Disability and Medicare

(The following is a guest post from a former examiner and former claims rep)

Once your have won an allowance on your Social disability claim, you may expect to have health coverage through Medicare right away. However, this is not always the case--Medicare coverage for Social Security disability recipients does not begin for twenty four months after the first month the individual becomes entitled to receive a monetary disability benefit.

What affects Medicare insurance coverage entitlement dates? An individual’s date of entitlement may be affected by the five-month disability waiting period.

What is the five month disability waiting period? The five month disability waiting period is a five month period that begins with your date of onset or last date of work and ends with the last day of the fifth month following your disability onset.

Social Security never pays monetary benefits for these months. Consequently, your date of entitlement will be the sixth month following the five month disability waiting period. As you can see, this may cause an individual who is allowed for disability at the initial level to wait more than twenty four months from their disability onset to receive Medicare coverage, if you consider that there are five additional months that do not count toward the Medicare waiting period.

Of course, if an individual applies for disability benefits and their onset is in the past, they may have a date of entitlement in the past, which may allow for fewer months to actually wait once they have received an allowance for Social Security disability benefits. This is not a change in the two year Medicare waiting period--it just means that some of the waiting period months were prior to the actual disability allowance decision.

What about those individuals who are approved for Social Security benefits and are entitled to Medicare benefits immediately after winning their Social Security disability claim? Such persons, who are entitled to receive Medicare benefits at the time of their Social Security disability allowance, are those individuals who have had to go through the lengthy Social Security appeal process leading to an administrative law judge hearing. In other words, they have already waited many months for the hearing, consequently they have already satisfied the twenty four month waiting period for Medicare coverage.

Unfortunately, the disability process often takes more than two years from the initial level through the administrative law judge hearing, due to significant delays and backlogs at Social Security hearings offices across the nation.


Return to the Social Security Disability SSI Benefits Blog










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