Medicare is a crucial healthcare program that provides essential coverage for individuals in the United States. While Medicare is commonly associated with individuals who are 65 years and older, it’s important to note that people with certain disabilities can also qualify for Medicare, regardless of their age.
This article will provide you with the information you need to know about getting Medicare through Social Security Disability (SSDI).
Understanding Social Security Disability Insurance (SSDI)
The Social Security Administration (SSA) administers the SSDI program to offer financial support to individuals who are unable to work due to a qualifying disability. The SSA has a set of criteria you must meet to qualify for SSDI benefits:
- Medical Condition: You must have a medical that is expected to last for at least one year or result in death.
- Work Capability: Your medical condition must be severe enough that it prevents you from engaging in work that you have done in the past or any other type of work you may qualify for considering your age, education, work experience, and disability. Any work you do cannot pay more each month than what the SSA calls substantial gainful activity (SGA),
- Work History: You need to have a sufficient work history and earn a certain number of SSA work credits based on your age.
Medicare Eligibility for Individuals with Disabilities
If you gain approval for disability benefits through the Social Security Administration, you will become eligible to receive Medicare health benefits as well. Yet, you could face a two-year waiting period before that happens.
The SSA implements this waiting period to help mitigate the cost of adding disability beneficiaries to the Medicare program and allows individuals to maintain coverage through other means, such as COBRA, during the initial stages of disability.
For those receiving SSDI, their eligibility for Medicare depends on the date of entitlement (DOE) in connection with their filing a disability application. Generally, this is five months following the start of the medical condition. But, since the approval process can take a while, it is possible you could already be eligible for Medicare when your SSDI benefits applications gets accepted.
Special Circumstances: Medicare with ALS or ESRD
Medicare with ALS (Lou Gehrig’s Disease)
If you have ALS and receive SSDI benefits, you automatically qualify Medicare the month your disability benefits begin. ALS is a severe condition that warrants immediate access to comprehensive healthcare coverage.
Medicare with ESRD (End-Stage Renal Disease)
For individuals with ESRD, Medicare coverage usually starts on the first day of the fourth month of dialysis treatment. However, some specific conditions and requirements need to be met. If you undergo a kidney transplant, your Medicare coverage starts the month you’re admitted to a Medicare-certified hospital for the transplant or related services.
If you participate in an at-home dialysis training program, your Medicare coverage may begin in the first month of regular dialysis treatment, provided you meet certain criteria set by Medicare.
Getting Help with Getting Medicare
If you are dealing with a serious medical condition, the last thing you want to be doing is worrying about not having healthcare coverage because you cannot work. Filing for disability benefits can help you financially, but also provide you with needed healthcare coverage through Medicare. Yet, the process of filing for SSDI so you can receive those benefits may feel daunting and more stressful than you need.
The disability attorneys at Brock and Stout have over 27 years of experience helping clients get Medicare through SSDI. Reach out to us today for evaluation of your health situation and let us see how we can help you.