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Home / Resources / How Long Does It Take to Get Medicare After Being Approved for Disability?

How Long Does It Take to Get Medicare After Being Approved for Disability?

By Donna Frederick

After retiring from a career as an executive travel counselor in 2006, Donna Frederick embarked on a second career as a licensed insurance agent. During that first year, many clients told Donna how ov ...erwhelmed they felt by Medicare, but that her assistance helped them finally understand the Medicare program. That experience inspired Donna to focus her efforts on educating her clients to ensure they fully understand their Medicare options. Today, Donna takes pride in providing outstanding customer service and going the extra mile to make sure each client knows all of their options and has a sound understanding of their Medicare plan, from costs to coverage and all points in between.Read more

Feb 11, 2021

There is a 2-year Medicare waiting period for most people who receive Social Security disability benefits. However, the waiting period may be waived if you have either amyotrophic lateral sclerosis (ALS) or end-stage renal disease (ESRD). There is also no waiting period for anyone age 65 or older.

Who Qualifies for Medicare?

Medicare is America's health insurance program for U.S. citizens age 65 and older. You may also be eligible for Medicare before turning 65 if you are age 18 or older and at least one of the following applies:

  • Collect Social Security Disability Insurance (SSDI) for 24 months
  • Have amyotrophic lateral sclerosis, better known as Lou Gehrig's disease
  • Have end-stage renal disease

Please note that SSDI is not the same thing as Supplemental Security Income (SSI) benefits, even though both are through the Social Security Administration (SSA). You will not qualify for Medicare before turning 65 due to receiving SSI benefits.

What Is the Medicare Waiting Period If You Qualify Due to Disability?

If you are not yet 65 years old and collect SSDI benefits, Medicare enrollment occurs automatically during month 25. Like those who age into the Medicare program, you'll have an Initial Enrollment Period (IEP) that lasts for the 7 months surrounding your eligibility month. Your IEP begins in month 22 and extends through month 28, with your Medicare coverage beginning on the first day of the 25th month.

For example, if you were approved for SSDI benefits on April 3, 2019, you'll be automatically enrolled in Medicare on April 1, 2021.

So, if enrollment occurs automatically, why do you need the Initial Enrollment Period? Simple: This is the period when you can also sign up for Medicare Advantage, Part D, and Medigap plans.

What Does Automatic Enrollment Include?

In month 25, you'll be automatically enrolled in Original Medicare. This includes:

  • Medicare Part A, which covers inpatient care received in a hospital or skilled nursing facility (SNF)
  • Medicare Part B, which covers outpatient services like doctor visits, mental health care, lab work, durable medical equipment (DME), and much more

Although enrollment in Parts A and B is automatic, you may decide you'd rather delay Part B, particularly if you have group health insurance through an employer (theirs or their spouse's). Before your coverage begins, you should receive your red, white, and blue Medicare card in the mail. If you prefer to delay Part B, just follow the instructions included with your Medicare card.

Signing Up for a Medicare Plan

Your 7-month IEP is the best time to sign up for a Medicare plan. All of these plans are provided by private insurance companies working under the guidance of the Centers for Medicare & Medicaid Services (CMS). Your options are:

  • Medicare Part C, more commonly known as Medicare Advantage, combines your Parts A and B benefits in a single plan that's similar to the group health insurance many people have through an employer. Medicare Advantage plans must provide the same benefits you get with Original Medicare, but most offer additional coverage as well, with prescription drug coverage being the most common. Please note that, even if your Advantage plan has a monthly premium, you are still responsible for the Part B premium.
  • Medicare Part D provides prescription drug coverage. You may join a standalone Part D prescription drug plan or a Medicare Advantage Prescription Drug plan (MA-PD). Medicare beneficiaries must maintain creditable prescription drug coverage (i.e., a plan that is comparable to Medicare Part D in terms of both cost and benefits). If you do not have creditable coverage elsewhere AND you don't sign up for a Part D plan, you may owe lifelong late enrollment penalties. Learn more here.

There is also Medicare Supplemental Insurance, more commonly known as Medigap, which helps cover some of your out-of-pocket Medicare costs. The best time to sign up for a Medicare Supplement plan is during your Medicare Open Enrollment Period (OEP), because you cannot be denied coverage or charged a higher rate, even if you have preexisting conditions.

Unfortunately, federal law only offers this protection to Medicare beneficiaries who are both age 65 or older and enrolled in Original Medicare. Luckily, many states provide consumer protections for under-65 Medicare enrollees. The bottom of our Medicare Supplement information page includes links for each state. Just click on your state to see the rules for beneficiaries who qualify for Medicare due to a disability.

If your state does not offer these consumer protections, you'll have the same Medigap OEP that those who age into the program do once you turn 65.

Our Find a Plan tool makes it easy to compare your Medicare plan options. Just enter your zip code to review plans in your area.

What Happens If You Turn 65 During the Medicare Waiting Period?

Those who turn 65 during their 2-year waiting period may, of course, sign up for Medicare during the same Initial Enrollment Period as those who age into the Medicare program. In this case, your IEP begins 3 months before your 65th birthday and ends 3 months after your birth month. So, if your birthday is June 10, your IEP begins on March 1 and ends on September 30. The only difference is if your birthday falls on the first of the month. In that case, move those dates forward by one month (February 1 through August 31 if you were born on June 1).

It's important to note that Medicare enrollment is NOT automatic when you age into the program unless you began receiving Social Security benefits at least 4 months before your 65th birthday. If you turn 65 during your 2-year waiting period and are not collecting either Social Security or Railroad Retirement Board (RRB) benefits, you must choose to sign up for Medicare. You do so through the SSA by clicking here.

What Is the Medicare Waiting Period for People with Lou Gehrig's Disease?

If you have ALS, you don't need to wait 24 months for your Medicare benefits. Instead, you will be automatically enrolled in the first month you receive SSDI approval from the Social Security Administration. You also get the same 7-month IEP that other new Medicare beneficiaries receive.

What Is the Medicare Waiting Period if You Have ESRD?

Most people going through the final stages of kidney failure (ESRD) require dialysis treatments or may be under consideration for a kidney transplant (or both). If you need dialysis, you don't have to wait 24 months to get Medicare. Instead, you'll be automatically enrolled on the first day of the fourth month of dialysis treatment. ESRD patients who complete training for at-home dialysis (assuming you use a Medicare-approved training program) can get Medicare coverage starting with their first month of treatment.

Before January of 2021, ESRD Medicare beneficiaries were not able to join a Medicare Advantage plan. However, that option is now available to ESRD patients. You may join a Part C and/or Part D plan during your IEP.

The Medicare.gov ESRD page provides more detailed information.

Applying for Disability Benefits

You apply for disability benefits through the Social Security Administration. Click here for more information.

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Originally posted on Feb 25, 2021 06:02:30

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Last Updated 01/13/2021