Medicare Waiting Period

The 24 Month Medicare Waiting Period for SSDI Beneficiaries

Generally, SSDI beneficiaries under age 65 are eligible for Medicare coverage in the month after they have received 24 months of SSDI benefits. There is also an additional 5 month waiting period from onset of disability for disabled individuals to qualify and receive SSDI benefits. This results in a total of 29 months after the onset of the disability before an individual is eligible for Medicare benefits. The usual 24 month waiting period for Medicare has been eliminated for SSDI recipients diagnosed with Lou Gehrig's Disease (ALS) and individual's diagnosed with end-stage renal disease or kidney failure.

Legislative History

In 1971, the House Committee on Way and Means Report recommended extending Medicare coverage to the disabled and stated that the Committee felt it was "imperative to proceed on a conservative basis." The Report went on to state that the 24 month waiting period was intended to:

....help keep the costs within reasonable bounds, avoid overlapping private health insurance protection, particularly where a disabled worker may continue his membership in a group insurance plan for a period of time following the onset of his disability and minimize certain administrative problems that might otherwise arise...Moreover, this approach provides assurance that the protection will be available to those whose disabilities have proven to be severe and long lasting."

The Social Security Amendments of 1972, P.L. 92 - 603, extended Medicare to disabled people who had been entitled to SSDI benefits for at least 24 consecutive months. The provision required the waiting period to begin with the first month of SSDI entitlement, which is 5 months after the onset of the disability.

Health Insurance During the 24 Month Waiting Period

There are other programs that may provide health insurance during the 24 month waiting period.

Medicaid

Certain SSDI beneficiaries who have limited assets and resources may also qualify for Supplemental Security Income ("SSI") benefits. Under SSI, disabled, blind, or aged individuals who have low incomes and limited resources are eligible for benefits regardless of their work histories. In most states eligibility for SSI benefits will entitle a person to Medicaid benefits. These benefits begin the month after the SSI application was filed.

COBRA

Title X of the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA, P.L. 99 - 272) requires employers who offer health insurance to continue coverage for persons who would otherwise lose coverage due to a change in work or family status. Coverage generally lasts 18 months but, depending on the circumstances, can last for longer periods. If SSA makes a determination that the date of an individual's onset of disability occurred during the first 60 days of COBRA coverage or earlier, the individual is eligible for an additional 11 months of continuations coverage. This equates to a total of 29 months from the date of the qualifying event. This provision was designed and intended to provide a source of coverage and protection while individuals wait for Medicare coverage to take effect.

Other Programs

SSDI beneficiaries may qualify for other government programs including Veterans' programs for hospital and medical care.

The Future

There have been several proposals and bills introduced that have tried to reduce or end the Medicare waiting period. The Ending the Medicare Disability Waiting Period Act of 2009, hoped to phase out Medicare's two-year waiting period over a 10 year span. The phase out initially would have reduced the wait to 18 months, and then reduce the wait by 2 months every year over a 10 year period. The bill would have also immediately eliminated the wait for people with life-threatening illnesses as determined by the Secretary of Health and Human Services. The proposed legislation also required the HHS Secretary, when compiling the list of life-threatening diseases, to consult the Social Security Administration's Compassionate Allowance list, which was created to provide benefits quickly to applicants whose medical conditions are so serious that their conditions obviously meet disability standards. While the Act never came into fruition, there is still some interest by members of Congress and in lobbying circles with revisiting the issue of Medicare waiting periods.