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.
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.
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