Medicare is a federal health insurance program most often associated with senior citizens. However, most people who are under 65 and receive Social Security Disability Insurance (SSDI) benefits are eligible for Medicare after a 24-month qualifying period. This can provide a vital lifeline for those with high healthcare costs related to their disability.
There are four parts to what is broadly referred to as Medicare:
- Part A. Also known as hospital insurance, Part A provides coverage for serious illnesses requiring inpatient hospitalization or care in a skilled nursing facility—but not long-term nursing home stays.
- Part B. Also known as medical insurance, Part B covers things such as preventative care, medically necessary services for illness or injury not requiring hospitalization, and durable medical equipment.
- Part C. Offered through the private market, Part C expands on the benefits provided by Part A and Part B coverage. It’s sometimes referred to as Medicare Advantage.
- Part D. This type of Medicare offers prescription drug coverage through the private market.
It is a common misconception that Medicare provides free health care coverage. The vast majority of people pay premiums, in addition to deductibles and copays. Part A is free only if you have at least 40 calendar quarters of work in any job where you paid Social Security taxes—which means most SSDI recipients don’t qualify.
Calculating the Waiting Period for Medicare Benefits
Typically, the Social Security Administration (SSA) will count each month you receive SSDI payments as a month towards your 24-month waiting period. Since there is a five-month waiting period to begin receiving SSDI benefits after your disability onset date, this means most people will not receive Medicare until the 30th month of disability.
Previous periods of disability can be counted towards the 24-month qualifying period if your new disability begins within 60 months after the termination of the previous disability benefits, within 84 months after the termination of your disabled widows` or widowers` benefits or your childhood disability benefits, or if the current disabling impairment is either identical or directly related to your previous SSDI qualifying disability.
During the qualifying period, you will need to obtain your health insurance coverage from another source. You can:
- Apply for Medicaid coverage for low-income adults
- Purchase coverage from the open market
- Obtain coverage from a former employer
- Be added to a spouse’s plan
Please note that there are two exceptions to the 24-month qualifying period. SSDI recipients with End Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS or Lou Gehrig’s disease) do not have to wait to receive Medicare benefits.
How Returning to Work Affects Medicare Coverage
If you are receiving SSDI and decide to return to work, you can receive at least 93 months of Medicare hospital and medical insurance after your trial work period, as long as you still have a disabling impairment. There is no premium for hospital insurance during this time, even if your cash benefits have ceased due to your return to work.
When your SSDI Medicare stops because you have returned to work, but you still have a disability, you are eligible to purchase Medicare coverage. If you are offered the option to purchase Medicare, you can:
- Buy Part A and Part B at the same monthly cost which uninsured eligible retired beneficiaries pay.
- Buy Part A without buying Part B. Medicare beneficiaries can only buy Part B coverage if they purchase Part A coverage first.
If you purchase Medicare and have health coverage through your work, Medicare generally becomes the "secondary payer" used to cover expenses not paid by your employer-provided coverage.
Have You Or A Loved One Been Denied Social Security Disability Benefits?
If you or a loved on has been denied Social Security Disability Benefits you need to speak with an experienced SSD attorney as soon as possible. Please contact us online or call our Virginia Beach office directly at 757.490.3500 to schedule your free consultation. We have offices throughout Virginia including Chesapeake, Newport News, Norfolk and Suffolk.