Monday, November 19, 2007

SSD and Medicare Benefits

An advice column for social security disability applicants rendered the statement "You are eligible for medicare after you have been on SSD for two years.

I think I've responded to this one several times but it's probably worth repeating: in most cases, you don't actually have to be on SSD for two years before you can receive medicare benefits. But let me be more specific than that to avoid any confusion---after you have been approved for disability benefits, you don't necessarily have to wait two full years before you can receive medicare.

This can be confusing, I know, and this is probably why I run into so many occurrences of individuals stating that you can't receive medicare until you've been on SSD for two years. But this is how it works:

When an individual is approved to receive social security disability benefits, an established onset date, or EOD, is set. The established onset date simply means "when a person's disability started".

How far back the onset date can be set is certainly an important matter. It will affect how much a claimant may receive in back pay benefits, but it is also important in terms of medicare. So for this reason, it is vital that a claimant can not only present sufficient medical record documentation to establish an ongoing state of disability, but also establish the earliest possible date of onset.

At the initial claim and reconsideration levels, onset is determined by the disability examiner who has been assigned to the case. Once the onset date has been determined, a claimant's eligibility to receive disability benefits will begin five months from this date. This five month time frame is known as the five month waiting period. If you haven't already figured it out, it is a very convenient way for the government to basically rob you of five months of your disability benefits, and for no good reason.

Now back to medicare eligibility. After the established date of onset (when your disability began, according to the medical records) has been determined, and the five month waiting period has been added to this (this becomes your effective date of entitlement, the point at which you are now eligible to receive disability benefits), your medicare eligibility begins two years from this time.

At first glance, it might seem as though a claimant who has just been approved will have to really wait two full years before they can receive medicare. However, this is typically not the case and here's why. Most social security disability cases drag on for two to three years, meaning that by the time most claimants are approved following a disability hearing, they will most likely have "served" some or all of the two year medicare waiting period.

So, if you get awarded disability benefits, will you have to wait two years for medicare? In a small percentage of cases, that might be true. But many approved applicants will not have to wait more than a few months, and many will not have to wait at all.

Return to the Social Security Disability SSI Benefits Blog

Other Posts:
Requirements for disability
How to apply for disability
Medicare disability
How to get SSI
Applying for disability