Jeffrey Wade
If you receive Social Security Disability Insurance (SSDI) benefits, there is a waiting period before you can access Medicare. This waiting period is typically two years, but there are exceptions. For instance, if you are diagnosed with amyotrophic lateral sclerosis (ALS) or end-stage renal disease (ESRD), the waiting period is waived, and you will receive Medicare coverage immediately. Similarly, if you are 65 years old during the waiting period, your Medicare benefits will start at that time. During the interim period, individuals can explore alternative healthcare coverage options such as Medicaid, COBRA, or the Health Insurance Marketplace.
| Characteristics | Values |
|---|---|
| Waiting period for SSDI benefits | 5 months |
| Waiting period for Medicare for SSDI recipients | 2 years |
| Waiting period waived for | End-stage renal disease (ESRD), Amyotrophic Lateral Sclerosis (ALS) |
| Alternative coverage during waiting period | Medicaid, COBRA, Health Insurance Marketplace |
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What You'll Learn
The 24-month waiting period for Medicare coverage
For those under 65 who receive Social Security Disability Insurance (SSDI) benefits, there is a 24-month waiting period before Medicare coverage begins. This waiting period is considered a qualifying period, during which beneficiaries may be eligible for alternative health insurance coverage.
The 24-month waiting period does not apply to everyone. For example, those with end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS) are exempt from the waiting period. In the case of ESRD, Medicare coverage can begin as early as the first day of the fourth month of dialysis treatment. If an individual completes a Medicare-approved training program for at-home dialysis, coverage can start from the first month of dialysis. For those with ALS, Medicare coverage begins as soon as SSDI benefits are received.
During the 24-month waiting period, individuals can explore alternative healthcare coverage options. These include Medicaid, the Consolidated Omnibus Budget Reconciliation Act (COBRA), and the Health Insurance Marketplace. Medicaid is a potential option for those with low incomes or those under 65 who are eligible based on disability. COBRA allows certain employees and their families to retain their group healthcare coverage after leaving employment, although individuals must pay the full cost of the premium. The Health Insurance Marketplace offers coverage options based on income and household size, and lower costs may be available depending on these factors.
It is important to note that the waiting period for Medicare coverage begins after the Social Security Administration (SSA) approves an application. Individuals can expect to receive their Medicare card for Medicare Part A (hospital insurance) and Medicare Part B (medical insurance) around three months before coverage starts.
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Applying for Medicaid during the waiting period
If you receive Social Security Disability Income (SSDI), you may have to wait 24 months for your Medicare coverage to begin. During this waiting period, you can apply for Medicaid coverage. You can apply for Medicaid in two ways: by creating an account or logging in to complete an application. When asked if you have a disability, answer "yes".
If you are turned down for Medicaid, you may be able to enrol in a private health plan through the Marketplace while waiting for your Medicare coverage to start. You may qualify for lower costs on Marketplace coverage based on your income and household size. When asked about your income on your Marketplace application, be sure to include your SSDI income.
If you are waiting for a disability status decision, it is important not to assume that you will get SSDI. When estimating your income on the Marketplace application, do not include SSDI payments you think you may get. If you get a positive disability decision, you may have to wait 24 months before Medicare coverage starts. If you get a negative disability decision, you can fill out a Marketplace application to apply for coverage.
Medicare has two parts: Part A and Part B. Most people do not have to pay for Part A, which is hospital insurance. Most people pay monthly for Part B, which is medical insurance. If you are under 65, continue to have a disabling impairment, sign up for Premium Hospital Insurance (Part A), have limited income, and have resources worth less than $4,000 for an individual and $6,000 for a couple (not counting your home, one car, and certain insurance), you may be eligible for help with your Medicare Part A premiums.
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The 5-month waiting period for SSDI benefits
If you receive Social Security Disability Insurance (SSDI), you may have to wait 24 months for your Medicare coverage to begin. During this period, you can apply for Medicaid coverage. Alternatively, if you are turned down for Medicaid, you can enrol in a private health plan through the Marketplace.
