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Medicare Benefits

Everyone eligible for Social Security Disability Insurance (SSDI) benefits is also eligible for Medicare after a 24-month qualifying period. When you become eligible for disability benefits, the Social Security Administration will automatically enroll you in Medicare.

The first 24 months of disability benefit entitlement is the waiting period for Medicare coverage. During this qualifying period for Medicare, the beneficiary may be eligible for health insurance through a former employer. The employer should be contacted for information about health insurance coverage.

If you were previously on disability, those previous months of disability may be counted toward the 24 month waiting period. 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.

There are certain diseases where special rules apply meaning you do not have to wait the usual 24 months. Special rules apply to:

  • End-stage renal disease (permanent kidney failure). People with permanent kidney failure get Medicare beginning:
    • The third month after the month a regular course of renal dialysis begins; or
    • The month of kidney transplantation.
  • Lou Gehrig's disease (amyotrophic lateral sclerosis). People with amyotrophic lateral sclerosis get Medicare beginning:
    • The month they become entitled to disability benefits.

If you decide to go back to work, you may receive at least 93 months of hospital and medical insurance after the trial work period as long as you still have a disabling impairment. This allows for you to continue having health insurance when you go back to work and are engaging in substantial gainful activity. You do not pay a premium for hospital insurance. Although your cash benefits may cease once you start working, you have the assurance of continued health insurance.

After your premium free Medicare coverage ends due to your return to work, you can purchase Medicare hospital and medical insurance if you continue to have a disability at the end of the 93-month period. To learn more about the Medicare system and to learn if you qualify, visit the Social Security Administration’s website.

Medicare Overview

Medicare is the nation’s health insurance program for people age 65 and older, but younger people may qualify, too. The Medicare system has four elements:

  • Hospital insurance (Part A) helps pay hospital bills and some follow-up care. The taxes you paid while you were working financed this coverage, so it's premium free.
  • Medical insurance (Part B) helps pay doctors' bills and other services. There is a monthly premium you must pay for Medicare Part B and you have the option to refuse this coverage.
  • Medicare Advantage (Part C) plans generally cover many of the same benefits a supplemental policy would cover, such as extra days in the hospital after you have used the number of days Medicare covers. People with Medicare Parts A and B can choose to receive all of their health care services through one of these provider organization under Part C. There might be additional premiums required for some plans; and
  • Prescription drug coverage (Part D) helps pay for medications doctors prescribe for treatment. Anyone who has Medicare hospital insurance (Part A), medical insurance (Part B) or a Medicare Advantage plan (Part C) is eligible for prescription drug coverage (Part D). Joining a Medicare prescription drug plan is voluntary and you pay an additional monthly premium for the coverage.

Call us today to learn more about applying for Medicare, and to learn how the social security disability attorneys of Orange County, California can help you get the benefits you deserve.