why do i have to wait 5 months for medicare

The main reason for the five month waiting period is to help ensure that only people with long term disabilities will apply for SSDI

. If your initial application for disability is approved, then you will not start receiving benefits until it has been 5 complete months since the onset of your disability.

Full Answer

Is there a waiting period for Medicare after 2 years?

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. What is the Medicare waiting period?

Why is there a 5 month waiting period for SSDI?

The five month waiting period for Social Security Disability Insurance (SSDI) means that you cannot collect SSDI benefits until you have been disabled for 5 complete months. The main reason for the five month waiting period is to help ensure that only people with long term disabilities will apply for SSDI.

How long after SSDI can I get Medicare (and why)?

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.

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.

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).

Can you get medicaid if you have 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 qualify for the regular program can still qualify for Medicaid. In these states, Medicaid applicants can subtract their medical expenses from their income in order to meet that state's Medically Needy Income Limit (MNIL). (Read more about this in Nolo's article on Medicaid's medically needy program .)

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.

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.

Do people on Social Security get Medicare?

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 before coverage kicks in.

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 ...

When does Medicare start?

If you want Medicare coverage to start when your job-based health insurance ends, you need to sign up for Part B the month before you or your spouse plan to retire. Your coverage will start the month after Social Security (or the Railroad Retirement Board) gets your completed forms. You’ll need to fill out an extra form showing you had job-based health coverage while you or your spouse were working.

What happens if you don't sign up for Medicare?

If you don’t sign up when you’re first eligible, you’ll have to wait to sign up and go months without coverage. You might also pay a monthly penalty for as long as you have Part B. The penalty goes up the longer you wait to sign up.

When does Part B start?

If you sign up during this 8-month period, your Part B coverage will start the month after Social Security (or the Railroad Retirement Board) gets your completed forms. You’ll need to fill out an extra form showing you had job-based health coverage while you or your spouse were working.

Can you get help with Medicare if you have medicaid?

Depending on the type of Medicaid you have, you may also qualify to get help paying your share of Medicare costs. Get details about cost saving programs.

Does Medicare cover hospital visits?

Medicare can help cover your costs for health care, like hospital visits and doctors’ services.

Does my state sign me up for Medicare?

Your state will sign you up for Medicare (or if you need to sign up).

Do you have health insurance now?

Are you or your spouse still working for the employer that provides your health insurance coverage?

When does the five month waiting period start?

The five-month waiting period starts on the claimant's established onset date (EOD) of disability. (This is the date that the SSA says the claimant became disabled.) Thus the date of entitlement to Social Security benefits (when the claimant starts to be owed a monthly payment) doesn't start until five months after the EOD.

How long is the waiting period for SSI?

SSI. SSI claimants who have been approved to receive disability benefits are not subject to the five-month waiting period. SSI claimants will be eligible for their first payment on the first of the month after they apply for disability (but they will likely receive the first few months' payments in SSI back payments, ...

How long before protective filing date can you file for Social Security?

The date of entitlement to benefits can be 12 months before your protective filing date, which means that your established onset date disability can be 17 months before the protective filing date. In other words, you can be paid disability benefits for 12 months before your protective date, if Social Security finds you were disabled five months ...

How does a protective filing date affect the waiting period?

How a Protective Filing Date Affects the Waiting Period. If you have a protective filing date (the date you advised Social Security you'd be applying for disability benefits), it becomes like your application date for the purposes of the 17-month time limit discussed above.

How long do you have to wait to get SSDI?

If you were approved for SSDI benefits, went back to work, stopped receiving benefits, and then become disabled again, you will not have to wait five months to receive benefits, as long as no more than five years has passed between your first onset date of disability and the second. This is called expedited reinstatement.

How far back does the SSA set the EOD?

Of course, the EOD is only set that far back when the SSA believes you have been disabled for 17 months before the application date, or longer. For some claimants, the SSA actually sets the EOD after the application date.

How long do you have to wait to receive Social Security disability?

Laurence, Attorney. Disability claimants who have been approved to receive Social Security disability insurance benefits (also known as SSDI, SSD, and Title II disability benefits) are subject to a five-month waiting period ...

Why do I have to wait 5 months to get SSDI?

