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Are SSDI Recipients Eligible for Medicare?


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If you are receiving SSDI payments, can you still get Medicare benefits? The answer is yes. However, there is a waiting period involved that may hinder your ability to obtain Medicare payments right away.

You must wait 2 years (24 months) to receive Medicare after becoming entitled to SSDI benefits.

In reality, you may have to wait up to 30 months to start receiving Medicare payments from the month you become eligible for SSDI. This is because there is a 5-month waiting period to begin receiving SSDI payments from the time you initially apply. For example, if you are injured and apply for SSDI benefits in January of 2015, you may become entitled for SSDI sometime around May of 2015, and will then become eligible for Medicare in May of 2017. The bottom line is that you will most likely have to wait between 24 and 30 months from the date you apply and become entitled to SSDI to get Medicare coverage.

The ALS Exception

For patients who suffer from Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig’s disease, there is no waiting period to receive Medicare benefits. This means, if you have ALS, you can start receiving Medicare coverage in the same month you become entitled for SSDI benefits. Typically, you will have to wait 4 weeks until you receive your Medicare card in the mail, but you will not have to wait for the full 2 years that is required for other SSDI and Medicare recipients.

Understanding Medicare Coverage

There are 4 parts of Medicare coverage. Part A covers general hospital bills, hospice care, home health care, skilled nursing facility (SNF) care, and inpatient medical expenses. Typically, SSDI benefit recipients do not have to pay for Part A Medicare coverage. Part B covers doctor’s visits, medical supplies, outpatient care, and medical/surgical supplies and services not covered in Part A. Part B also covers certain preventative health care services, therapies, mental health services, and diagnostic testing. It is important to note that you may opt out of Part B if you are covered under a private insurer or under a family member’s work insurance.

Part C coverage includes Medicare Advantage (MA) Plans. Medicare-approved private insurers, including HMOs and PPOs, provide coverage for Part C. You may have to use hospitals and doctors in your plan, and you can typically receive all the Medicare-covered services of Part A and B through this coverage. Depending on the situation, you may also combine Part D under this coverage.

Part D is known as Medicare Prescription Drug Coverage. It helps pay for outpatient drug treatments. Part D is available to everyone with Medicare, and you must enroll in a Medicare-approved plan to receive coverage. Furthermore, extra help is offered to those with chronic medical conditions who need extensive, long-term medication and drug treatment.

If you are receiving SSDI benefits, you are still able to receive all parts of Medicare. This can provide much needed financial assistance to help with the medical costs of your disability. It is important to keep the waiting period in mind when applying for SSDI payments, and to understand your options for receiving coverage under Medicare programs.

Knowledgeable Assistance for Social Security Issues in Detroit

Goodman Acker P.C. has guided hundreds of clients through various Social Security legal issues. Whatever your situation, we can talk with you and help determine effective legal strategies as you pursue a beneficial outcome. We know you are going through a stressful time. That is why we strive to handle the complex issues so you can focus on healing.

Contact us today to discuss your situation with our experienced Detroit Social Security attorneys. We provide free consultations to all prospective clients.