Medicare Blog

why is it 2 years after becoming disabled to be eligible for medicare?

by Mr. Marcelino Maggio Published 2 years ago Updated 1 year ago

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.

This legislation was created to keep costs down and to avoid replacing coverage for a disabled worker still receiving benefits under a private group health plan. Individuals with disabilities must undergo a lengthy process before receiving Medicare coverage.

Full Answer

How long do you have to be disabled to receive 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.

Will My Medicare coverage continue if I receive disability benefits?

Jul 09, 2020 · 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 payment and when you are eligible for Medicare.

Who is eligible for Medicare if I have a disability?

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 doesn’t automatically mean that every person approved for SSDI must wait two years to get their Medicare coverage.

Do you have to wait two years to get Medicare after SSDI?

Jul 16, 2020 · Once you have collected SSDI payments for two years, you will become eligible for Medicare. You won’t even have to sign up—Medicare 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 doesn’t have to be all at once.

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 diseases waive the 2-year wait for Medicare when SSDI is granted?

People who receive SSDI benefits and are under the age of 65 can benefit from Medicare. However, there is a 2-year waiting period for most people before their healthcare coverage begins. Medicare waives the waiting period for those who have ESRD or ALS.Jun 30, 2020

How does disability affect Medicare?

Medicare coverage is the same for people who qualify based on disability as for those who qualify based on age. For those who are eligible, the full range of Medicare benefits are available.

Does Medicare automatically come with disability?

You will typically be automatically enrolled in Original Medicare, Part A and B, after you've received Social Security disability benefits (or certain Railroad Retirement Board disability benefits) for two straight years. Your Medicare coverage will start 24 months from the month you qualified for disability benefits.

What is the difference between SSI and SSDI?

The major difference is that SSI determination is based on age/disability and limited income and resources, whereas SSDI determination is based on disability and work credits. In addition, in most states, an SSI recipient will automatically qualify for health care coverage through Medicaid.

What happens to my Medicare if I lose SSDI?

If you go off SSDI when you return to work you can continue Medicare coverage for 93 months after completing the 9 months work period. Combined with the trial work period, therefore, you can receive Medicare Part A coverage premium-free for a total of 8 and half years.Feb 17, 2005

How much money can you have in the bank with Social Security disability?

WHAT IS THE RESOURCE LIMIT? The limit for countable resources is $2,000 for an individual and $3,000 for a couple.

Why did my Social Security disability benefits decrease?

If you recently started receiving Social Security benefits, there are three common reasons why you may be getting less than you expected: an offset due to outstanding debts, taking benefits early, and a high income.

How can I increase my Social Security disability payments?

Increasing Your Disability Income. There are two ways that your PIA can increase, which would then increase your disability income: 1) a cost of living adjustment and 2) a recalculation of disability benefits.Mar 24, 2021

What month is Medicare deducted from Social Security?

The Medicare premium that will be withheld from your Social Security check that's paid in August (for July) covers your Part B premium for August. So, if you already have Part B coverage you'll need to pay your Medicare premiums out of pocket through July.Mar 5, 2021

Does Social Security pay for Medicare?

Will a beneficiary get Medicare coverage? Everyone eligible for Social Security Disability Insurance (SSDI) benefits is also eligible for Medicare after a 24-month qualifying period. The first 24 months of disability benefit entitlement is the waiting period for Medicare coverage.

Can you get both Social Security and disability?

Yes, you can receive Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) at the same time. Social Security uses the term “concurrent” when you qualify for both disability benefits it administers. However, drawing SSDI benefits can reduce your SSI payment, or make you ineligible for one.

When did Medicare become part of disability?

When Social Security began, it did not include healthcare. It was not until the Social Security Amendments of 1972 that Medicare became part of disability insurance. At the time, it was a controversial decision.

How long do you have to wait to get medicare?

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 a two year waiting period. ...

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 ...

When did Medicare start?

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

Who was the first person to be enrolled in Medicare?

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. When Social Security began, it did not include healthcare.

Is Medicaid handled by state governments?

Medicaid is handled by state governments rather than the federal government . Obamacare expanded Medicaid eligibility in many states, but not in Texas. To make matters worse, Texas has some of the hardest-to-meet eligibility criteria in the union.

Does Texas have Medicaid?

Obamacare expanded Medicaid eligibility in many states, but not in Texas. To make matters worse, Texas has some of the hardest-to-meet eligibility criteria in the union. In order for an adult to receive Medicaid in Texas, they must be disabled and have a low income and limited resources.

How long can you wait to get Medicare if you are disabled?

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 ...

How long after you apply for Social Security disability can you get Medicare?

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. For instance, let’s pretend you became disabled in July 2016.

When does Medicare kick in for 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.