There is a five-month waiting period for SSDI benefits. This means that the Social Security Administration (SSA) will hold your first five months of benefits. The SSA will pay your first benefit in the sixth full month after the date they determine your disability began. For example, if the SSA awards benefits on February 1st, they will be dispersed in July. The date that the applicant can begin receiving benefits is known as the date of entitlement.
The five-month waiting period exists to ensure that the SSA is not paying benefits to people whose disabilities end up not being long-term. This rule only applies to SSDI, not SSI. If your disability results from amyotrophic lateral sclerosis (ALS), there is no waiting period if you were approved for benefits on or after July 23, 2020.
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Waivers for ALS and ESRD patients
People diagnosed with End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS), also called Lou Gehrig's disease, may be eligible for Medicare coverage, even if they are younger than 65 years of age.
For those with ALS, Medicare eligibility begins as soon as they start receiving Social Security Disability Insurance (SSDI) benefits. Previously, there was a five-month waiting period for SSDI benefits, but this was eliminated in late 2020.
Individuals with ALS can receive SSDI benefits sooner than some other younger people with disabilities. They will be eligible for SSDI five months after being declared disabled by a healthcare provider.
For those with ESRD, Medicare eligibility typically begins on the first day of the fourth month of dialysis treatment. However, if an individual opts for home dialysis, they may be eligible for Medicare coverage as early as the first month of dialysis.
If a person with ESRD receives a kidney transplant, their Medicare coverage will generally end three years after the transplant. However, if they require additional medical services related to ESRD, they may become eligible for Medicare again.
It is important to note that Medicare Part A has no premium for most enrollees, but Medicare Part B does have a monthly premium. Enrollees can choose to select only Medicare Part A, but it is essential for people with ESRD to enrol in both parts to receive full benefits, including coverage for certain dialysis and kidney transplant services.
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Marketplace plans as supplemental insurance
Marketplace plans are a great way to get health insurance for individuals, families, and small businesses. The Health Insurance Marketplace is a one-stop shop to compare and enrol in a health insurance plan. It offers a range of plans with different benefits and restrictions to cater to varied needs.
Supplemental insurance can be a useful addition to your Marketplace plan, helping to cover some of the out-of-pocket costs that come with lower metal-tier plans. For example, accident insurance, critical illness insurance, cancer insurance, and fixed-indemnity insurance can all help to reimburse you for unexpected medical expenses. These supplemental plans can be especially useful if you have a significant medical event that requires you to meet a high deductible.
The Small Business Health Options Program (SHOP) Marketplace, for instance, helps small businesses provide health coverage to their employees. It offers flexibility, choice, and online application and account management.
Marketplace plans also have essential health benefits that are minimum requirements. These include routine health care, such as screenings, check-ups, and patient counselling to prevent illnesses. Some plans also offer additional benefits, such as vision care, and medical management programs for specific needs.
Additionally, you can use a tax credit to lower your monthly insurance payment when enrolling in a Marketplace plan. This tax credit is based on your income estimate and household information provided in your Marketplace application.
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Frequently asked questions
SSDI, or Social Security Disability Insurance, has a 5-month waiting period between when your application is approved and when your benefits start. This is separate from the Medicare waiting period.
During the SSDI interim medical waiting period, individuals can find alternative healthcare coverage through Medicaid, COBRA, or the Health Insurance Marketplace.
Yes, there is a 2-year waiting period for most individuals before their Medicare coverage begins. However, there are exceptions for people with certain severe health conditions such as end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS).
SSDI is Social Security Disability Insurance, which provides benefits to those who are unable to work due to a disability. Medicare is a health insurance program that provides coverage for individuals over the age of 65 or with certain disabilities.
Yes, you may be able to enroll in a private health plan through the Marketplace while waiting for your Medicare coverage to start. You may qualify for lower costs on Marketplace coverage based on your income and household size.
