Why do I have to wait 24 months to get medical insurance on SSDI?

Recently on our legal forum a user asked, “I was approved for Social Security Disability Insurance (SSDI) benefits two months ago. I mainly requested benefits so I could get medical insurance. Now I am being told that I won’t qualify for Medicare for 24 months. Is this true? What am I supposed to do until I can get medical help?”

getting-disability-benefits

SSDI background information

Social Security Disability Insurance or SSDI is provided to workers who are disabled and cannot work for at least 12 continuous months. Workers must also have paid employment taxes and earned sufficient work credits to be considered insured for SSDI.

Another benefit of receiving SSDI benefits is that a worker will also qualify for Medicare benefits. In fact, for some workers the ability to receive affordable health care is more important than the wage replacement benefit offered through SSDI.

Why do workers have to wait 24 months for Medicare coverage?

Now, let’s take a look at your question. Medicare is a federal health insurance program for people who are 65 or older and for certain younger people with disabilities.

Medicare, however, was only made available to disabled workers beginning in 1972. At the time Congress expanded the program they were tasked with keeping the cost down. To accomplish this task and to avoid providing redundant healthcare benefits to workers who were already covered under a private insurance plan, they decided to limit a disabled worker’s right to receive medical insurance through Medicare until they had been receiving SSDI benefits for 24 months.

Note: exceptions to the 24 month waiting period have been made for workers who are diagnosed with ALS and for those suffering from end-stage renal disease.

What do I do for health coverage while I wait for Medicare?

Unfortunately, it’s estimated that up to 39% of SSDI recipients do not have health coverage while they are waiting for their Medicare benefits to start. The remaining participants will receive coverage from employment sponsored plans or may qualify for medical coverage under COBRA.

So what’s the solution? Unfortunately, congress has not developed a solution to the current problem, although different bills have been introduced at various times. As with other programs that might be beneficial, there is a huge cost to US taxpayers for eliminating the 24 month waiting period. In fact, it’s estimated it could costs upwards of $113 billion over ten years.

What do proponents of eliminating the waiting period suggest?

Other proponents of eliminating the waiting period argue that although the costs may seem high, it might actually be costing US taxpayers more in the long run as individuals forgo medical treatments, stop medications, and further compromise their health during the 24 month waiting period.

Bottom Line:

Unless you are covered under a private insurance plan, you are able to purchase COBRA, or you have sufficient savings to pay for medical care outright, you might have difficulty getting good medical care in the 24 months you have to wait for your Medicare benefits.

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