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 doesn’t automatically mean that every person approved for SSDI must wait two years to get their Medicare coverage.

How long does it take for Medicare to kick in?

Medicare coverage kicks in for most SSDI recipients two years after the first month they are eligible for their monthly disability benefits. However, this doesn’t automatically mean that every person approved for SSDI must wait two years to get their Medicare coverage.

How long is the waiting period for Medicare?

The two-year Medicare waiting period generally gets calculated from the date of your SSDI entitlement (the date you are eligible to receive your monthly award). Normally, this is the date your disability began plus the five-month SSDI waiting period.

When will Medicare start?

Since it has been two years since your Date of Entitlement, you will start receiving Medicare benefits in December 2018. 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.

Can I get Medicare based on disability?

Medicare enrollment for SSDI recipients. To become eligible for Medicare based on disability, you must first qualify for Social Security Disability Insurance. SSDI pays monthly benefits to people with disabilities who might be limited in their ability to work. If you are injured or have a medical condition that limits your ability to work, ...

How long do you have to work to qualify for Medicare?

However, even if you’re diagnosed with ESRD, you must have an employment history—typically around 10 years —to be eligible for Medicare. If your work record doesn’t meet the standard, you may still qualify if you are the spouse or child of someone with an eligible work history.

When will Medicare be available for seniors?

July 16, 2020. Medicare is the government health insurance program for older adults. However, Medicare isn’t limited to only those 65 and up—Americans of any age are eligible for Medicare if they have a qualifying disability. Most people are automatically enrolled in Medicare Part A and Part B once they’ve been collecting Social Security Disability ...

Is Medicare for older adults?

Medicare is the government health insurance program for older adults. However, Medicare isn’t limited to only those 65 and up—Americans of any age are eligible for Medicare if they have a qualifying disability.

Can I get Medicare at 65?

However, Medicare isn’t limited to only those 65 and up—Americans of any age are eligible for Medicare if they have a qualifying disability. Most people are automatically enrolled in Medicare Part A and Part B once they’ve been collecting Social Security Disability Insurance (SSDI) payments for 24 months. But some people may be eligible ...

What conditions are considered to be eligible for Medicare?

Even though most people on Social Security Disability Insurance must wait for Medicare coverage to begin, two conditions might ensure immediate eligibility: end-stage renal disease (ESRD) and Lou Gehrig’s disease (ALS).

Does Medicare waive the waiting period for ESRD?

ESRD, also known as permanent kidney failure, is a disease in which the kidneys no longer work. Typically, people with ESRD need regular dialysis or a kidney transplant (or both) to survive. Because of this immediate need, Medicare waives the waiting period. 2. However, even if you’re diagnosed with ESRD, you must have an employment ...

How long does it take to get Medicare after a disability?

All Social Security disability insurance (SSDI) recipients can receive Medicare coverage two years after the first month they are eligible for their monthly disability benefits.

How long do you have to wait to get Medicare?

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 (SSDI) recipients can receive Medicare coverage two years after the first month they are eligible for their monthly disability benefits. This does not mean that every individual who is ...

How long does it take to get Medicare after receiving Social Security?

Updated By Bethany K. Laurence, Attorney. All Social Security disability insurance (SSDI) recipients can receive Medicare coverage two years after the first month they are eligible for their monthly disability benefits. This does not mean that every individual who is approved for Social Security disability will necessarily have to wait two years ...

How long is the waiting period for Medicare?

In general, the two-year waiting period for Medicare is calculated from your date of SSDI entitlement—when you are eligible to start receiving monthly benefits. This is usually the date your disability began, plus five months (due to the five-month waiting period for SSDI).

When will Isaiah be eligible for Medicare?

But he is eligible for retroactive benefits only going back to October 1, 2018, five months after his disability onset date. Because his date of entitlement is October 1, 2018, he'll be eligible for Medicare on October 1, 2020. Note that his eligibility for Medicare starts only 14 months after his application date, and only one month after his decision date.

When does Medicare cover end stage renal disease?

If you require ongoing dialysis or a kidney transplant, Medicare coverage can begin the third month after the month in which your dial ysis began. Amyotrophic lateral sclerosis (ALS). Individuals with amyotrophic lateral sclerosis (ALS) qualify for Medicare as soon as they are eligible ...

When will the SSDI start?

Thirteen months later, on September 1, 2020, she is approved for SSDI benefits with a disability onset date of August 1, 2019. She is eligible for retroactive benefits only going back to January 1, 2020, five months after her disability onset date.

How long do you have to wait to get medicare after being approved for Social Security?

However, in most cases, individuals who have been approved for Social Security Disability do not actually have to wait two years to receive medicare.

How long does Medicare take to start?

Medicare based upon Social Security Disability will begin two years after the first date that you are entitled to receive a Social Security Disability benefit. What does this mean?

