If You Get Approved For SSDI Will You Also Get Medicare?

An important question for all SSDI (social security disability insurance) disability beneficiaries is "Will I get any kind of health insurance now that I have been approved for benefits"? This is a very real concern, since most disability beneficiaries have lost all health insurance by the time they are approved for disability benefits.

Unfortunately, if you have been approved for SSDI benefits, you most likely have pre-existing conditions that would prevent you from getting private health insurance, or if you were able to get health insurance your premiums would be extremely high.

Social Security recognizes the need for health coverage for disability beneficiaries; however Medicare coverage is not available to disability beneficiaries immediately. Unfortunately, Social Security requires a two-year waiting period for Medicare benefits. You will receive Medicare benefits twenty four months from the month you were first eligible to receive your monthly disability benefit, not the date you became disabled and unable work.

If you have health insurance coverage at the time you receive disability benefits, do not drop your coverage. You should try to keep your coverage for the two-year waiting period. If you have cobra insurance coverage it would be advisable to keep your coverage for as long as you can.

The simple truth is that you could potentially be without health insurance for up to two years, especially if you are approved for disability benefits with your initial disability claim (we say potentially because the two year wait for medicare does not necesssary mean that you actually have to wait for two years as the following paragraphs will indicate).

Please check with Social Security to as certain when you are eligible for Medicare benefits prior to terminating your health insurance.

Note: By the very nature of the disability determination process (how long it takes to get claims approved, how the determination on "onset" is made, and how far back benefits may be paid) many disability beneficiaries will not feel as though they had to wait two years for Medicare benefits. This is simply because the two year waiting period does not begin from the time you get a notice of award letter.

For example, if you are approved for disability benefits through an administrative law judge disability hearing, you may receive Medicare benefits at the time you receive your approval for SSDI disability benefits.

How is this possible? Well basically, your date of entitlement to disability benefits may be far enough in the past that, when coupled with the time it takes to get to a disability hearing, you may have eliminated most or all of your Medicare waiting period.

Currently, hearings offices across the nation have disability hearing backlogs of twelve months or more; therefore, it is easy to see how you might eliminate the two year Medicare waiting period, if you are not approved for SSDI disability benefits until your disability hearing.

WHAT YOU NEED TO KNOW BEFORE YOU APPLY

The national denial rate is quite high at 65%, one big reason for this is that many people do not get representation until they have been denied. 

Many lawyers are partly to blame for this since it is very common for someone looking for a lawyer at application level for their SSDI or SSI claim to be told to "apply and call back when you are denied". Some lawyers(not all) do this because an attorney's fee is based on past due benefits and if the lawyer wins a case at application they feel the fee does not cover the work involved in handling a case at this level.

This approach should be avoided because it is very important that the case be handled properly from the beginning, not only to assure you have the best chance to win at application, but also to ensure that an application that was not properly done does not come back to haunt you at a later stage in the process. Approval rates are much higher at the initial application level.

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