Health insurance is a central concern for virtually every American, whether they are working and healthy or disabled due to an injury or illness. When a worker becomes disabled and files for Social Security Disability Insurance (SSDI or SSD), they naturally want to know what type of health insurance they get when they are on disability.
As we’ll explain below, the answer depends on which of the federal Social Security disability programs is involved. The Social Security Administration (SSA) oversees two programs designed to provide some financial support to people in these situations:
- Social Security Disability Insurance (SSD)
- Supplemental Security Income (SSI)
While both programs use common standards to determine what qualifies as a disability, the two programs differ significantly in other aspects. One of the central differences is what insurance coverage is provided with disability benefits and when that insurance coverage begins.
When you contact a want disability law firm, you are working with lawyers who know all the complexities of the various disability programs. They want their clients to understand exactly what benefits are available to them when they suffer a disabling injury or illness. Benefit payment amounts, eligibility requirements, and health insurance coverage are tremendously important subjects when you suffer a disability.
Two Federal Disability Programs – Very Different Health Insurance Coverage
The Social Security Disability (SSD) program and the Supplemental Security Income (SSI) are often confused with one another by those unfamiliar with the programs. But they are actually very different programs.
The SSD program pays monthly benefits only to people who worked a sufficient number of years and contributed payroll taxes before becoming too disabled to work. The SSI program is needs-based and provides payments to eligible disabled people with low income and minimal resources, regardless of whether they ever worked or paid taxes.
Other than differences in benefit payment amounts and income eligibility, the most striking difference between the programs is the availability of health insurance.
SSI benefit recipients get immediate Medicaid Insurance coverage. However, those who receive SSD benefits get Medicare Insurance coverage only after two years from the date their benefit payments began. Remember, though, there is a five-month waiting period between the disability onset date and the beginning of benefit payments. That means the actual Medicare waiting period works out to 29 months.
The Two-Year Medicare Waiting Period for Social Security Disability
The Social Security Disability program’s two-year waiting period before Medicare covers their healthcare costs is a source of great controversy in and out of Congress. Many advocates condemn the long waiting period as unnecessary and inconsistent with the purpose of a program called “Social Security Disability Insurance.”
Why Is There a Two-Year Wait for Medicare?
The reason cited to justify the long 24-month waiting period before an SSD benefits recipient gets Medicare coverage has several prongs:
- 2-year Medicare waiting period ensures only truly long-term disabilities are covered,
- any proposed shorter Medicare waiting period would deplete Medicare’s funds too quickly,
- alternate sources of health insurance coverage are available to most SSD recipients during the waiting period.
Are these valid arguments justifying a 2-year wait for Medicare?
- The arbitrary selection of 2 years to qualify for Medicare on SSD seems illogical. Social Security eligibility rules provide that all SSD applicants whose disability last for 12 months qualify for monthly payment benefits. If 12 months is the legal measure to qualify for full disability benefits, why require an additional one-year wait for Medicare?
- Medicare is paid from money in two trust funds, one of which is financed by payroll taxes of employees and employers, by income taxes on Social Security benefits, by returns on the fund’s investments, and by Medicare Part A premiums. The second trust fund is financed by Congress, by Medicare Part B and D premiums, and by return on investments. Given these funding sources, Medicare may be more self-sustaining than some argue. Would the additional Medicare cost to cover SSD beneficiaries who have no other coverage and who have been disabled for a year or more truly bankrupt the trust funds?
- Many SSD recipients might have alternate sources of healthcare insurance, especially since many disabilities arose from work-related injuries and illnesses, enabling them to receive worker’s compensation. But non-work-related medical costs are not covered, nor are family members healthcare expenses.
Key’s to Dealing with the Long Medicare Waiting Period
Any SSD claimant who must wait for the full 24 months for Medica (plus the 5-month benefit waiting period) may have options. Many states administer their own healthcare assistance programs and expand Medicaid eligibility to cover more people. Your disability lawyer should strongly advocate for the earliest possible “disability onset date,” the date recognized by SSD as when your disability began.
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