Individuals with chronic renal disease would only have to wait. Not only is there a medicare waiting period, but also an ssdi waiting period which makes beneficiaries wait an additional five months before they are first entitled to benefits, from the date they are found disabled. You do not need to take action or call anyone to get the ball rolling. The 24month waiting period begins when an ssdi beneficiary is first entitled to benefits.
Public law 106554 amended section 226 of the social security act to waive the 24month waiting period for medicare coverage for disabled individuals medically determined to have amyotrophic lateral sclerosis als, better known as lou gehrigs disease. How long does it take to get medicare coverage through. Part of this law was a required 2year waiting period. The first is the 5 month waiting that is analogous to an elimination period for a private insurance policy. If you enrolled in a marketplace plan before getting medicare, you can. This waiting period is called a preexisting condition waiting period. The reason for the 24 month waiting period is mainly for the government to save money and to ensure that only those with a longterm disability will receive medicare. Although most people have to go through the medicare waiting period, there are two exceptions. The fivemonth waiting period for benefits congressional research service summary social security disability insurance ssdi is authorized by title ii of the social security act and provides income replacement for eligible individuals who are unable to. Medigap, supplement preexisting condition waiting period. However, there is a 24month waiting period before health insurance begins. This lets you enroll in, switch, or disenroll from plans without waiting for the annual election period or the medicare advantage open enrollment period that occurs each year.
Recommending elimination of the 24 month medicare waiting period. The waiting period was put in place as a costsaving measure, so it is very unlikely it will ever change. During this qualifying period for medicare, the beneficiary may be eligible for health insurance through a. Exceptions to the twoyear waiting period for medicare. His medicare, however, does not kick in until july, 2010. Special enrollment periods for medicare advantage plans and. If you are younger than 65 and disabled, you must observe a 24month waiting period for medicare, during which time you may collect social security disability insurance. If you suffer from one of the following medical conditions, you can receive expedited medicare coverage sooner than.
Individuals under age 65 with disabilities other than als or esrd must have received social security disability benefits for 24 months before gaining eligibility for medicare. Medicare eligibility for those under 65 medicare interactive. Are there exceptions to the 24month medicare complete a 24month waiting period known as the medicare qualifying there are also some additional circumstances when the mqp is either waived entirely. Qualifying for medicare when receiving disability benefits patient. Health coverage options for people who get social security. Your waiting period in this example would be almost seven months. A bill to waive the 24 month waiting period for medicare eligibility and the 5 month waiting period for social security disability insurance benefits for individuals with metastatic breast cancer. Eliminating the medicare waiting period for social security disabled. If you get social security disability income ssdi, you probably have medicare or are in a 24month waiting period before it starts. Thus, at the beginning of the 30th month since the onset of the qualifying disability, ssdi beneficiaries become eligible for medicare coverage. The other is for people with amyotrophic lateral sclerosis als, known as lou gehrigs disease. You will be covered as soon as your disability payments begin. Eliminating the medicare waiting period for social security disabled wcyrker beneficiaries by barry v.
There are a couple of exceptions to the twoyear wait for medicare. In the original 1972 legislation there was one exception to the 24 month medicare waiting period. Individuals who become entitled to title ii disability benefits generally are required to complete a 24month waiting period known as the medicare qualifying period or mqp before medicare coverage may begin. Exceptions to the waiting period have been made for individuals with als, and for those with endstage renal disease. This is a 24 month waiting period after the entitlement to cash benefits begins. The 24 month waiting period for medicare begins with the claimants first month of entitlement to ssd benefits. How the preexisting condition waiting period works. Exceptions requests are granted when a plan sponsor determines that a requested drug is medically necessary for an enrollee. Section 115 of the medicare, medicaid and schip benefits improvement and protection act of 2000, waives the 24 month waiting period for beneficiaries whose primary or secondary diagnosis is amyotrophic lateral sclerosis als. A bill to waive the 24 month waiting period for medicare. This report will be updated to reflect legislative activity.
