Thursday, June 15, 2006



Social Security Disability & the two year waiting period for Medicare Benefits

I just came across a great blog post that touches on one of the most important issues for social security disability claimants, which is medical coverage. Unfortunately, a great many claimants go without proper access to medical care at the very time:

1. their condition has become disabling

AND

2. they are trying to document their condition for the social security administration (difficult to do if you can't get seen by a doctor and get medical records generated).

Bill Darling's post references a senate bill I'd not heard of (the Ending The Medicare Disability Waiting Period Act of 2005) till now. The post (Coralandopal.blogspot.com) also quotes information from www.emphysema.net that I thought I'd try to further clarify.

Here's the quoted text from emphysema.net:

"Before they can get Medicare coverage, people with disabilities must first receive Social Security Disability Insurance (SSDI) for 24 months. But SSDI generally does not begin until five months after an individual’s disability has been certified. As a result, people with disabilities face three consecutive waiting periods prior to getting health coverage: (1) a determination of SSDI approval from the Social Security Administration; (2) a five-month waiting period to receive SSDI; and, (3) another 24-month waiting period to get Medicare coverage"

The quoted information is essentially accurate, but it's still potentially misleading to say that you actually wait 5 months for benefits and it's misleading also to refer to the medicare situation as a "two year wait" because in some cases by the time a person has been approved for disability benefits, the two year requirement for medicare will already have been served.

How is this? Well, here's how it works: when you file for disability, you allege an onset date for your disability. That is, you state when you think you became disabled. This is called AOD, or alleged onset date. If you get approved for disability, you're given an EOD, or established onset date. This is the date on which it is determined that your disability actually began (according to the medical records).

Do you get disability benefits starting with your EOD? If your disability claim was for SSI, yes. If your disability claim was for SSDI (social security disability insurance), the answer is no. Social security disability claims are subject to a five month waiting period. That does not mean that you "wait" five months for benefits. It simply means that the social security administration confiscates (what else would you call it) five months of your benefits.

So, social security disability benefits (remember, we're talking about SSDI, not SSI) begin five months after your established onset date, or EOD. This is called your date of eligibility. But you don't actually do any waiting. They simply rob you of five months of your benefits.

When does medicare start for a social security disability recipient? Medicare starts two years after the date of eligibility, which is your date of entitlement.

Now to address an issue that can be confusing, if things aren't already. In some cases, depending on the claimant's established onset date, they will have to wait 2 years before receiving medicare. But...in other cases, if the onset date is pushed back, or established, far enough back, the two year period will already have been served by the time a social security disability claimant's case has been approved.

This is one reason why it can be important to have representation at a disability hearing----to get the most favorable onset date possible. Now (another potentially confusing wrinkle), how far back the onset can be established will depend on when a social security disability claimant filed an application. This is a limiting factor; however, SSDI benefits can be paid 12 months retroactive to the date of an SSDI application.

Also, if the medical evidence warrants, earlier applications for SSDI benefits that were filed by a claimant can be "reopened".

Aain, another reason to consider representation at the hearing level, since a competent and qualified claimant's representative (attorney or non attorney) will get for their client the best outcome possible---in other words a disability rep who's worth anything will work (via argument and obtaining the records) to not only win a claimant's case, but also establish the earliest possible onset date. Because "onset" doesn't affect just the size of the backpayment, it can affect medical coverage.



Return to the Social Security Disability SSI Benefits Blog




Other Posts

Social Security Disability SSI and Chronic Pain
How hard is it to find a lawyer for a social security disability or SSI claim?
Application for disability
Social security appeal

1 Comments:

Anonymous Anonymous said...

Thanks for your blog.
If one is already 64 years old when filing for SSDI, does that mean the "two year" period before becoming eligible for Medicare kicks in, which would otherwise be only one year, at age 65?
Sounds dumb, I know, but "leave no stone unturned."

9:29 PM  

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