Overview of Disability
Disability Back Pay
Requirements for Disability
Applications for disability
Tips and Advice for Disability Claims
How long does Disability take?
Winning Disability Benefits
Common Mistakes after a Denial
Mental Disability Benefits
Denials for Disability
Appeals for denied claims
Disability Benefits from SSA
Child Disability Benefits
Qualifications and How to Qualify
Working and Disability
Disability Awards and Notices
Disability Lawyers, Hiring Attorneys
Social Security List of Conditions
What Social Security considers disabling
Medical Evidence and Disability
Filing for Disability Benefits
Eligibility for Disability Benefits
SSD SSI Definitions
SSDRC authored by Tim Moore
Ask a question, get an answer
Do I automatically receive Medicare benefits if I'm approved for disability benefits?
You will not receive medicare benefits if you are approved for title 16 disability benefits. Title 16 is another way of saying SSI, or supplemental security income, disability. SSI recipients receive medicaid benefits and these benefits may vary from state to state. Typically medicaid will provide for a specified number of physician visits per year, as well as a specified number of medication prescriptions per month.
If you are approved for title 2 disability benefits (social security disability insurance, or SSDI), then you will receive medicare. However, there are some unfortunate restrictions that concern just when a person who is eligible to receive SSDI benefits may access their medicare coverage.
It is commonly reported that a person has to wait for 24 months before they can use their medicare coverage. However, saying it this way is a bit misleading. It is more accurate to say that in the SSA (the social security administration) disability system, medicare begins 24 months from the month that a beneficiary became entitled to receive their SSDI monthly benefits.
What does this mean exactly? Simply this: if a person files an application for disability, they claim something known as an AOD, or alleged onset of disability. This is the date that they presume that they became disabled.
Do their disability benefits begin from this date? Not exactly. Depending on the level the claim is currently at--it depends on the judge (administrative law judge) or the disability examiner determining when the claimant's condition became disabling. This is done according to the social security administration definition of disability. This determination is based on a review of the claimant's work history and medical treatment history and the analysis provides for something known as an EOD, or established onset of disability.
So, back to the crux of the matter, when does medicare start? Basically---
1. You start with the EOD, the date given for when the claimant's disability is thought to have begun, based primarily on the medical records.
2. Add five months to this date. Why five months? This is known as the five month waiting period. This 5 month waiting period only applies to SSDI, not SSI, and it essentially takes away five months of benefit payments to anyone who is approved for SSDI benefits. Why does it exist? Possibly because of the supposition that some claimants may already have long term disability insurance coverage. However, the simple truth, when it all comes out in the wash, is that this is simply a cost-savings device for the federal government.
3. The established date of onset (EOD), plus the five month waiting period, gets you to a date that is considered the month of entitlement. This is actually the first month in which an SSDI applicant is eligible to receive monthly disability benefits. If a claimant's established date of onset is set far enough back to allow for back pay (months for which the social security administration owes claimants money), then this is the time from which back pay would be calculated.
4. Twenty-four months after the month of entitlement is when medicare coverage begins.
If this sounds like a very long wait...it can be. However, because a disability case can literally drag on for years before a person is eventually approved for disability benefits, a few things often happen.
1. The claimant is usually owed back pay. Often significant amounts of back pay.
2. Very often, the five month waiting period has already been served out so that the approved individual can immediately begin receiving disability benefits.
3. Often as well, the 24 month waiting period will have been served out as well, meaning that access to medicare can be obtained quickly after the case has been concluded.
Return to: Social Security Disability Resource Center, or read answers to Questions
If You Get Approved For SSDI Will You Also Get Medicare?
If you are applying for Social Security disability when does Medicare start?
Do I automatically receive Medicare benefits if I'm approved for disability benefits? (not SSI)
Social Security Disability Health Coverage
Do you get medical healthcare benefits with Social Security disability?
The Social Security Medicare 24 Month Waiting Period
How do you get meds in the two wait for Medicare after an Approval for Disability?
Does Social Security disability pay for medicine prescriptions?
Why doesn't Social Security Disability provide automatic medical care when SSI does?
Do you get medical health care coverage with SSI?
Information on the following topics can be found here: Social Security Disability Questions and in these subsections:
Frequently asked questions about getting Denied for Disability Benefits | FAQ on Disability Claim Representation | Info about Social Security Disability Approvals and Being Approved | FAQ on Social Security Disability SSI decisions | The SSD SSI Decision Process and what gets taken into consideration | Disability hearings before Judges | Medical exams for disability claims | Applying for Disability in various states | Selecting and hiring Disability Lawyers | Applying for Disability in North Carolina | Recent articles and answers to questions about SSD and SSI
These pages answer some of the most basic questions for individuals who are considering filing a claim.
Filing for disability - How to file for SSD or SSI and the Information that is needed by Social Security
How to Apply for Disability - What medical conditions can you apply and qualify for?
Applying for Disability - How long does it take to get Social Security Disability or SSI benefits?
What happens if I file a disability application and it is denied by a disability examiner or Judge?
How to Prove you are disabled and qualify to win disability benefits
How do you prove your disability case if you have a mental condition or impairment?
Social Security Disability Back pay and How Long it Takes to Qualify for it and receive it
Social Security Disability SSI - Eligibility Requirements and Qualifications Criteria