage facility provided them. You don’t need to get this facility separately if you are recognized under the disability list of SSDI then you automatically get the benefits of it.

What percentage of Medicare increases would be for beneficiaries who stay in the program?

In particular, only 20 percent of the increase in Medicare costs would be for beneficiaries who stay in the program and who might be viewed as the prime candidates for Medicare support as an aid to return to work. Variation in the additional costs by diagnosis is large.

What percentage of disabled people had no health insurance in 1982?

Data from the New Beneficiary Survey indicate that in 1982 about . 27 percent of disabled-worker beneficiaries had no health insurance coverage in the last 6 months of their waiting period.

What happens if you don't get Part B?

If you didn't get Part B when you're first eligible, your monthly premium may go up 10% for each 12-month period you could've had Part B, but didn't sign up. In most cases, you'll have to pay this penalty each time you pay your premiums, for as long as you have Part B.

How much is the penalty for Part B?

Your Part B premium penalty is 20% of the standard premium, and you’ll have to pay this penalty for as long as you have Part B. (Even though you weren't covered a total of 27 months, this included only 2 full 12-month periods.) Find out what Part B covers.

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