- You’ll be automatically enrolled in Medicare once you’ve received Social Security disability benefits for 24 months.
- The waiting period is waived if you have amyotrophic lateral sclerosis (ALS) or end stage renal disease (ESRD).
- There is no Medicare waiting period if you’re over 65.
- You can apply for other types of coverage during the waiting period.
People who receive Social Security Disability Insurance (SSDI) are eligible for Medicare. In most cases, you’ll be automatically enrolled in Medicare after a two-year waiting period.
Your Medicare coverage will begin the first day of your 25th month of receiving benefits. However, if you have either ALS or ESRD, you can receive Medicare coverage without the two-year waiting period.
The Medicare waiting period is a two-year period that people need to wait before they’re enrolled in Medicare coverage. The waiting period is only for those receiving SSDI, and doesn’t apply if you’re 65 or older. Americans are eligible to enroll in Medicare up to three months before their 65th birthday.
This means that if you apply for SSDI benefits and are approved when you’re 64, your Medicare benefits will begin at 65, just like they would have if you didn’t receive SSDI. However, if you apply for SSDI at any other time, you’ll need to wait the full two years.
No matter your age, you’re eligible for Medicare if you’ve been receiving SSDI benefits for 24 months. In order to get benefits, you’ll need to apply with the Social Security Administration (SSA). Your disability will need to meet the SSA requirements.
According to the SSA, your disability needs to:
- keep you from working
- be expected to last for at least a year, or be classified as terminal
You’ll start the two-year waiting period once you’ve been approved for SSDI. You’ll be enrolled in Medicare Part A (hospital insurance) and Medicare Part B (medical insurance). You’ll receive your Medicare cards and information in the mail during your 22nd month of benefits, and coverage will start during the 25th month. For example, if you were approved for SSDI in June of 2020, your Medicare coverage would begin on July 1, 2022.
Most SSDI recipients need to wait 24 months before Medicare coverage begins. However, there are exceptions. For some life threatening conditions, the waiting period is waived and coverage begins sooner. You won’t need to wait the full two years if you have ASL or ESRD.
The waiting period for people with ALS
ALS is also known as Lou Gehrig’s disease. ALS is a chronic condition leading to loss of muscle control. It’s degenerative, which means the condition gets worse over time. There’s currently no cure for ALS, but medication and supportive care can improve quality of life.
People with ALS need medical care to help them live comfortably. Many people with ALS need the care of home health nurses or nursing facilities. Since this disease moves rapidly and needs so much medical care, the Medicare waiting period is waived.
If you have ALS, you’ll be enrolled in Medicare coverage the first month you’re approved for SSDI.
The waiting period for people with ESRD
ESRD is sometimes referred to as end stage renal disease or established renal failure. ESRD occurs when your kidneys are no longer functioning well enough to meet your body’s needs. ESRD is the last state of chronic kidney disease. You’ll likely need dialysis treatments when you have ESRD, and you may be considered for a kidney transplant.
You don’t need to wait the full two years to receive Medicare coverage if you have ESRD. Your Medicare coverage will begin the first day of the fourth month of your dialysis treatment. You can get coverage as soon as your first month of treatment if you complete a Medicare-approved training program to do your own at-home dialysis treatment.
In some cases, this can mean your coverage will actually start before you apply. For example, if you’re receiving dialysis at a medical center and apply for Medicare during your seventh month of treatment, Medicare will retroactively cover you dating back to your fourth month.
You have a few options for coverage during the two-year waiting period. These include:
- Medicaid coverage. You might automatically qualify for Medicaid if you have a limited income, depending on your state’s policies.
- Coverage from the Health Insurance Marketplace. You can shop for coverage using the United States Health Insurance Marketplace. The Marketplace application will consider you for Medicaid and for tax credits that could reduce your costs.
- COBRA coverage. You can purchase the plan offered by your previous employer. However, you’ll pay the entire premium amount including the part your employer was paying.
- Medicare coverage is available to people under 65 who receive Social Security disability benefits.
- Most people are automatically enrolled after a two-year waiting period.
- If you have ESRD or ALS, the two-year waiting period will be waived.
- You can take advantage of programs such as Medicaid, COBRA, or the Health Insurance Marketplace to get health insurance coverage during the waiting period.