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How to file for disability, Filing for SSI
Disability Requirements, Disability Status
How long is the wait?, Disability Application
The Social Security List of Impairments
Qualifying for Disability, Mental Disability
Disability Lawyer Info, Disability Back Pay

Social Security Disability in California & the two year waiting period for Medicare Benefits



 
A great many claimants in California go without proper access to medical care at the very time:

1. their condition has become disabling

AND

2. they are trying to document their condition for the social security administration (difficult to do if you can't get seen by a doctor and get medical records generated).

Here's a quote from emphysema.net:

"Before they can get Medicare coverage, people with disabilities must first receive Social Security Disability Insurance (SSDI) for 24 months. But SSDI generally does not begin until five months after an individual’s disability has been certified. As a result, people with disabilities face three consecutive waiting periods prior to getting health coverage: (1) a determination of SSDI approval from the Social Security Administration; (2) a five-month waiting period to receive SSDI; and, (3) another 24-month waiting period to get Medicare coverage"

The quoted information is essentially accurate, but it's still potentially misleading to say that you actually wait 5 months for benefits and it's misleading also to refer to the medicare situation as a "two year wait" because in some cases by the time a person has been approved for disability benefits, the two year requirement for medicare will already have been served.

How is this? Well, here's how it works: when you file for disability, you allege an onset date for your disability. That is, you state when you think you became disabled. This is called AOD, or alleged onset date. If you get approved for disability, you're given an EOD, or established onset date. This is the date on which it is determined that your disability actually began (according to the medical records).

Resources:

1. Social Security Disability Medicare Health Coverage
2. Do I automatically get Medicare if I'm approved for disability?
3. If you are applying for Social Security Disability when does Medicare start?
4. Disability and Medicare- how does it work?


Do you get disability benefits starting with your EOD? If your disability claim was for SSI, yes. If your disability claim was for SSDI (Social Security Disability insurance), the answer is no. Social Security Disability claims are subject to a five month waiting period. That does not mean that you "wait" five months for benefits. It simply means that the social security administration confiscates (what else would you call it) five months of your benefits.

So, Social Security Disability benefits (remember, we're talking about SSDI, not SSI) begin five months after your established onset date, or EOD. This is called your date of eligibility. But you don't actually do any waiting. They simply rob you of five months of your benefits. When does medicare start for a Social Security Disability recipient? Medicare starts two years after the date of eligibility, which is your date of entitlement.

Now to address an issue that can be confusing, if things aren't already. In some cases, depending on the claimant's established onset date, they will have to wait 2 years before receiving medicare. But...in other cases, if the onset date is pushed back, or established, far enough back, the two year period will already have been served by the time a Social Security Disability claimant's case has been approved.

This is one reason why it can be important to have representation at a disability hearing----to get the most favorable onset date possible. Now (another potentially confusing wrinkle), how far back the onset can be established will depend on when a Social Security Disability claimant filed an application. This is a limiting factor; however, SSDI benefits can be paid 12 months retroactive to the date of an SSDI application.

Also, if the medical evidence warrants, earlier applications for SSDI benefits that were filed by a claimant can be "reopened".

Aain, another reason to consider representation at the hearing level, since a competent and qualified claimant's representative (attorney or non attorney) will get for their client the best outcome possible---in other words a disability rep who's worth anything will work (via argument and obtaining the records) to not only win a claimant's case, but also establish the earliest possible onset date. Because "onset" doesn't affect just the size of the backpayment, it can affect medical coverage.








Essential Questions

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Can you work while getting or applying for Disability?

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Tips for getting Social Security Disability or SSI benefits approved

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Receiving a Disability Award Letter

Conditions Social Security will recognize as a disability

Previously answered questions regarding SSD and SSI

Applying for disability in your state



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SSD and SSI applications in California

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For the sake of clarity, SSDRC.com is not the Social Security Administration, nor is it associated or affiliated with SSA. This site is a personal, private website that is published, edited, and maintained by former caseworker and former disability claims examiner, Tim Moore, who was interviewed by the New York Times on the topic of Social Security Disability and SSI benefits in an article entitled "The Disability Mess" and also by the Los Angeles Times on the subject of political attempts to weaken the Social Security Disability system.

The goal of the site is to provide information about how Social Security Disability and SSI work, the idea being that qualified information may help claimants pursue their claims and appeals, potentially avoiding time-consuming mistakes. If you find the information on this site helpful and believe it would be helpful to others, feel free to share links to its homepage or other pages on website resource pages, blogs, or social media. Copying of this material, however, is prohibited.

To learn more about the author, please visit the SSDRC.com homepage and view the "about this site" link near the bottom of the page.