Social Security Disability Resource Center

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Social Security Disability Medicare Health Coverage

Social Security disability beneficiaries will not in some cases receive Medicare insurance coverage immediately upon being approved for disability benefits. Unfortunately, Social Security disability beneficiaries have a two year waiting period for Medicare disability health coverage that begins with the first month they are eligible for monthly disability benefits.

Not only is there a wait of two years for health coverage, the waiting period does not begin with the month they became disabled but the month they are eligible to receive a monetary benefit. For some Social Security disability beneficiaries the additional five month Social Security waiting period just prolongs the wait for health coverage.

However, there are some mitigating factors that can can often ease the effect of the twenty-four month Medicare waiting period.

When do you not have to actually wait two years for medicare health coverage?

If a beneficiary is approved at an administrative law judge disability hearing their date of entitlement is usually determined to be in the past. This is because, by the time a decision at a disability hearing has been made, 2-3 years have often passed from the time an application for disability was initially filed.

Thus, many beneficiaries have already waited more than twenty-four months to get to their hearing. As a result, their twenty-four month Medicare waiting period has already passed when they are approved for disability and they begin to receive medicare immediately.

Even if a beneficiary is approved at the initial disability claim level. or reconsideration appeal level, they may still have served a good portion of the twenty-four month Medicare waiting period. This is because Social Security disability beneficiaries are allowed twelve months retroactive entitlement if they have not worked for at least seventeen months prior to filing for disability.

With an entitlement date twelve months in the past, disability applicants serve a good portion of their Medicare insurance waiting period by the time they are approved for disability. The twenty-four month Medicare waiting period most adversely affects disabled individuals who are approved for disability at the initial disability claim level and have worked up to the date they filed for disability benefits—meaning that, in those cases, there has not been an extended period of time between applying for disability and actually getting disability benefits.

What are the Medicare entitlements and what do they cover?

The Medicare insurance program offers two major health coverage entitlements: Medicare part A and B, along with more recent additions part C and D. Medicare Part A is free coverage that covers some of the expenses incurred during a hospitalization, while Medicare Part B is meant to cover doctor visits both in and out of the hospital as well as some types of testing.

Medicare Parts C and D were put in place to help with prescriptions and to provide a way for Medicare recipients to pay expenses not paid by Medicare part B. It is important to remember Medicare is a twenty / eighty insurance policy at best; this means that Medicare beneficiaries may left owing twenty percent of their bill if they only have Medicare Part A and B.

Medicare Part B, C, and D have premiums that can be deducted from a disability beneficiary’s monthly disability benefits.

Social Security works with many insurance companies to help provide more cost effective coverage for disability beneficiaries. Some disabled individuals may qualify for a subsidy that offsets the cost of their Medicare part C and D. Others may be eligible for help paying their part B Medicare premiums through their local Social Service offices.

Health coverage for individuals receiving SSI Disability

Those who receive SSI only do not receive medicare. Supplemental Security Income disability (SSI) beneficiaries are entitled to receive Medicaid health coverage immediately. They have no waiting period for health benefits. Medicaid for disabled adults generally (we say generally because Medicaid eligibility and coverage can differ from state to state) provides for hospitalizations, some testing, a minimum number of doctor's visits per year, and a minimum number of medication prescriptions per month.

While most Social Security disability beneficiaries are not eligible for Medicaid for the entire two year waiting period for Medicare health coverage, they may be entitled to receive Medicaid for the five month waiting period (that applies to social security disability) or even longer if they are concurrently entitled to receive both Social Security disability and SSI disability benefits.

Some Social Security disability beneficiaries have monthly disability benefits that are lower than the SSI maximum monthly disability benefit amount; making them potentially eligible for monthly SSI disability benefits provided they meet income and resource requirements.

  • What medical conditions will get you approved for disability?

  • What kind of Mental Problems Qualify for Disability?

  • Which conditions will social security recognize as a disability?

  • Tips for getting Social Security Disability or SSI benefits approved

  • SSDRC Homepage:

    Social Security Disability and SSI Resource Center

    The Most Basic questions about Getting Disability Benefits

    Social Security Disability SSI and whether or not you can work

    Common Mistakes to avoid after being denied for Disability

    Social Security Disability SSI Questions and Answers

    More Social Security Disability SSI Questions and Answers

    Common Questions about Social Security Disability and SSI

    Winning Social Security Disability or SSI Benefits

    The SSI Disability Benefits Program

    Medical exams for disability claims

    Applying for Disability in various states

    Social Security Disability SSI and Doctors - Yours and Theirs

    Social Security Disability and SSI Claim Reviews

    Social Security Disability SSI System and Benefits for Children

    Denials, Appeals, and Getting a Disability Lawyer or Representative

    What you should know about Social Security Disability and SSI Denials

    Questions about Disability Lawyers and Hiring a Disability Attorney

    Frequently asked questions about getting Denied for Disability Benefits

    FAQ on Disability Claim Representation

    Disability hearings before Judges

    Selecting and hiring Disability Lawyers

    Various Types of Benefits including SSI, Mental, and Child benefits

    Social Security and SSI based on Mental Disability

    Social Security Disability or SSI Benefits for Children

    Disability Benefits through Social Security

    Filing for Social Security Disability or SSI Benefits

    Social Security Disability SSI: Medical Evidence and Records

    Filing your claim for disability benefits

    Eligibility for receiving disability benefits

    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

    Resources on this site

    Social Security Disability, SSI Terms and Definitions

    Previously answered questions regarding SSD and SSI

    For Individuals living in North Carolina

    Applying for Disability in North Carolina

    North Carolina Disability Lawyer

    Related pages:

    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?
    Eligibility for disability with ADHD
    If you apply for disability in New Mexico
    Getting a Disability Lawyer in New Mexico

    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?
    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