Why Is There a Two-Year Waiting Period for Medicare for the Disabled?

Question:

Because of incompetent social workers in the local office, things were not handled right for my husband. So we are now waiting for his Medicare insurance. Thank God we did finally find the right advocate to help us with his disability. In March 2012 he went through lung cancer surgery and then November the same year brain cancer. He was approved for disability December 2013, EOD. Now we wait for Medicare. Who ever decided that in our government has no compassion for people. I do not expect an answer. But for sick people to wait 24 to 29 months for Medicare when they can no longer make a income is ridiculous.

Answer:

I'm sorry to hear of your husband's medical problems. I'm surprised your husband didn't get an earlier disability onset date, with two cancers in the same year (I think you're saying that your husband's established onset date of disability was in December 2013). Unfortunately, you're right, your husband will have to wait at least another year for Medicare coverage. There are two exceptions to this rule: those with permanent kidney failure (known as end-stage renal disease, or ESRD) and amyotrophic lateral sclerosis (ALS) aren't subject to the two-year waiting period. You would think that metastatic brain cancer and other life-threatening illnesses would also be on that short list, but unfortunately they are not.

Medicare was originally intended for those over 65, and when Medicare was expanded to include persons with disabilities, a very expensive expansion, the two-year waiting period was added as a cost-saving measure. When Congress expanded Medicare to those with disabilities, it was their hope that, during the two years of the waiting period, disability recipients could either continue under their former employers' plans under COBRA or qualify for Medicaid. If you've ever used COBRA, however, you know that the premiums are very high, especially for someone who no longer has earnings from work. Things may be a little more hopeful on the Medicaid front for some people. About a third of disability recipients receive Medicaid coverage during the waiting period.

In three-quarters of the states, Medicaid has a "medically needy" program, so that individuals with high medical expenses but too much income to qualify for the regular program can still qualify for Medicaid. In these states, Medicaid applicants can subtract their medical expenses from their income in order to meet that state's Medically Needy Income Limit (MNIL). (Read more about this in Nolo's article on Medicaid's medically needy program.)

Unfortunately, over a third of disability recipients don't have health insurance coverage at some point during the Medicare waiting period. And it can be argued that this is the population that needs medical care the most. Indeed, about 4% of disability recipients die while waiting for Medicare coverage.

Over the last several years, there have been legislative attempts to phase out the waiting period and/or to eliminate it immediately for those with life-threatening illnesses (in addition to ESRD and ALS). Unfortunately, these attempts haven't been successful, due to the high cost of phasing out and eliminating the waiting period, estimated by some to be about $10 billion per year.

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