28 Apr Medicare and SSDI Benefits
How does Medicare coverage work once you begin to receive disability benefits?
SSDI Qualification and Healthcare
When you have a mental or physical disability, having health care is essential. Those who qualify for Social Security disability insurance (SSDI) benefits can expect to receive health care through Medicare. However, this coverage does not begin immediately.
Medicare Coverage
Medicare coverage is generally available to two groups of people, those who are 65 or older, and those who receive SSDI benefits. Disability beneficiaries do not have to wait until they reach the age of 65 to start receiving Medicare, although there is a waiting period.
Once you are approved for SSDI benefits you are automatically enrolled in Medicare. After you have received disability benefits for 24 months, your Medicare coverage will begin. This two year waiting period is standard and only waived for those with ALS or end-stage renal disease.
Why Does the Waiting Period Exist?
The two year waiting period exists for financial reasons. In 1972, when congress voted to extend Medicare to those receiving SSDI, they created the waiting period. The idea behind it was that by delaying benefits they could manage the cost of coverage easier. While this waiting period is applied to almost all SSDI beneficiaries, some do not feel it is fair. Recently there have been politicians trying to remove or reduce the wait.
Unfortunately, until these changes are made, beneficiaries can expect to ensure the two year period. For Medicare coverage, your 24 month waiting period could be extended to 29 months, to include the 5 month waiting period for benefits- But this is not always the case. It depends on when the Social Security Administration (SSA) determines when your disability onset date is.
The Waiting Period Explained
The waiting period begins as soon as you are entitled to SSDI benefits. Similar to how the 5 month waiting period works for benefits, you can be entitled to SSDI before you are approved by the Social Security Administration (SSA).
For example, let’s say you had a disability beginning on January 1st, 2021. This disability prevents you from working and after five months of being unemployed you decide to apply for SSDI. In December of 2021, the SSA approves your application and deems you eligible for benefits. They will mark the start date of your disability as January 1st, 2021, and not the date that you submitted your application, because this is when you became medically entitled to benefits. Following this same idea, your Medicare waiting period would have also began on January 1st, 2021. Meaning, in this scenario, once the SSA approves you for benefits, you have already completed eleven months of your waiting period.
While it is a complicated process, benefierices can rest assured knowing that the time they spend waiting for the SSA to approve them for benefits will count towards their Medicare waiting period. After this waiting period, you will receive Medicare coverage. It is important to understand how to maintain your eligibility for coverage so that you do not risk losing it.
How Could I Lose Medicare Coverage?
Once you no longer qualify for SSDI, you could lose your Medicare coverage. The SSA does periodical checks on beneficiaries to see if they are still eligible for disability benefits. Factors that can make a person ineligible for SSDI could be an improvement in their condition, or an increase in earned income. Any change to a person’s situation that does not meet the SSDI qualifying criteria could result in a loss of benefits, and therefore a loss of Medicare coverage.
See: What are the SSDI qualification requirements?
However, there are some instances where you can begin working again without risking losing your benefits. The SSA offers a trial work period to beneficiaries. This program is meant to encourage disabled individuals to return to work. With the trial work period, you can return to a job and even earn over the SSDI income limit for nine months. At the end of the period, if you are able to maintain an income above the required limit, you will lose your SSDI benefits- But you may be able to keep Medicare coverage.
Even if you are no longer receiving SSDI, if you have a qualifying disability, you are able to continue to receive Medicare for 93 consecutive months. Once this time ends you are able to keep Medicare, at a cost, or wait until you turn 65 and then begin to receive it again.
Important to Note
-Medicare coverage is only available for those 65 and old, or those who receive SSDI. Supplemental Security Income (SSI) does not come with Medicare. In some states, SSI beneficiaries may receive Medicaid.
-Three months before your Medicare coverage begins, the SSA will send you your Medicare card. This card includes your name, Medicare number, and the dates that your Medicare parts A and B coverage will begin. Once your coverage begins, the SSA will deduct premiums from your benefits. Generally, Medicare Part A is a requirement for beneficiaries, and you will not have to pay for this coverage. Medicare Part B is optional to beneficiaries, technically you do not have to pay for it. Although, you choose to, the Medicare Part B premium in 2022 is $170.10 per month or a bit less.
Not Currently Receiving Benefits?
If you are not currently receiving SSDI benefits, consider contacting a disability attorney. An attorney will be able to answer any questions you may have about Social Security disability benefits and guide you through the claims process. Studies have shown that those who choose to hire legal representation for their SSDI claims are three times more likely to win benefits than those who do not
Victory Disability is a nationwide law firm. We specialize in helping disabled workers get the benefits that they have earned and deserve. To see if we can assist you, take our free evaluation by clicking here.