Medicare Blog

why is there a 2 year waiting period for medicare on ssdi

by Cierra Kris Published 2 years ago Updated 1 year ago

This is because the two year wait starts from the time a person is actually eligible to get SSDI

Social Security Disability Insurance

Social Security Disability Insurance is a payroll tax-funded federal insurance program of the United States government. It is managed by the Social Security Administration and designed to provide income supplements to people who are physically restricted in their ability to be employed because of a notable disability. SSD can be supplied on either a temporary or permanent basis, usually directly correlated to …

benefits. Usually, this is a date that is in the past and, thus, the two year wait is often "served", in whole or part, by the time a person is notified of an approval.

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.

Full Answer

Can you qualify for SSDI, Medicaid at the same time?

Some disability recipients will be approved for concurrent benefits; that is, they will draw disability money from both SSDI and SSI. In such instances, the issue of whether a claimant will get Medicare or Medicaid is not so cut and dry.

How the SSDI waiting period may affect your disability claim?

  • How Workers' Compensation And Other Disability Payments May Affect Your Benefit;
  • Windfall Elimination Provision; or
  • Government Pension Offset.

Does Medicare have a waiting period?

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.

When can I get Medicare after disability?

You have to wait two years after you are entitled to disability benefits to get Medicare unless you fit into an exception. 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.

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

When Is the Medicare Waiting Period Waived?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).More items...

How long does an SSDI recipient wait for their Medicare to start?

24 monthsEveryone 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.

Why does SSDI have a waiting period?

Applicants can begin to receive benefits starting the sixth month after their established onset date (EOD) due to a mandatory five-month waiting period maintained by the SSA. The purpose of this waiting period is to ensure that applicants have long-term disabilities before they receive any benefits.

Do people on SSDI automatically get Medicare?

Health insurance is critical when you have a disabling medical condition. The good news is that if you receive Social Security Disability Insurance (SSDI), you automatically qualify for Medicare.

What happens to my SSDI when I turn 65?

When you reach the age of 65, your Social Security disability benefits stop and you automatically begin receiving Social Security retirement benefits instead. The specific amount of money you receive each month generally remains the same.

How long does it take for Medicare to approve a procedure?

Medicare takes approximately 30 days to process each claim. Medicare pays Part A claims (inpatient hospital care, inpatient skilled nursing facility care, skilled home health care and hospice care) directly to the facility or agency that provides the care.

How much does SSDI pay in 2021?

$3,148 per monthWhile SSDI is valuable to many, applicants need to carefully consider the program before applying. The maximum disability you can receive in 2021 is $3,148 per month. However, the average recipient will likely receive an amount of around $1,277 per month.

What is the most approved disability?

1. Arthritis. Arthritis and other musculoskeletal disabilities are the most commonly approved conditions for disability benefits. If you are unable to walk due to arthritis, or unable to perform dexterous movements like typing or writing, you will qualify.

Do I get back pay for SSDI?

Back pay covers the months between application and approval. Because SSDI eligibility technically begins with your disability onset date, you may be eligible for additional “retroactive” benefits if you became disabled well before you applied.

Do I lose Medicare if I lose SSDI?

Yes. 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.

How can I increase my Social Security disability payments?

You can increase Social Security Disability payments by working at least 35 years before retiring, understanding the benefits of working past retirement age, and avoiding Social Security's tax consequences. If you are married, married applicants can maximize their disability payments by claiming their spousal benefits.

How do I get my $144 back from Medicare?

Even though you're paying less for the monthly premium, you don't technically get money back. Instead, you just pay the reduced amount and are saving the amount you'd normally pay. If your premium comes out of your Social Security check, your payment will reflect the lower amount.

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).

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.

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 .)

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.

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 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 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.

How long do you have to wait to get medicare?

The Medicare waiting period is a 2-year period that people need to wait before they’re enrolled in Medicare coverage. The waiting period is only for those receiving SSDI, and doesn’t apply if you’re 65 years old or older. Americans are eligible to enroll in Medicare up to 3 months before their 65th birthday.

When does Medicare start?

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.

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.

What is SSI disability?

Supplemental Security Income (SSI) Disability & Medicaid coverage. Waiting for a disability status decision and don’t have health insurance. No disability benefits, no health coverage. The Marketplace application and disabilities. More information about health care for people with disabilities.

How long do you have to wait to get Medicare if you have Social Security Disability?

Social Security Disability Insurance (SSDI) & Medicare coverage. If you get Social Security Disability Income (SSDI), you probably have Medicare or are in a 24-month waiting period before it starts. You have options in either case.

Can you get medicaid after enrolling in Medicare?

If you’re eligible for Medicaid, your Medicaid eligibility may continue even after you enroll in Medicare.

Can I get medicaid if I have SSDI?

You may be able to get Medicaid coverage while you wait. You can apply 2 ways: Create an account or log in to complete an application. Answeryes” when asked if you have a disability.

Do you have to include SSDI income on Marketplace?

When asked about your income on your Marketplace application, be sure to include your SSDI income.

Do you have to pay a penalty if you don't have health insurance?

You’re considered covered under the health care law and don’t have to pay the penalty that people without coverage must pay.

How long does it take for Medicare to cover ESRD?

People with ESRD do not need to wait for 2 years before Medicare coverage begins. The waiting period is shorter, and Medicare begins on the first day of the fourth month of the person’s dialysis treatment. Medicare coverage may start up to a year before someone applies. Medicare calls this retroactive coverage.

How long does Medicare extend SSDI benefits?

