Do you get medical healthcare benefits with Social Security Disability?

Social Security offers healthcare benefits through the Medicare health insurance program. Medicare is available to individuals age 65 and older, disability beneficiaries, and individuals with end state renal disease that requires dialysis or a kidney transplant.

The different parts of Medicare

Medicare insurance consists of two major parts. Part A is hospital insurance and Part B is medical insurance. Medicare Part A is free to an eligible beneficiary; however Part B is paid for through monthly premium deductions or payments.

Medicare also offers two other programs used in conjunction with Part A and B. Medicare part C (also known as Medicare Advantage) plans allow an individual to choose to have all their health care services through an insurance provider. Medicare part C plans help some beneficiaries lower their medical costs and for a monthly fee they may get some additional benefits.

Lastly, Medicare offers a Part D to help with prescription drug coverage. Part D coverage is voluntary and it is paid for by monthly premiums. If an individual meets certain means testing (eligibility ) requirements, they may be eligible for a subsidy that helps offset the cost of Part D coverage. Additionally, some disability and retirement beneficiaries may be eligible for help in paying their Medicare part B premiums provided that they meet income limits.

The Medicare Waiting Period

Unfortunately, Social Security Disability beneficiaries have a Medicare waiting period that in most cases must be served before they are eligible for healthcare coverage. Medicare has a twenty-four month qualifying period, or waiting period, for health coverage. The twenty-four month period begins with the first month that an individual is eligible to receive a monthly monetary disability benefit.

For example, if an individual is entitled to receive Social Security Disability benefits starting in March of 2021, they will not be entitled to Medicare healthcare coverage until March 2023.

While this seems like a long time, many Social Security Disability beneficiaries do not notice the wait so much, because they were approved for disability benefits at an administrative law judge disability hearing. Due to the long wait for disability hearings and the decisions following them, many have either served a good portion or even the entire Medicare qualifying period by the time that they are approved for disability benefits.

Even if an individual is approved at their initial disability claim, they may have served twelve months of their waiting period. Social Security allows a twelve month retroactive disability benefit period that begins with the date of filing. If a disability beneficiary was unable to work for seventeen months prior to filing for disability, they may be entitled to the entire twelve month period of retroactive benefits.

This means they have already served a year of the Medicare qualifying period. Still other individuals may have their Medicare qualifying period lessened if they have had other periods of disability entitlement, or, in some cases, SSI disability entitlement.

Special Rules

Special rules apply to:

1. Social Security beneficiaries who receive their Medicare benefits on the basis of end stage renal disease requiring a course of dialysis. They are entitled to Medicare insurance benefits the first day of the third month following the month they began dialysis. For example, if an individual began their dialysis on May 15, 2021 they would be entitled to Medicare benefits as of 8/01/2021.

2. Individuals who have kidney transplants are entitled to Medicare benefits the month they receive their kidney transplant.

3. Individuals who have Lou Gehrig's disease (amyotrophic sclerosis) get their Medicare benefits the first month they are entitled to receive their disability benefits.

Still other Social Security Disability beneficiaries may be eligible for healthcare benefits through the Medicaid health coverage program during their twenty four-month waiting period provided they meet the income and resource limits of the Medicaid program. This is true especially true for disability beneficiaries who are entitled to SSI disability or who are entitled to both SSI and Social Security Disability.

Individual states set the rules and guidelines for their Medicaid programs, consequently coverage may differ from state to state.

About the Author: Tim Moore is a former Social Security Disability Examiner in North Carolina, has been interviewed by the NY Times and the LA Times on the disability system, and is an Accredited Disability Representative (ADR) in North Carolina. For assistance on a disability application or Appeal in NC, click here.

Most popular topics on

Social Security Disability in North Carolina

Common Mistakes to avoid after being denied for Disability

Tips to Prepare for Filing for Social Security Disability or SSI

Advice to Win SSD and SSI Benefit Claims

Social Security Disability SSI Questions

What is the difference between Social Security Disability and SSI?

How to get disability for depression

Getting disability for fibromyalgia

SSI disability for children with ADHD

What is the Application Process for Social Security Disability and SSI?

Social Security Disability SSI Exam tips

More Social Security Disability SSI Questions

What makes you eligible for Social Security Disability or SSI?

Related pages:

Disability lawyers in North Carolina
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?
Can I file for SSI online?
SSI Back Pay after being Approved
Will I qualify for Social Security Disability SSI in California
Getting a Social Security Disability SSI Attorney in California
How long do disability claims take in California and why