Qualifying for Medicare When Receiving Disability Benefits

Medicare coverage kicks in for most SSDI recipients two years after the first month they are eligible for their monthly disability benefits. However, this doesn’t automatically mean that every person approved for SSDI must wait two years to get their Medicare coverage. The two-year Medicare waiting period generally gets calculated from the date of your SSDI entitlement (the date you are eligible to receive your monthly award). Normally, this is the date your disability began plus the five-month SSDI waiting period.

However, things get a little tricky depending on your disability onset date. Depending on how far back you became disabled, you may have met a good portion of the waiting period by the time you are approved for benefits. But, because Social Security only allows a maximum of 12 months of retroactive benefits, plus the 5-month waiting period for benefits, the earliest that you can become eligible for Medicare is one year after you apply for Social Security disability.

For instance, let’s pretend you became disabled in July 2016. Since there is a five-month waiting period, your Social Security Date of Entitlement would be in December of 2016. You didn’t apply for Social Security benefits as soon as you became disabled, so your application date was January 2017. You had to go through the appeals process as you were initially denied, but you were finally approved for benefits in September 2018 with an entitlement date of December 2016. Since it has been two years since your Date of Entitlement, you will start receiving Medicare benefits in December 2018.

But, if you recently become disabled and were approved with an entitlement date of August 2018, you would not become eligible to receive Medicare benefits until August 2020. There are exceptions to this rule if your disabling diagnosis is End Stage Renal Disease or Amyotrophic lateral sclerosis (ALS). People with these conditions receive expedited Medicare coverage.

In most states, if you are approved for SSI, you will receive benefits automatically through Medicaid as SSI’s income and asset limits mirror that of Medicaid’s. However, there are a few states that still require you to complete a separate application process for Medicaid benefits because those states choose to make their own Medicaid determinations. For SSI recipients, there is no waiting period to receive Medicaid. Generally, people on SSI can still get Medicare benefits as well, but only when they turn age 65. At that point, they can file an “uninsured” Medicare claim, which means the state they live in pays the medical premium for Medicare.

Check out our Disability Training Series to learn more!