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.
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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These pages answer some of the most basic questions for individuals who are considering filing a claim.
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