If you qualify for disability benefits, then you will also qualify for
some time of health insurance coverage. These benefits will either be
through your state’s Medicaid program or the federal Medicare program.
Individuals who qualify for Supplemental Security Income (SSI) benefits
are eligible for Medicaid. If you qualify for Disability Insurance Benefits,
then you are eligible for Medicare.
Unfortunately, your eligibility for Medicare benefits is not effective on the same date that you are found to be disabled. Congress has established that you may receive Medicare benefits 24 months after you are first eligible for a disability check. This two year wait is extended further because you are not eligible to receive a check until you have been disabled for five full calendar months. This means effectively that you will not receive your Medicare benefits until 29 months after the date you have been determined to be disabled.
Example: Jim suffered a major heart attack and stroke on January 1, 2013. Despite months in the hospital and physical therapy, he was not able to return to work. In June 2013, he decides to file for Social Security Disability benefits. After being denied at the Initial and Reconsideration levels, he ultimately goes to a hearing before an Administrative Law Judge (ALJ). Because of the lengthy appeals process, this hearing does not take place until December 2014. In February 2015, he receives a Fully Favorable Decision from the ALJ which states that he has been found to be disabled since his January 1, 2013 heart attack.
When is Jim eligible for Medicare under these facts? Under these facts, since his disability was found to have commenced on January 1, 2013, his Medicare coverage will be effective 29 months from this date. His coverage will therefore start in June 2015.
Finally, the Social Security Administration waives the waiting period for
only two conditions. The only exceptions to the waiting period are for
individuals with these conditions: renal disease requiring dialysis (end
stage renal disease), kidney transplants and amyotrophic lateral sclerosis
(common referred to as ALS or Lou Gehrig’s Disease). If you have
these conditions, make sure to inform Social Security, as you may be able
to bypass the 2-year waiting period for your Medicare eligibility.
How much will Medicare Coverage cost me?
Most individuals who qualify for Medicare must pay a monthly premium to continue their coverage. These monthly premiums are automatically deducted from your monthly Social Security Disability check. Some states, such as Tennessee, elect to assist certain disabled individuals in paying their Medicare premium. For example, through TennCare, Tennessee will provide low income individuals TennCare benefits and pay their Medicare premium in certain limited instances. If you are awarded disability insurance benefits and Medicare, it is worth a trip to the Department of Human Services to see if the state will provide any additional help in paying for monthly payments. Tennessee residents should visit the TennCare website for more information. (http://www.tn.gov/tenncare/mem-categories.shtml#QMB).
The Donati Law Social Security lawyers are experienced in the area of Social Security Disability law. With over 100 years of legal experience in Social Security matters, the attorneys of Donati Law can help you achieve results. The administrative process is complex, and the majority of people who apply for Social Security disability benefits are initially denied. Without the benefit of legal representation, the process can be overwhelming.