How Social Security Disability Benefits Link with Medicare

A health insurance policy is essential if you have a disability. The fortunate thing is that you become qualified for Medicare after collecting Social Security Disability Insurance (SSDI). However, before fully benefiting from this insurance, you will have to wait for some time.

The government Medicare program is primarily designed for seniors aged 65 and above but is also accessible to disabled young adults. Most Social Security Disability Insurance (SSDI) recipients usually qualify for federal Medicare 2 years after eligibility for Social Security disability benefits. The Medicare waiting period doesn’t apply to people with end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS).

Economic reasons are the primary drive behind the Medicare waiting period. To mitigate beneficiaries’ rolling cost and avoid coverage replacement through COBRA, Congress added a two-year delay while expanding Medicare coverage to disabled people. 

Apart from the delay period, the federal Medicare works for disabled people as it works for eligible seniors. You wouldn’t pay for hospitalization coverage (Medicare Part A) if you paid Medicare taxes before leaving the workforce. 

However, if you enroll in these Medicare Parts, you may use your Social Security Disability Insurance (SSDI) benefit to pay your monthly premiums for prescription drug plan (Part D) and Part B physician and outpatient services. 

How the Medicare delay period works

The Social Security Administration (SSA) includes all the months you are eligible for the Social Security Disability Insurance (SSDI) payment in the 2-year qualifying period for Medicare.

Before the SSDI payments start, there is also a delay period. This period lasts for five full years after the SSA establishes your disability. The SSA establishes your disability when you can no longer work because of your medical condition. You are eligible for Medicare coverage 29 months after the “onset” of disability, as established by the Social Security Administration (SSA). Your disability onset might be before you apply for SSDI payment or before it is approved. SSDI payment approval takes months and maybe longer if you need to make an appeal. With your medical evidence, the Social Security Administration (SSA) might pay you retroactive benefits of 1 year if the medical evidence affirms that your disability precedes your SSDI application.

Your previous disability period can be added to your Medicare start date if the current onset happens within five years after the last stint on Social Security Disability Insurance (SSDI) ended or if a  similar medical condition occurs.

If you start working again

You will stop receiving benefits if you are no longer regarded as disabled by the Social Security Administration (SSA). Your Medicare coverage will also stop when this occurs since it is linked to the SSDI payment. The SSA periodically reviews your medical status to determine your continuing eligibility for Social Security benefits.

If you are still working and your earnings exceed the substantial gainful activity (SGA), your SSDI may end. The substantial gainful activity is a monthly limit of $2,260 for blind people and $1,350 for other people. Therefore, if you have more monthly income, your benefit may stop.

However, due to the work incentives provided by social security, your Medicare coverage may not stop. The work incentive is intended to facilitate the easier transitioning of disabled beneficiaries into the federal workforce.

Conclusion

If you are eligible for Medicare, you may not be eligible for Supplemental Security Income (SSI) and other benefits administered to people with disability by the Social Security Administration (SSA). If you are receiving Supplemental Security Income (SSI), you are automatically eligible for Medicaid, a health insurance program designed for people with low earnings.

Suppose you are an SSDI beneficiary and meet Medicaid qualifying criteria; you can apply for Medicaid while waiting for your Medicare to begin. With this approach, you can quickly fill your healthcare coverage gaps.

If your employer offers you health insurance, you can receive Medicare coverage as long as your medical disability persists. 

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Bio:
I grew up in Dubuque, Iowa, where I learned the concepts of hard work and the value of a dollar. I spent years in Boy Scouts and achieved the honor of Eagle Scout. I graduated from Iowa State University and moved to Chicago and spent a few years managing restaurants. I then started working in financial services and insurance helping families prepare for the high cost of college for their children. After spending years in the insurance industry, I moved to Arizona and started working with Federal Employees offing education and options on their benefits. I became a Financial Advisor / Fiduciary to further help people properly plan for the future. I enjoy cooking and traveling in my free time.

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