The main reason for the five month waiting period is to help ensure that only people with long term disabilities will apply for SSDI. If your initial application for disability is approved, then you will not start receiving benefits until it has been 5 complete months since the onset of your disability. For most people, the Social Security ...

Why is there a 5 month waiting period for SSDI?

Why is there a five month waiting period for Social Security Disability Benefits? The five month waiting period for Social Security Disability Insurance (SSDI) means that you cannot collect SSDI benefits until you have been disabled for 5 complete months. The main reason for the five month waiting period is to help ensure ...

How long does it take to get back pay for disability?

All the months that you were disabled, after the 5 month waiting period and before your application for disability was approved, will be paid to you in one lump sum. So, if you were approved 10 months after becoming disabled, you will get 5 months of back pay.

How long can you get back pay?

The maximum number of months that you can receive back pay is 12 months prior to your initial application for disability. So, for you to get the maximum amount of back pay, your disability onset date needs to be 17 months or more prior to the date of your initial application.

When can I get medicare?

Once you reach age 65 and are eligible for Medicare, sorting through your options can be tricky. Add in any layer of complexity to the maze — i.e., jumping in and out of the workforce, dropping and picking up coverage — and look out.

How long does it take to enroll in Medicare if you stop working?

First, once you stop working, you get an eight-month window to enroll or re-enroll. You could face a late-enrollment penalty if you miss it. For each full year that you should have been enrolled but were not, you’ll pay 10% of the monthly Part B base premium.

What happens if you don't follow Medicare guidelines?

And if you don’t follow those guidelines, you might end up paying a price for it. “You could be accruing late-enrollment penalties that last your lifetime,” said Elizabeth Gavino, founder of Lewin & Gavino in New York and an independent broker and general agent for Medicare plans.

What happens if you don't sign up for Part B?

Also, be aware that if you don’t sign up for Part B during your eight-month window, the late penalty will date from the end of your employer coverage (not from the end of the special enrollment period), said Patricia Barry, author of “Medicare for Dummies.”.

How much Medicare will be available in 2026?

For those ages 75 and older, 10.8% are expected to be at jobs in 2026, up from 8.4% in 2016 and 4.6% in 1996. The basic rules for Medicare are that unless you have qualifying insurance elsewhere, you must sign up at age 65 or face late-enrollment penalties. You get a seven-month window to enroll that starts three months before your 65th birthday ...

How long does it take for Medicare to restart?

For those who may cycle in and out of the workforce and therefore in and out of workplace insurance: Each time you lose the coverage, the eight-month window restarts, said a spokesman for the Centers for Medicare and Medicaid Services.

Why do people sign up for Medicare at 65?

While most people sign up for Medicare at age 65 because they either no longer are working or don’t otherwise have qualifying health insurance, the ranks of the over-65 crowd in the workforce have been steadily growing for years. And in some cases, that means employer-based health insurance is an alternative ...

How long do you have to wait to get Medicare after you leave the program?

whose disabilities are severe and long lasting. For disabled workers who are able to return to work, cash disability benefits are terminated, even if the worker continues to have a severe impairment. Under the 1980 Amendments Social Security Act, such beneficiaries continue to receive Medicare coverage for 2 years after cash benefits are terminated, and they do not have to undergo another 24-month waiting period to be eligible for Medicare coverage, if they become reentitled to DI benefits within 5 years after leaving the program. These provisions were added to encourage DI beneficiaries to return to work.

How long does it take to get Medicare?

Medicare eligibility for Social Security Disability Insurance beneficiaries begins no earlier than 24 months after entitlement to cash benefits. 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. Some policymakers have advocated shortening or eliminating the waiting period to improve access to medical services and to alleviate the burden of very high medical expenses. Using a unique file of longitudinal data from Social Security and Medicare records, Medicare costs during the waiting period have been estimated for a randomly selected cohort of 18,782 disabled- worker beneficiaries first entitled to disability benefits in 1972. The estimates suggest that the lo-year cost to Medicare of this cohort would have increased by about 45 percent if the waiting period had been eliminated and if Medicare were the primary payer during that time. Thirty percent of the increase in expenses would have been for persons who died within 2 years of entitlement to disability benefits. Data from the New Beneficiary Survey indicate that in 1982 about

