People who cannot work due to a disability might be able to receive financial help from Social Security Disability Insurance (SSDI). Enrolling in Medicare is another benefit of getting SSDI benefits.
Medicare coverage becomes available to recipients of SSDI after a 24-month waiting period. When they become eligible, Original Medicare (Parts A and B) is immediately offered to them, assuring access to critical medical services. Medicare coverage is maintained if the person continues to be qualified to receive SSDI benefits.
This article will go into detail on how SSDI affects your Medicare coverage.
Everything You Need to Know About Medicare
Medicare is health insurance coverage for seniors 65 and older, qualifying disabled individuals younger than 65, and those experiencing end-stage renal disease and permanent kidney failure managed with dialysis or a transplant.
Medicare consists of two parts. Hospital insurance is part A. Most people may be exempt from paying for Part A. Medical insurance is Part B. For Part B, most people may have to pay a monthly premium.
Will a Beneficiary Get Medicare Coverage?
After a 24-month qualifying period, everyone who qualifies for SSDI benefits is also eligible for Medicare. The waiting period for Medicare coverage is 24 months after being eligible for disability benefits.
The beneficiary may be qualified for health insurance through a prior employer throughout this Medicare eligibility period. When requesting information regarding health insurance coverage through a previous employer, the employer should be contacted.
Getting SSDI and Having Medicare
Health insurance is not mandatory at the federal level. Some states may impose a tax penalty if you do not have health insurance, but the federal government no longer does that.
With this in mind, you are considered to be in compliance with the health care law if you receive SSDI and are enrolled in Medicare.
You are exempt from the fines associated with those who do not have health coverage. It’s important to remember that you cannot sign up for a Marketplace plan to either complement or replace your current Medicare coverage.
This rule does have one exception, though. If you acquired a Marketplace plan before enrolling in Medicare, you have the option to retain it as supplementary insurance.
However, you should be aware that choosing this path will result in the forfeiture of any premium tax credits and other savings associated with your Marketplace plan.
Waiting Period Before Getting Medicare
There are opportunities for acquiring health care coverage during this interim period if you receive SSDI benefits and are in the 24-month waiting period before becoming eligible for Medicare. You have two options for obtaining Medicaid coverage.
First, you can establish an online account or log in to finish a previous application and submit an application online. When asked if you have a disability, select yes. Your state Medicaid agency will then receive your application.
Alternatively, you can apply for Medicaid directly with your state’s Medicaid office. Go to the Medicaid page’s contact information option and choose your state to find your nearest office. If you are eligible for Medicaid during this time, your eligibility can last even after you sign up for Medicare.
If your Medicaid application is rejected, you may still be able to sign up for a private health plan through the Marketplace.
At the same time, you may wait for your Medicare coverage to start. Depending on the size of your household and income, you might be qualified for lower premiums on Marketplace insurance.
How Does the SSA Count Months?
For every month of disability benefits eligibility, the SSA counts one month.
Months in previous periods of disability may be counted towards the 24-month Medicare qualifying period if the new disability begins:
- Within 60 months after the termination month of the workers` receiving disability benefits; or
- Within 84 months after the termination of disabled widows` or widowers` benefits or childhood disability benefits; or
- At any time, if the current disabling impairment is the same as, or directly related to, the impairment which was the basis for the previous period of disability benefit entitlement.
Medical Coverage and Employment
If the beneficiary continues to have a debilitating condition after a trial employment period, they can receive at least 93 months of medical insurance.
Due to this clause, health insurance can continue even after a recipient starts working and engaging in substantial gainful activity.
The hospital insurance beneficiary is guaranteed ongoing health insurance even though monetary benefits may end.
Beneficiaries may be eligible for Medicare hospital and medical insurance if they still have a disability at the end of the 93-month term. They will be responsible for paying the premiums for coverage..
Eligibility for Buying Medical Coverage
Medicare coverage may be purchased by beneficiaries in certain situations. People who may be included are those who are disabled and under age 65. Beneficiaries whose Medicare coverage ended for reasons relating to their employment may also be eligible to regain it.
If eligible retired individuals without insurance want Premium Hospital Insurance (Medicare Part A), they can get it for $506 (in 2023) or $278.00 if they’ve earned 30 quarters of coverage. They can also choose to buy Premium Supplemental Medical Insurance (Medicare Part B) for $164.90 (in 2023).
When Can a Beneficiary Enroll?
Beneficiaries can sign up for Medicare in several ways, including the following:
- Initial Enrollment Period – This time frame begins when they learn that their premium-free health insurance is ending and lasts for the following seven months.
- Annual General Enrollment Period – Beneficiaries may additionally sign up for Medicare during the annual general enrollment period, which runs from January 1st through March 31st each year.
- Special Enrollment Period – Special enrollment is an option if a group health plan currently covers them through their employment.
It’s important to remember that some beneficiaries with low incomes and few resources can be eligible for state aid to help cover these costs, making Medicare coverage available for those who need it.
Conclusion
For those unable to work due to a disability, Social Security Disability Insurance offers a vital lifeline, and one of its significant benefits is the ability to receive Medicare coverage. Individuals receiving SSDI benefits are immediately enrolled in Original Medicare after a 24-month waiting period, assuring access to critical healthcare services.
This coverage continues as long as the beneficiary is still eligible for SSDI benefits, providing them with valuable assistance for their healthcare needs.