Toms eligibility, therefore, begins as of july, 2008. Recommending elimination of the 24 month medicare waiting. For more information on how the 12 month period of retroactive coverage works, visit. Medicare supplements do have a 6 month look back period for pre x, which is clearly stated in the first paragraph on page 15 of publication 02110 choosing a medigap policy. Qualifying for medicare after collecting ssdi keller. If you have als lou gehrigs disease, there is no waiting period to get medicare coverage. But very often, due to a how long it can take for a disability claim to be approved it can take years due to disability appeals and b. Medicare and other programs for people with disabilities. An authority on medicare and prescription part b, she is the writer of ask ms. Medicare is not only a health insurance program for people 65 and older, it is also health insurance for some disabled individuals. Social security disability insurance ssdi and medicare congressional research service summary recipients of social security disability insurance ssdi benefits are eligible for medicare benefits after a 24month waiting period. After this period has passed, the social security administration will enroll you in medicare.
Thus, the claimant who became disabled on july 2, 2008 would not. You may qualify for medicare due to a disability if you have been receiving ssdi checks for more than 24 months, also known as the twoyear waiting period. There are actually a couple of waiting periods that apply to social security disability and not ssi. During this qualifying period for medicare, the beneficiary may be. The diagnosis code either primary dig or secondary sdig will be 3350. Finally, after receiving their ssdi benefits, individuals must wait an additional 24 months before they receive medicare coverage. January, 2008 does not count in this 5 month period because it is a partial month, so the waiting period includes february, march, april, may, and june, 2008. No one really understands the logic of this waiting period to be frank, and there doesnt seem to.
Because many disability applicants do not actually begin receiving disability benefits on the day they become eligible, it may be less than two years between when you get your first payment and when you are eligible for medicare. Effective july 1, 2001, a disability beneficiary diagnosed with als will not have to serve the 24month medicare waiting period. Social security disability insurance ssdi and medicare. Recipients of social security disability insurance ssdi benefits are eligible for medicare benefits after a 24month waiting period. Ultimately, the choice to enroll in or delay part b will depend on your specific situation, including your health needs, costs, and other coverage you may have. The twoyear waiting period begins on the first month you are eligible for benefits, not from your date of disability or when you actually start receiving benefits. Initial enrollment period the initial enrollment period iep is the first time you are eligible for medicare parts a and b. There are many exceptions to medicares eligibility age requirement. There is no waiting period or preexisting condition clause for medicare parts a hospital, b doctor visits, c medicare advantage, or d rx. For example, individuals with lou gehrigs disease or on dialysis for kidney failure qualify for medicare coverage earlier. In addition, you may be able to change your medicare advantage coverage by qualifying for a special election period sep. Why is there a twoyear waiting period for medicare for the. Why is there a twoyear waiting period for medicare for.
The 24 jul 14, 2005 the 24month medicare waiting period for social 65 years of age, there are exceptions to the required 24month waiting period for certain. Medicare waiting period exceptions medicare timeline. Eliminating, or reducing, the 24 month medicare waiting period for social security disability beneficiaries would address the insurance needs of a highrisk, highneed population and provide financial relief and access to health care services at a time when health care needs are especially pressing and few alternatives exist. For tiering exceptions, the prescribers supporting statement must indicate that the preferred drug s. Here is an example of the 24month qualifying period. You may need to manually sign up for medicare if one of the following circumstances apply to you. This report explains this waiting period and its legislative history. Are there exceptions to the 24month medicare qualifying period mqp. The original purposes of the 24month waiting period. Everyone eligible for social security disability insurance ssdi benefits is also eligible for medicare after a 24month qualifying period. Medicare part b enrollment periods medicare rights center. But for sick people to wait 24 to 29 months for medicare when they can no longer.
