When most people think of Medicare, they think of it as health care for seniors starting at age 65. But there is a whole other group who qualify for Medicare benefits- those receiving Social Security Disability benefits. Approximately 16% of those on Medicare are individuals with disabilities under the age of 65.
Getting approved for Social Security Disability benefits can be a long and frustrating process. Very few people are approved on their first attempt. If this is your situation, you may wonder how long it will take to get Medicare benefits after you have finally been approved for disability.
This article will answer that question. We will also examine some of your options if you are on disability and waiting for Medicare coverage to kick in. To better understand what Social Security Disability Insurance (SSDI) is and how to qualify for benefits, read this article here.
When Will My Medicare Coverage Begin?
If you have been approved for disability, your Medicare Part A coverage will begin immediately. Part A is your hospital care coverage and will pay for inpatient, hospice, and skilled nursing care once your deductible has been met. If you have worked for at least ten years or 40 quarters, your Part A coverage will not have a monthly premium.
Your Medicare Part B, which covers outpatient medical services such as doctor visits, and lab work, will begin 24 months after your Medicare Part A begins. Your Part B coverage will have a deductible and a monthly premium based on your income (or joint income if you’re married) for the past two years.
The exception to this two-year wait is for those who qualify for disability due to End Stage Renal Disease (ESRD), also known as Kidney Failure, and ALS, also known as Lou Gehrig’s Disease. If you have either of these conditions, you will receive immediate Medicare benefits from both Part A and Part B.
If you have received disability benefits in the past, previous periods of disability may count toward your 24-month qualifying period under certain circumstances. If your current disability is the same, or directly related to, a disability for which you have previously received disability benefits, that time may count toward your current qualifying period.
Alternatively, suppose a new disability begins within 60 months after your disability benefits have ended or within 84 months after the disabled widow’s or widower’s benefits or childhood disability benefits. In that case, that may count toward the qualifying period.
Once you have received both parts of Original Medicare, you can get a Medicare supplemental plan to fill in the gaps. A word of caution, however, depending on what state you live in, your options may be very limited and expensive. Most states do not require the same supplemental plans to be offered to those on Medicare under 65 as those provided to individuals 65 and older. However, you may qualify for a Medicare Advantage plan for those on Medicare due to disability.
If you decide not to sign up for Medicare after your two-year wait but later want to, bear in mind that you will be charged a late penalty for every year you were late. That late penalty is usually 10% per year. These penalties will go away when you turn 65.
What Do I Do for The Two Years Before My Coverage Begins?
Health insurance is necessary, especially when you have been diagnosed with a disabling condition. The two-year wait for Medicare Part B coverage may seem unfair. Nevertheless, Congress made this compromise to expand the availability of Social Security and Medicare benefits for those under the age of 65.
So, what can you do for medical coverage while you wait for Part B to begin? Depending on your circumstances, you may have a few options.
Employer Health Care
During your qualifying period, you may be eligible for group health insurance through your former employer. If you are married and your spouse qualifies for health insurance at work, you may also be able to get coverage through their work health plan. You can contact the employer for more information regarding your eligibility for health insurance coverage.
COBRA stands for the Consolidated Omnibus Budget Reconciliation Act of 1985. This law requires employers to allow employees and their dependents to keep their health coverage under certain circumstances even after leaving the group plan.
Each state may have slightly different rules governing COBRA. All states require companies with more than 20 employees to continue coverage to those who have lost their job or had their working hours reduced. Some states may require smaller companies to also allow former employees to keep their health insurance coverage for a while.
If you have lost your job, had a reduction in your working hours, or were covered by a spouse who has died or from whom you have divorced, you may qualify for this coverage. COBRA coverage usually lasts 18 months, though it may be as much as 36 months in some instances. You may also have to pay the employer’s share of the premium and your own.
Affordable Care Act
The Affordable Care Act, also known as Obamacare, is a healthcare reform law passed in 2010. Under the Affordable Care Act, you may qualify for reduced-cost health insurance based on your income. This law also ensures that you cannot be denied health insurance due to pre-existing conditions. We can help you navigate your state’s health insurance marketplace to find your best plan.
We Are Here to Help
Navigating Social Security Disability Insurance and Medicare can be a challenge. The lengthy process and months-long waiting periods can be stressful. But you don’t have to figure it out alone. The Medicare Family has over 40 years of experience. We can look at your unique circumstances and help you understand what is available in your state. Schedule an appointment today, and let us help you get the coverage you need.