If someone has received SSDI benefits for 24 months, Medicare will extend healthcare benefits to them regardless of their age.

How long is the waiting period for Medicare?

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. People can find alternative healthcare coverage during the waiting period through Medicaid, ...

What is the best Medicare plan?

We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan: 1 Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments. 2 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%. 3 Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.

How much is the Medicare premium for 2021?

If someone does not have enough work credits, in 2021, they need to pay a premium of $471 per month. If they have 30–39 credits, the premium is $259. People must also pay the first $1,484 in costs as the deductible before Medicare will contribute.

How long do you have to wait to get medicare?

People under the age of 65 who get certain benefits may have a 2-year waiting period before they can get Medicare benefits. However, Medicare may waive this waiting period under some conditions.

What is the difference between coinsurance and deductible?

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%.

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

Is there a waiting period for Social Security Disability Insurance (SSDI) benefits? If we find you disabled, there is generally a five-month waiting period before we can begin your benefits. We will pay your first benefit the sixth full month after the date we find your disability began.

When will ALS be approved for disability?

However, there is no waiting period if your disability results from amyotrophic lateral sclerosis (ALS) if you were approved for benefits on or after July 23, 2020. See When Your Benefits Start for more information.

How long is the waiting period for Medicare?

The two-year waiting period for Medicare starts running from the date you start receiving your monthly SSDI benefits. The date when you are eligible for SSDI payments is the date of your disability plus a five-month waiting period.

How long after applying for SSDI can I get Medicare?

Because the Social Security Administration (SSA) only pays 12 months of retroactive SSDI benefits, the earliest date that you can qualify for Medicare is one year after you apply for SSDI.

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

There is a two-year waiting period after the first month you are eligible for your monthly SSDI payments before you can receive Medicare. However, not everyone who applies for SSDI has to wait two years before being entitled to Medicare. Here is how the waiting period rules work:

When can I get Medicare for ALS?

If you need ongoing dialysis or a kidney transplant due to end-stage renal disease, you can obtain Medicare coverage the third month after you begin dialysis. Amyotrophic lateral sclerosis (ALS). You are eligible for Medicare as soon as you are eligible for SSDI if you suffer from ALS.

Can I get Medicare if I get SSDI?

If you are approved for SSDI benefits, you also qualify for Medicare. However, you are not are eligible for Medicare right away. Here, you can learn how this complicated waiting period for benefits works.

What is Medicare?

Medicare is health insurance provided by the Federal Government. Medicare is primarily for workers who are 65 years or older, however, other disabled claimants, including those with end-Stage Renal Disease (permanent kidney failure treated with dialysis or a transplant) can also get Medicare.

When do I get my Medicare benefits?

Many individuals, especially those who are unemployed, may need medical insurance. Many wonder what options are available to them, but unless you are elderly or disabled, Medicare is not available.

Why did the SSA create a Medicare waiting period?

There were several reasons the Medicare waiting period was implemented.

What happens to Medicare coverage if I return to work?

Frequently we get questions from SSDI recipients who want to return to work but who do not want to lose their Medicare coverage. According to the SSA, you may receive “at least 93 months of hospital and medical insurance after the trial work period as long as you still have a disabling impairment.”

Questions about Medicare

If you have questions about this coverage, you can contact Medicare toll-free at 1-800-MEDICARE (1-800-633-4227) to speak to a Medicare Customer Service Representative.

How long does it take to get SSDI if you have a brain tumor?

You have to stop working right away and start medical treatment. So, you apply for SSDI a second time in less than five years. The SSA’s rules around the SSDI waiting period don’t apply to your second application, since you’re in the five-year timeframe. If the SSA approves your claim this time, you’ll get your first payment in 30 days or less!

Why is there a 5 month waiting period for SSDI?

Why does the SSA make people suffer through a five-month waiting period before making payments? Believe it or not, until 1973, the SSDI waiting period was actually six months, not five! The SSA mostly enforces this rule to discourage people with short-term disabilities from filing claims. Social Security disability benefits only apply to people who’ve paid into the system through FICA tax withholdings. In addition, your disability must force you to stop working for 12+ months or become fatal. If your doctor says you’ll get better in less than a year, you won’t qualify for SSDI. The lone exception is a terminal illness.

How long does it take for a disability to be reviewed?

But you may not know there’s a required five-month SSDI waiting period before the SSA makes your first benefit payment. Will this legal rule affect your own application — and are there any exceptions? We’ll explain everything you need to know below.

What happens when you apply for Social Security?

When you apply for benefits, the SSA checks your eligibility for both programs. If your claim’s approved, you’ll either get Supplemental Security Income (SSI), or Social Security Disability Insurance (SSDI) benefits. (Very few people receive both; you usually get benefits from one program or the other each month.)

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

Anyone approved for SSDI may also qualify for up to 12 months of back pay in a single payment. Those 12 months are as far back as the SSA’s willing to pay you past-due SSDI benefits. The good news is, five months to the day after you apply for disability, your SSDI waiting period ends. Since the SSA takes 3-5 months to review applications, ...

How long does it take for the SSA to review a claim?

No, because the SSA could take longer than five months to review your claim. Or, you may get denied the first time you apply and need to appeal. Either way, don’t try to hold out an extra five months before filing your claim. There’s no guarantee you’ll get approved right away, or even at all.

How long does it take to get SSI?

Once approved, those people usually get their first SSI payment within 30 days. But if you’re thinking about doing this just to get paid a little faster, stop and read this first: SSI payments are significantly lower than most SSDI benefits, on average. In 2021, the max SSI monthly payment per person is $794.

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