All Social Security Disability recipients can receive Medicare coverage two years after the first month they are eligible for their monthly disability benefits. This does not mean that every individual who is approved for Social Security disability will necessarily have to wait two years for their medicare coverage, however, because if the claimant's established onset date is far enough back, much or all of the 24 month waiting period can potentially be "served" by the time a claimant gets a favorable decision. And, of course, there is the fact that many claims drag on in the system for longer than 24 or even 36 months.
To reiterate (because there usually seems to be a great deal of confusion as to when medicare coverage kicks in for approved SSD claimants:
Many individuals who become entitled to disability benefits at an administrative law judge hearing and they have a date of entitlement far in the past. For these individuals, Medicare entitlement may already be in place or they may have to wait a shorter time for medicare coverage because their entitlement date is in the past.
Why the two-year waiting period? Social Security has had this two-year waiting period in place (which, as we said, does not always mean necessarily having to wait two full years for medicare after a case has been approved) since Medicare became part of the disability process. Unfortunately, the waiting period was put in place as a cost saving measure, so it is very unlikely it will ever change.
Expedited Medicare
There are three exceptions to the two-year wait for Medicare. If you suffer from one of the following medical conditions, you can receive Medicare coverage sooner than normal:
- end-stage renal disease with kidney failure
- terminal illness with a life expectancy of six months or less and receiving hospice care, or
- amyotrophic lateralsclerosis (ALS).
Extra Help Program
For people with limited income and assets, Medicare offers "Extra Help" for prescription drug costs. This Extra Help covers the costs of a Medicare prescription drug plan -- including monthly premiums and prescription co-pays. The application is online at www.socialsecurity.gov/prescriptionhelp.
Medicare for SSI Recipients?
Do you get medicare coverage if you were approved for SSI? Claimants who are approved for SSI only typically receive medicaid coverage in most states. And like SSI, medicaid is subject to income and asset - resource limitations.
Can you ever get medicare if you get SSI? Medicare coverage for SSI recipients does not occur until an individual reaches the age of sixty-five if they were only entitled to receive monthly SSI disability benefits. At the age of sixty-five, these individuals are able to file an uninsured Medicare claim, which saves the state they reside in the cost of Medicaid coverage. Basically, the state pays the medical premiums for an uninsured individual so that their costs in health coverage provided through Medicaid goes down.
If an individual is concurrently receiving SSI and Social Security disability (some people receive both, based on their insured status, the amount of their social security benefits, and their assets/resources), they are entitled to Medicare coverage in the same two-year time frame as other Social Security disability beneficiaries.