Unfortunately, youre right, your husband will have to wait at least another year for medicare coverage. Disability and the 24 month medicare waiting period. Individuals younger than 65 who are still on their employers plan when they receive approval for social security disability insurance ssdi benefits may enroll in medicare after a. Here are some pros and cons of delaying medicare part b enrollment. One is for people with endstage renal disease esrd, kidney failure needing regular dialysis or a kidney transplant who meet the conditions for obtaining medicare.
Pros and cons of delaying medicare part b enrollment. Will i receive medical insurance if i am approved for. If you have esrd end stage renal disease, coverage will begin three months after a course in dialysis or a kidney transplant. Medicare is a federal health insurance program primarily available to those over the age of 65, but it is also available to some disabled persons under the age of 65. A fivemonth waiting period is required after a beneficiary is determined to be disabled before a beneficiary begins to collect social security disability benefits. If you have been receiving retirement benefits from social security before age 65. The first 24 months of disability benefit entitlement is the waiting period for medicare coverage. Therefore, an enrollees prescriber must submit a supporting statement to the plan sponsor supporting the request. Waiting period medicare health insurance information. Medicare waiting period for social security disabled wcyrker beneficiaries by barry v. The twoyear medicare waiting period generally gets calculated from the date of your ssdi entitlement the date you are eligible to receive your monthly award.
There are exceptions to this rule if your disabling diagnosis is end. There have been many attempts to pass new legislation that would phase out this 24 month waiting period. Medicare based on esrd and dont enroll right away, you may be eligible for up to 12 months of retroactive coverage, once youre enrolled in medicare. There are some exceptions to the 24month qualifying period. The insurance company can exclude coverage for the preexisting condition if the condition was treated or diagnosed within six months before the coverage starts under the medigap policy. Medicare twoyear waiting period for people with disabilities background when medicare expanded in 1972 to include individuals with significant disabilities, congress stipulated that people with disabilities must first receive social security disability insurance ssdi for 24 months before gaining medicare eligibility. The twoyear medicare waiting period generally gets calculated from the date of. There are two exceptions to this 24month waiting period. Disability and the 24 month medicare waiting period december 29, 2016 by jeff schwab one of the key benefits of getting on social security disability ssd, also known as ssdi is the access to medicare before the age of 65. Exceptions to medicares 24month waiting rule greeman.
This report also provides information on other programs that may provide access to health insurance during the required waiting period. The date of entitlement to medicare is the date of entitlement to disability doed benefits or july 1, 2001, whichever is later. If you are under 65 and have alslou gehrigs disease, your medicare benefits will start the same month your disability benefits begin theres no 24month waiting period. The cost of eliminating the 24month medicare waiting period for. There are a few exceptions to the 24 month waiting period. The social security medicare 24 month waiting period. Understanding medicare eligibility age requirements. After collecting social security disability benefits for 2years, you could start getting medicare. Riley medicare eligibility for social security disability insurance beneficiaries begins no earlier than 24 months after entitlement to cash benefits. Eliminating the medicare waiting period for social. However, once the 24 month waiting period has been served they are entitled to receive medicare part a, b, c, and d insurance coverage.
Under current law, persons entitled to ssdi become entitled to medicare benefits after a 24month waiting period. Social security should mail your medicare card to you three months before your 25th month of disability. Background individuals diagnosed with metastatic breast cancer automatically qualify for. In such a situation your medicare would begin on month 30 after you first get paid ssdi. It occurs when you turn age 65 or have been receiving social security disability benefits for 24 months. Atlanta ssdi medicare medicaid ginsberg law offices. In fact, social security disability beneficiaries must wait 24 months from the month they are first eligible to receive a monthly disability benefit to receive medicare coverage. The original purposes of the 24month waiting period were to limit costs to the medicare trust funds at a time when many workers might have other health insurance. People who are found disabled by the social security administration, and entitled to social security disability insurance ssdi benefits, automatically qualify for medicare coverage, but there is a catch.