Winning a Social Security Disability
Insurance claim not only entitles an individual to cash benefits, but it also
entitles a beneficiary to Medicare insurance. Due to the rising costs of medical treatment
and insurance premiums, Medicare entitlement is often the primary reason that
claimants apply for Social Security Disability. When planning to apply for
Social Security Disability Insurance, however, one must keep in mind that
Medicare has a 24 month waiting period for entitlement after an individual becomes
entitled to cash benefits through the Social Security Administration (“SSA”). What
does this mean exactly you may ask? Let me tell you.
Let us take an individual whose onset of
disability is July 1, 2015. The Social Security Administration has a standing rule
that every individual must be disabled for a full five months before he or she
becomes entitled to a cash benefit. Thus, in this example, the individual’s entitlement
date for cash benefits is December 1, 2015. Add two years to this
date-of-entitlement for cash benefits and you have the Medicare entitlement
date of December 1, 2017.
As you can imagine, this two year waiting
period can be devastating to individuals who desperately need medical insurance
to treat chronic conditions. The Medicare waiting period developed due to the
impression that COBRA insurance from the former employer would fill in the gap
of medical insurance while a claimant waited for Medicare entitlement.
Federal COBRA regulations allow a former
employee to stay on his or her employer’s insurance plan for a maximum of 18
months. While COBRA does have an extension program that allows COBRA insurance
to be extended up to a maximum of 29 months, if an individual is found disabled
by the Social Security Administration, it fails to take into account two major
problems. First, in order to be entitled to a COBRA extension, a claimant must
be found disabled by the Social Security Administration within the initial 18
months that an individual is entitled to COBRA insurance. Most individuals who
apply for Social Security Disability are required to attend a hearing in front
of an Administrative Law Judge (“ALJ”). On average, it takes 2 to 2 ½ years to
have a hearing with an ALJ. Thus, many individuals do not get their favorable determination
from Social Security Disability within the 18 month window that COBRA requires.
Second, the COBRA premiums are often so high that they are cost-prohibitive for
a former employee to afford. Many former employers do not elect to take the
COBRA insurance due to the high monthly costs. Thus, COBRA insurance and COBRA
extensions are not always realistic options for medical insurance during SSA’s
Medicare waiting period.
There are two exceptions to the Medicare
waiting period with SSA. The usual 24 month waiting period for Medicare
has been eliminated for SSDI recipients diagnosed with Amyotrophic
Lateral Sclerosis (“ALS”), sometimes referred to as Lou Gehrig's disease, and individuals diagnosed with end-stage renal disease or kidney failure.
These two exceptions are due to the poor prognosis of these diseases and the result
of extensive lobbying efforts by support groups and advocates who work with individuals
from these populations. In spite of the countless other life-threatening
diseases out there, no other groups have been successful in eliminating the
waiting period for Medicare.
Please
keep in mind that these Medicare waiting periods only apply to Social Security
Disability recipients. Individuals found eligible for SSA’s Supplemental
Security Income program and MediCal/Medicaid insurance, are not subjected to
any waiting periods.
Got a question about SSDI or SSI that you
need us to answer? Please check out our website at www.westcoastdisability.com . We try to
provide you with helpful information on our website that will allow you to successfully
navigate the Social Security Disability process. Also, feel free to email me
your questions at megan@westcoastdisability.com or call me at (800)
459-3017 x 103.