How long is Medicare retroactive?

retroactively, Medicare entitlement is also established retroactively to the specific date 24 months from the entitlement date for cash benefits. In such cases, the beneficiary has 6 months to file Medicare claims retroactively for services received after the Medicare entitlement date. If the waiting period for Medicare is defined retroactively as the result of retroactive entitlement to disability benefits, the advantages created by waiving the 2-year waiting period may be substantially diluted. The monies for medical care would not actually be available soon after the onset of disability. Administration of the Medicare program might also be very difficult if long periods of retroactivity are permitted for many beneficiaries, Table 5 shows the frequency of retroactive entitlement to DI benefits. The data are derived from an extract of the Master Beneficiary Record (MBR) for a l-percent sample of new DI benefit awards in 1987. I* The award date refers to the date that the payment record was posted to the MBR. The date of posting roughly corresponds to the date a decision to award DI benefits was made. In a few cases, however, several months may elapse between the award decision and the posting of the award to the MBR. From the l-percent file, records were selected for workers who were under age 62 in the month of entitlement and who had no previous periods of DI entitlement. This selection resulted in a sample of 2,993 records. For each beneficiary in the sample, the number of months between the date

How many equations were used to calculate Medicare costs?

program) as of December 1981. A total of 12 equations was estimated, four for each of the three outcome groups. The four equations measured (1) the probability of Medicare utilization in a year; (2) the probability of hospital use in a year, given Medicare utilization in that year; (3) the average reimbursement per month, given hospital use in a year; and (4) the average reimbursement per month, given Medicare utilization but no hospital use in a year. These equations were used to estimate expected Medicare costs for the 1972 beneficiary cohort in both years of the waiting period and separately in the second year only. To obtain the overall cost estimates, monthly costs were estimated for each person during the Byear waiting period and then totaled over the period. Similar calculations were made for the second year of the waiting period separately. Beneficiaries who were in the program for less than 1 year did not contribute to the costs of eliminating the waiting period in the second year. Expected costs were inflation- adjusted to 1981 dollars.

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.

Why do people with AIDS have a waiting period for Medicare?

Because DI beneficiaries are, by definition, in ill health, many of them experience high medical care costs during the waiting period for Medicare entitlement. These expenses can create severe financial hardship and limit access to needed health services for DI beneficiaries without health insurance. Some policymakers advocate eliminating the waiting period because of its potential adverse effect on access to medical care. The number of DI beneficiaries with Acquired Immune Deficiency Syndrome (AIDS) is increasing rapidly. The Congressional Budget Office (CBO), using data from the Centers for Disease Control, estimates that more than 15,000 DI beneficiaries will be diagnosed as having AIDS by the end of 1989; this number is expected to increase to nearly 35,000 by the end of 1992. 2 Persons with Al DS often have very high medical care costs. For 1988, the CBO estimates that Medicare costs averaged $40,000 for beneficiaries with AIDS. Some Members of Congress and the Department of Health and Human Services have considered eliminating the 24-month waiting period for Disability Insurance beneficiaries with AIDS because of their high medical care costs.s In 1987, for example, resolutions introduced in both houses of Congress (House resolution 276 and Senate resolution 24) would have waived the 24-month waiting period for DI beneficiaries a 5-year period after enactment. A

When did Medicare extend to disabled people?

Social Security Disability Insurance (DI) beneficiaries have been eligible for health insurance benefits under the Medicare program since July 1, 1973. Medicare coverage was extended to these beneficiaries by the 1972 Amendments to the Social Security Act. Disabled workers, disabled widows and widowers, and adults disabled as children qualify for Medicare coverage. In mid-1987, disabled beneficiaries with Medicare entitlement numbered more than 3 million and accounted for 10 percent of the Medicare population. Before becoming eligible for Medicare, a disabled beneficiary must have been entitled to benefits for not less than 24 months. This 24-month waiting period was enacted primarily to limit program costs, according to the Senate Finance Committee report that accompanied the amendments. 1 This report indicated a concern that overlapping private health insurance protection might result in cost shifting onto the Medicare trust funds, particularly with regard to group insurance that may continue for a period of time after the onset of disability. The report also stated that the waiting period would help assure that Medicare protection would be extended only to persons