Social Security Disability Insurance (SSDI or SSD) provides monthly benefit payments to people who earned the required number of work credits and suffer from a disabling physical or mental impairment. But no immediate health insurance coverage is provided for most SSD recipients until after 24 months.
London Eligibility Disability advocates want every one of our clients to understand their SSD benefits completely, including what is not covered by the SSD program. This blog post will explain how Medicare kicks in after 24 months for most recipients, why the health insurance coverage is delayed, and what other sources of health insurance coverage might be available during your two-year Medicare waiting period. Contact an experienced SSD lawyer or SSD and SSI advocate at London Eligibility for more details.
Medicare’s 24-Month Waiting Period
It is surprising to many SSD applicants and benefit recipients that Medicare will not cover their healthcare costs until they have been eligible for SSD benefits for 24 months. It seems like any government program that pays monthly benefits based on a recipient’s disability would logically include healthcare insurance as well.
The only exceptions to the 24-month waiting period are people whose disability is amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s Disease, or end state renal disease (ESRD). The ALS patients receive Medicare coverage immediately and the ESRD sufferers are enrolled after three months of dialysis treatment.
The Social Security Administration (SSA) implemented the 24-month Medicare waiting policy for several reasons:
1). Medicare Trust Fund Preservation: The most recent financial analysis of Medicare funds indicates that the Medicare Part A funding will be depleted by 2026. Expanding Medicare coverage to every SSD recipient immediately upon approval of their benefits was thought to be too draining of limited resources.
2). Short Term Disability: The second reason given for the 24-month delay in Medicare coverage for SSD claimants is the frequency of impairments improving over time, sometimes much faster than expected. No one whose disability is expected to resolve in less than a year is eligible for SSD. The risk of expending Medicare funds on those whose disability might not be permanent further motivated the 24-month waiting period.
Insurance Options During the 24-Month Medicare Waiting Period
Several other sources of healthcare insurance are available to Social Security Disability benefit recipients. Some of the programs are employment-related and others are based on financial need. A partial list of alternative insurance sources includes the following:
State Worker’s Compensation
The Social Security Disability Insurance program pays benefits to disabled people who worked at least long enough to accumulate the work credits necessary to qualify for the program. The fact that all SSD recipients worked before they were disabled means that a high number of SSD recipients suffered work-related injuries or illnesses. For those SSD benefits recipients, state worker’s compensation benefits provide payments for any healthcare or medical expenses incurred because of the work-related injury or illness. Unfortunately, worker’s comp does not cover costs for any healthcare required for non-work-related illness or injury.
Supplemental Security Income (SSI)
Social Security Disability claimants whose disabling impairment is not related to their prior employment, may be eligible for Supplemental Security Income (SSI). Unlike the SSD program, SSI is a needs-based program that pays monthly benefits to low-income disabled persons who have limited financial resources. The SSI program provides immediate Medicaid coverage to all benefit recipients.
You may be eligible to collect both SSD and SSI benefits at the same time. Others SSD applicants qualify for SSI during the months they are waiting for the decision on their SSD application. As long as an SSI claimant’s countable income and resources remain within the program limits, SSI-based Medicaid will continue.
Medicaid coverage can be available even for those not eligible for SSI. Each state has the freedom to decide its eligibility criteria regarding Medicaid coverage, especially since the Affordable Care Act (Obamacare) expanded coverage parameters. Since SSD income eligibility is set higher than the SSI program limits, a person may be eligible for SSD but not SSI. That will require them to seek Medicaid coverage without SSI.
State Health Insurance Marketplace
If you are applying for or receiving SSD benefits and you are not eligible for worker’s compensation, SSI, or Medicaid, there are other options for healthcare insurance.
The Affordable Care Act (ACA) Marketplace in each state offers subsidized, discounted health insurance policies that may be affordable. There are various levels of coverage available, hopefully with at least one within your ability to pay. You can get help navigating the available policies by going to your state’s healthcare.gov website.
Employment Continuing Coverage
Even if your disabling impairment is not work-related, some employers will continue your company-paid health insurance coverage for a time following your stopping work. Following that, the government requires your company insurance provider to offer to continue the policy at the group rate available to your employer, but entirely at your expense. This proves to be a prohibitively expensive option for most people.
London Eligibility wants to answer all your questions about insurance and assist you in finding a resource that may apply to your individual case. We are here to help.