How Long Does It take to Get Medicare Coverage Through Social Security Disability (SSD)?
You have to wait two years after you are entitled to disability benefits to get Medicare unless you fit into an exception.
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 Medicare coverage, however, as you'll see below.
When Medicare Starts
In general, the two-year waiting period for Medicare is calculated from your date of SSDI entitlement—when you are eligible to start receiving monthly benefits. This is usually the date your disability began, plus five months (due to the five-month waiting period for SSDI). (For more information on calculating your date of entitlement, our article on disability onset and backpay.)
But if your disability onset date is far enough back, you may have already "served" much or all of the two-year waiting period by the time you get a favorable decision (approval of benefits) from Social Security. (For some claims that go through the appeal process to a hearing in front of an administrative law judge, it can take one to two years to get a disability decision.)
However, your onset date for payment purposes can only be 17 months before your application date—that's because Social Security allows a maximum of 12 months of retroactive benefits. (This maximum gets you to 12 months before your application date, plus five months for the waiting period, so your earliest your effective onset date can be is 17 months before the application date.) In this case, the earliest that you can become eligible for Medicare is one year after you apply for Social Security disability. But for disability applicants who apply for benefits only when they become disabled, and not before, the date that their Medicare coverage will start is more likely to be two years and five months after they apply for disability.
Why the two-year waiting period for Medicare? Social Security has had this two-year waiting period in place since Medicare became part of the disability process. The waiting period was put in place as a cost-saving measure, so it is very unlikely it will ever change.
Exceptions to the Two-Year Waiting Period for Medicare
There are a couple of exceptions to the two-year wait for Medicare. If you suffer from one of the following medical conditions, you can receive expedited Medicare coverage sooner than normal:
- End-stage renal disease (ESRD) with kidney failure. If you require ongoing dialysis or a kidney transplant, Medicare coverage can begin the third month after the month in which your dialysis began.
- Amyotrophic lateral sclerosis (ALS). Individuals with amyotrophic lateral sclerosis (ALS) qualify for Medicare as soon as they are eligible to receive disability benefit payments.
Learn more about the Medicare that comes with disability benefits.
Medicaid in the Interim
Those with low income and low assets may qualify for the Medicaid program during the two-year waiting period for Medicare. States set their own rules regarding Medicaid eligibility, but those granted SSI at the same time as SSDI automatically qualify for Medicaid.
While Medicare covers hospice for those who are expected to pass within six months, the waiting period prevents many with a terminal illness from using Medicare for hospice needs. However, all 50 states' Medicaid programs cover hospice for those with low income and low assets. States may vary on the length of hospice coverage they provide and the amount of inpatient care that's covered.
For more information on Medicaid eligibility, see the Medicaid section on Nolo.com.