How long do you have to pay Medicare if you are on disability?

Once an individual goes back to work, they do not have to pay Part A premiums for the first 8 years and 6 months. After this time, however, they must pay the Part A premiums.

How long do you have to be on Medicare?

A person with a disability who wishes to enroll in either Medicare Part D or an Advantage plan may do so during: 1 the 7-month period that begins 3 months before the 25th month of Social Security disability benefits 2 the 7-month period that includes the 25th month of disability benefits 3 the 7-month period that stops after the 25th month of disability benefits

What is a coinsurance for Medicare?

Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%. Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.

Does Medicare cover nursing home stays?

Through Medicare, healthcare coverage for a person with a disability is identical to the coverage for an individual who qualifies because of their age . Areas of coverage include certain hospital and nursing home stays, along with doctor visits and community-based services.

Does Medicare Part D include prescriptions?

Part D and Medicare Advantage costs. The coverage from parts A and B does not include prescription drug costs. Coverage for prescribed medication is known as Medicare Part D. A person may wish to include Part D as part of their plan, or they may decide to explore available options through Medicare Advantage.

Is Medicare Part D covered by Medicare Advantage?

Coverage for prescribed medication is known as Medica re Part D . A person may wish to include Part D as part of their plan, or they may decide to explore available options through Medicare Advantage. Enrollment in one of these plans is possible, but it must be within a certain time frame.

What is the cost of Medicare Advantage Plan 2020?

The average premium for a Medicare Advantage plan that includes prescription drug coverage is $36 per month in 2020. A person with an Advantage plan must also pay the Part B monthly premium of $148.50.

How long do you have to be a resident to qualify for medicare?

Persons must be U.S. Citizens or legal residents residing in the U.S. for a minimum of 5 years immediately preceding application for Medicare. Applicants must also be at least 65 years old. For persons who are disabled or have been diagnosed with end-stage renal disease or Lou Gehrig’s disease (amyotrophic lateral sclerosis), there is no age requirement. Eligibility for Medicare is not income based. Therefore, there are no income and asset limits.

How old do you have to be to qualify for medicare?

Citizens or legal residents residing in the U.S. for a minimum of 5 years immediately preceding application for Medicare. Applicants must also be at least 65 years old. For persons who are disabled or have been diagnosed with end-stage renal disease or Lou Gehrig’s disease (amyotrophic lateral sclerosis), there is no age requirement. Eligibility for Medicare is not income based. Therefore, there are no income and asset limits.

What is Medicare dual eligible?

Persons who are eligible for both Medicare and Medicaid are called “dual eligibles”, or sometimes, Medicare-Medicaid enrollees. Since it can be easy to confuse the two terms, Medicare and Medicaid, it is important to differentiate between them. While Medicare is a federal health insurance program for seniors and disabled persons, Medicaid is a state and federal medical assistance program for financially needy persons of all ages. Both programs offer a variety of benefits, including physician visits and hospitalization, but only Medicaid provides long-term nursing home care. Particularly relevant for the purposes of this article, Medicaid also pays for long-term care and supports in home and community based settings, which may include one’s home, an adult foster care home, or an assisted living residence. That said, in 2019, Medicare Advantage plans (Medicare Part C) began offering some long-term home and community based benefits.

What is Medicare Part A and Part B?

To be considered dually eligible, persons must be enrolled in Medicare Part A, which is hospital insurance, and / or Medicare Part B, which is medical insurance. As an alternative to Original Medicare (Part A and Part B), persons may opt for Medicare Part C, which is also known as Medicare Advantage.

Does Medicare cover out-of-pocket expenses?

Persons who are enrolled in both Medicaid and Medicare may receive greater healthcare coverage and have lower out-of-pocket costs. For Medicare covered expenses, such as medical and hospitalization, Medicare is always the first payer (primary payer). If Medicare does not cover the full cost, Medicaid (the secondary payer) will cover the remaining cost, given they are Medicaid covered expenses. Medicaid does cover some expenses that Medicare does not, such as personal care assistance in the home and community and long-term skilled nursing home care (Medicare limits nursing home care to 100 days). The one exception, as mentioned above, is that some Medicare Advantage plans cover the cost of some long term care services and supports. Medicaid, via Medicare Savings Programs, also helps to cover the costs of Medicare premiums, deductibles, and co-payments.

Is Medicare the first payer?

For Medicare covered expenses, such as medical and hospitalization, Medicare is always the first payer (primary payer). If Medicare does not cover the full cost, Medicaid ...

Is Medicare the primary or secondary payer?

For Medicare covered expenses, such as medical and hospitalization, Medicare is always the first payer (primary payer). If Medicare does not cover the full cost, Medicaid (the secondary payer) will cover the remaining cost, given they are Medicaid covered expenses.

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